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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

Ballard Rehabilitation Hospital

San Bernardino, CA · CCN 053037 · Rates published

6,582 distinct procedures filed
73 distinct payers
494,741 rate rows
2026-07-31 last MRF observed
Data quality

493,526 of 494,741 rate rows are consumer-grade (99.8%)

1,215 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
exceeds 10× this hospital's gross charge — excluded from medians 396
percent-of-charges filed in the dollar field — excluded from medians 311
template filing: same amount across many unrelated codes — excluded 242
per-diem day rate — not a per-procedure price 197
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 69
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://ballardrehab.com/wp-content/uploads/sites/4/2026/03/261465945_vibra-hospital-of-san-bernardino-_standardcharges.csv
Found on page https://ballardrehab.com/about-us/price-transparency/
Discovered viaCMS hospital list
Last fetch not_modified · 2026-10-12
Content fingerprint d0a953f85915cd38… · 36,991,076 bytes · first seen 2026-05-09

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
68875010201
NDC 		Gattex 32 $99,999.99 $99,999.99 $99,999.99 —
407
LOCAL 		Traumatic Spinal Cord Injury M <24.50 And A >=61.50 None A 32 $82,420.73 $105,074.43 $90,706.79 —
1904
LOCAL 		Guillain-barr� M <38.50 None A 27 $64,096.45 $90,920.53 $67,562.23 —
406
LOCAL 		Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 None A 27 $60,288.94 $76,858.58 $67,348.49 —
404
LOCAL 		Traumatic Spinal Cord Injury M <31.50 And A <61.50 None A 27 $59,414.10 $75,742.67 $66,371.76 —
1806
LOCAL 		Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 None A 32 $60,055.32 $85,524.89 $64,772.46 —
81425
CPT 		Genome Sequence Analysis 33 $32,217.91 $60,751.05 $60,751.05 nat. median
$5,031
outlier · 12.1×
81415
CPT 		Exome Sequence Analysis 33 $7,062.15 $57,718.50 $57,718.50 nat. median
$4,780
outlier · 12.1×
106
LOCAL 		Stroke M <41.50 And A <84.50 None A 32 $54,555.30 $72,233.39 $57,246.90 —
505
LOCAL 		Non-traumatic Spinal Cord Injury M <39.50 None A 32 $50,772.64 $74,964.76 $55,097.10 —
405
LOCAL 		Traumatic Spinal Cord Injury M >=31.50 And M <41.50 None A 32 $47,248.45 $60,234.26 $51,997.90 —
205
LOCAL 		Traumatic Brain Injury M <35.50 None A 32 $46,184.73 $65,575.21 $51,531.90 —
55292070255
NDC 		Hemin For Injection 32 $51,333.70 $51,333.70 $51,333.70 —
1705
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50 Tier 2 C 32 $42,558.65 $65,165.14 $50,653.34 —
105
LOCAL 		Stroke M <41.50 And A >=84.50 None A 32 $47,966.71 $63,507.43 $50,330.25 —
81521
CPT 		Onc Breast Mrna 70 Genes 33 $30,533.31 $46,768.20 $46,768.20 nat. median
$3,950
outlier · 11.8×
81541
CPT 		Onc Prostate Mrna 46 Genes 33 $310.50 $46,768.20 $46,768.20 nat. median
$3,950
outlier · 11.8×
81522
CPT 		Onc Breast Mrna 12 Genes 33 $872.85 $56,554.95 $46,768.20 nat. median
$3,912
outlier · 12.0×
81518
CPT 		Onc Brst Mrna 11 Genes 33 $172.50 $46,768.20 $46,768.20 nat. median
$3,912
outlier · 12.0×
81519
CPT 		Oncology Breast Mrna 33 $43,470.00 $56,554.95 $46,768.20 nat. median
$3,875
outlier · 12.1×
1805
LOCAL 		Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50 N… 32 $42,287.75 $60,221.83 $45,608.14 —
81540
CPT 		Oncology Tum Unknown Origin 33 $369.90 $56,554.95 $45,281.25 nat. median
$3,769
outlier · 12.0×
1004
LOCAL 		Amputation Lower Extremity M <47.50 Tier 1 B 32 $38,708.89 $57,189.74 $45,251.50 —
1903
LOCAL 		Guillain-barr� M >=38.50 And M <51.50 None A 32 $44,000.14 $62,416.37 $44,775.56 —
2102
LOCAL 		Burns M <52.50 Tier 2 C 32 $37,379.24 $57,599.82 $43,769.00 —
305
LOCAL 		Non-traumatic Brain Injury M <42.50 And A <78.50 None A 32 $41,050.06 $59,262.50 $43,552.78 —
81545
CPT 		Oncology Thyroid 33 $49.85 $43,470.00 $43,470.00 nat. median
$2,417
outlier · 18.0×
604
LOCAL 		Neurological M <43.50 None A 32 $39,014.58 $61,894.45 $43,259.51 —
1504
LOCAL 		Pulmonary M <45.50 Tier 3 D 32 $40,361.63 $56,526.16 $43,147.67 —
1304
LOCAL 		Rheumatoid Other Arthritis M <44.50 And A >=64.50 None A 27 $39,079.20 $53,225.65 $43,007.25 —
704
LOCAL 		Fracture Of Lower Extremity M <41.50 None A 32 $39,158.73 $57,840.89 $42,384.68 —
1305
LOCAL 		Rheumatoid Other Arthritis M <51.50 And A <64.50 Tier 1 B 32 $37,423.98 $50,971.46 $42,143.60 —
403
LOCAL 		Traumatic Spinal Cord Injury M >=41.50 And M <47.50 None A 32 $38,052.76 $48,511.00 $41,877.67 —
1604
LOCAL 		Pain Syndrome M <43.50 None A 27 $36,258.36 $58,342.93 $41,251.37 —
304
LOCAL 		Non-traumatic Brain Injury M <42.50 And A >=78.50 Tier 2 C 32 $37,222.66 $53,735.14 $41,241.43 —
2005
LOCAL 		Miscellaneous M <46.50 And A <77.50 None A 32 $37,493.56 $55,203.97 $41,191.72 —
2004
LOCAL 		Miscellaneous M <46.50 And A >=77.50 None A 32 $35,569.93 $52,373.19 $40,456.07 —
104
LOCAL 		Stroke M >=41.50 And M <50.50 None A 32 $38,358.46 $50,787.55 $40,249.79 —
81440
CPT 		Mitochondrial Gene 33 $3,146.40 $40,137.30 $40,137.30 nat. median
$3,324
outlier · 12.1×
1103
LOCAL 		Amputation Non-lower Extremity M <52.50 None A 27 $39,258.14 $49,845.61 $40,068.36 —
1704
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 32 $36,265.82 $55,529.54 $39,973.92 —
1204
LOCAL 		Osteoarthritis M <49.50 And A <74.50 None A 27 $35,368.61 $54,271.97 $39,973.91 —
904
LOCAL 		Other Orthopedic M <44.5 None A 32 $36,355.29 $53,225.65 $39,735.32 —
59627033304
NDC 		Avonex Pen 30 mcg/0.5mL 32 $39,676.03 $39,676.03 $39,676.03 —
59627022205
NDC 		Avonex 32 $39,676.03 $39,676.03 $39,676.03 —
504
LOCAL 		Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50 None A 32 $36,539.20 $53,948.88 $39,650.82 —
74368303
NDC 		Lupron Depot 32 $39,246.62 $39,246.62 $39,246.62 —
81595
CPT 		Cardiology Hrt Trnspl Mrna 33 $75.90 $56,554.95 $39,123.00 nat. median
$3,256
outlier · 12.0×
1404
LOCAL 		Cardiac M <45.50 None A 32 $35,942.72 $53,330.03 $39,061.80 —
204
LOCAL 		Traumatic Brain Injury M >=35.50 And M <49.50 None A 32 $36,057.05 $51,192.66 $38,296.32 —

Other procedures at this hospital

Browse this hospital's 6,582 published procedures. Use the slice to choose what to show, then sort or filter any column.

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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
             
68875010201 NDC Gattex 71 32 $99,999.99 $99,999.99 $99,999.99 $99,999.99 $99,999.99 2026-07-15
407 LOCAL Traumatic Spinal Cord Injury M <24.50 And A >=61.50 None A 188 32 $92,073.71 $92,073.71 $82,420.73 $105,074.43 $90,706.79 2026-07-15
1904 LOCAL Guillain-barr� M <38.50 None A 132 27 $67,562.23 $67,562.23 $64,096.45 $90,920.53 $67,562.23 2026-07-15
406 LOCAL Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 None A 132 27 $67,348.49 $67,348.49 $60,288.94 $76,858.58 $67,348.49 2026-07-15
404 LOCAL Traumatic Spinal Cord Injury M <31.50 And A <61.50 None A 132 27 $66,371.76 $66,371.76 $59,414.10 $75,742.67 $66,371.76 2026-07-15
1806 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 None A 160 32 $68,227.05 $66,499.76 $60,055.32 $85,524.89 $64,772.46 2026-07-15
81425 CPT Genome Sequence Analysis 72 33 $60,751.05 $60,751.05 $32,217.91 $60,751.05 $60,751.05 2026-07-15
81415 CPT Exome Sequence Analysis 72 33 $57,718.50 $57,718.50 $7,062.15 $57,718.50 $57,718.50 2026-07-15
106 LOCAL Stroke M <41.50 And A <84.50 None A 216 32 $72,233.39 $59,945.96 $54,555.30 $72,233.39 $57,246.90 2026-07-15
505 LOCAL Non-traumatic Spinal Cord Injury M <39.50 None A 216 32 $73,517.90 $56,708.83 23% off $50,772.64 $74,964.76 $55,097.10 2026-07-15
405 LOCAL Traumatic Spinal Cord Injury M >=31.50 And M <41.50 None A 160 32 $53,566.14 $52,782.02 $47,248.45 $60,234.26 $51,997.90 2026-07-15
205 LOCAL Traumatic Brain Injury M <35.50 None A 188 32 $54,008.53 $51,531.90 $46,184.73 $65,575.21 $51,531.90 2026-07-15
55292070255 NDC Hemin For Injection 71 32 $51,333.70 $51,333.70 $51,333.70 $51,333.70 $51,333.70 2026-07-15
1705 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50 Tier 2 C 160 32 $50,653.34 $48,781.89 $42,558.65 $65,165.14 $50,653.34 2026-07-15
105 LOCAL Stroke M <41.50 And A >=84.50 None A 160 32 $50,330.25 $52,703.74 $47,966.71 $63,507.43 $50,330.25 2026-07-15
81519 CPT Oncology Breast Mrna 72 33 $46,768.20 $46,768.20 $43,470.00 $56,554.95 $46,768.20 2026-07-15
81522 CPT Onc Breast Mrna 12 Genes 72 33 $46,768.20 $46,768.20 $872.85 $56,554.95 $46,768.20 2026-07-15
81521 CPT Onc Breast Mrna 70 Genes 72 33 $46,768.20 $46,768.20 $30,533.31 $46,768.20 $46,768.20 2026-07-15
81518 CPT Onc Brst Mrna 11 Genes 72 33 $46,768.20 $46,768.20 $172.50 $46,768.20 $46,768.20 2026-07-15
81541 CPT Onc Prostate Mrna 46 Genes 72 33 $46,768.20 $46,768.20 $310.50 $46,768.20 $46,768.20 2026-07-15
1805 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50 N… 188 32 $48,041.27 $46,824.71 $42,287.75 $60,221.83 $45,608.14 2026-07-15
81540 CPT Oncology Tum Unknown Origin 72 33 $45,281.25 $45,281.25 $369.90 $56,554.95 $45,281.25 2026-07-15
1004 LOCAL Amputation Lower Extremity M <47.50 Tier 1 B 188 32 $45,860.43 $45,251.50 $38,708.89 $57,189.74 $45,251.50 2026-07-15
1903 LOCAL Guillain-barr� M >=38.50 And M <51.50 None A 160 32 $47,984.11 $46,379.83 $44,000.14 $62,416.37 $44,775.56 2026-07-15
2102 LOCAL Burns M <52.50 Tier 2 C 128 32 $43,769.00 $43,769.00 $37,379.24 $57,599.82 $43,769.00 2026-07-15
305 LOCAL Non-traumatic Brain Injury M <42.50 And A <78.50 None A 216 32 $47,412.48 $45,482.63 $41,050.06 $59,262.50 $43,552.78 2026-07-15
81545 CPT Oncology Thyroid 72 33 $43,470.00 $43,470.00 $49.85 $43,470.00 $43,470.00 2026-07-15
604 LOCAL Neurological M <43.50 None A 216 32 $48,213.09 $44,799.17 $39,014.58 $61,894.45 $43,259.51 2026-07-15
1504 LOCAL Pulmonary M <45.50 Tier 3 D 160 32 $45,879.04 $44,513.35 $40,361.63 $56,526.16 $43,147.67 2026-07-15
1304 LOCAL Rheumatoid Other Arthritis M <44.50 And A >=64.50 None A 132 27 $43,007.25 $43,007.25 $39,079.20 $53,225.65 $43,007.25 2026-07-15
704 LOCAL Fracture Of Lower Extremity M <41.50 None A 188 32 $44,743.25 $43,563.96 $39,158.73 $57,840.89 $42,384.68 2026-07-15
1305 LOCAL Rheumatoid Other Arthritis M <51.50 And A <64.50 Tier 1 B 159 32 $42,143.60 $41,185.51 $37,423.98 $50,971.46 $42,143.60 2026-07-15
403 LOCAL Traumatic Spinal Cord Injury M >=41.50 And M <47.50 None A 160 32 $43,140.22 $42,508.94 $38,052.76 $48,511.00 $41,877.67 2026-07-15
1604 LOCAL Pain Syndrome M <43.50 None A 132 27 $41,251.37 $41,251.37 $36,258.36 $58,342.93 $41,251.37 2026-07-15
304 LOCAL Non-traumatic Brain Injury M <42.50 And A >=78.50 Tier 2 C 188 32 $42,991.10 $41,241.43 $37,222.66 $53,735.14 $41,241.43 2026-07-15
2005 LOCAL Miscellaneous M <46.50 And A <77.50 None A 216 32 $44,094.58 $42,643.15 $37,493.56 $55,203.97 $41,191.72 2026-07-15
2004 LOCAL Miscellaneous M <46.50 And A >=77.50 None A 244 32 $41,832.94 $40,456.07 $35,569.93 $52,373.19 $40,456.07 2026-07-15
104 LOCAL Stroke M >=41.50 And M <50.50 None A 188 32 $44,044.87 $42,147.33 $38,358.46 $50,787.55 $40,249.79 2026-07-15
81440 CPT Mitochondrial Gene 72 33 $40,137.30 $40,137.30 $3,146.40 $40,137.30 $40,137.30 2026-07-15
1103 LOCAL Amputation Non-lower Extremity M <52.50 None A 99 27 $40,068.36 $40,068.36 $39,258.14 $49,845.61 $40,068.36 2026-07-15
1704 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 188 32 $43,162.58 $41,568.25 $36,265.82 $55,529.54 $39,973.92 2026-07-15
1204 LOCAL Osteoarthritis M <49.50 And A <74.50 None A 132 27 $39,973.91 $39,973.91 $35,368.61 $54,271.97 $39,973.91 2026-07-15
904 LOCAL Other Orthopedic M <44.5 None A 188 32 $42,630.72 $41,183.02 $36,355.29 $53,225.65 $39,735.32 2026-07-15
59627022205 NDC Avonex 71 32 $39,676.03 $39,676.03 $39,676.03 $39,676.03 $39,676.03 2026-07-15
59627033304 NDC Avonex Pen 30 mcg/0.5mL 71 32 $39,676.03 $39,676.03 $39,676.03 $39,676.03 $39,676.03 2026-07-15
504 LOCAL Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50 None A 188 32 $41,969.63 $40,810.22 $36,539.20 $53,948.88 $39,650.82 2026-07-15
74368303 NDC Lupron Depot 71 32 $39,246.62 $39,246.62 $39,246.62 $39,246.62 $39,246.62 2026-07-15
81595 CPT Cardiology Hrt Trnspl Mrna 72 33 $39,123.00 $39,123.00 $75.90 $56,554.95 $39,123.00 2026-07-15
1404 LOCAL Cardiac M <45.50 None A 216 32 $42,011.88 $40,536.84 $35,942.72 $53,330.03 $39,061.80 2026-07-15
204 LOCAL Traumatic Brain Injury M >=35.50 And M <49.50 None A 188 32 $40,231.15 $40,231.15 $36,057.05 $51,192.66 $38,296.32 2026-07-15
81525 CPT Oncology Colon Mrna 72 33 $37,625.70 $37,625.70 $1.15 $39,296.80 $37,625.70 2026-07-15
1804 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50 N… 160 32 $39,625.97 $38,621.90 $34,879.01 $49,671.64 $37,617.83 2026-07-15
805 LOCAL Replacement Of Lower-extremity Joint M <42.50 None A 160 32 $41,107.22 $39,292.93 $34,956.05 $51,229.94 $37,478.65 2026-07-15
1203 LOCAL Osteoarthritis M <49.50 And A >=74.50 None A 188 32 $39,345.13 $38,118.62 $33,725.82 $51,754.34 $36,892.12 2026-07-15
1703 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50… 188 32 $38,134.78 $36,726.85 $32,043.25 $49,060.25 $36,726.85 2026-07-15
1003 LOCAL Amputation Lower Extremity M >=47.50 And M <55.50 Tier 1 B 188 32 $36,944.31 $35,346.24 $30,236.42 $44,671.17 $35,346.24 2026-07-15
81455 CPT Targeted Genomic Seq Analys 72 33 $35,255.55 $35,255.55 $17,960.70 $35,255.55 $35,255.55 2026-07-15
1503 LOCAL Pulmonary M >=45.50 And M <56.50 Tier 3 D 160 32 $37,046.21 $35,943.97 $32,592.51 $45,645.42 $34,841.73 2026-07-15
703 LOCAL Fracture Of Lower Extremity M >=41.50 And M <52.50 None A 216 32 $47,347.86 $35,660.64 25% off $32,055.68 $47,347.86 $34,695.09 2026-07-15
81538 CPT Oncology Lung 72 33 $34,669.05 $34,669.05 $200.10 $34,669.05 $34,669.05 2026-07-15
603 LOCAL Neurological M >=43.50 And M <52.50 None A 188 32 $35,721.53 $35,721.53 $31,108.77 $49,353.52 $34,493.78 2026-07-15
1803 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50 T… 160 32 $36,235.99 $35,318.90 $31,896.62 $45,421.74 $34,401.82 2026-07-15
303 LOCAL Non-traumatic Brain Injury M >=42.50 And M <52.50 None A 216 32 $46,346.28 $35,569.93 23% off $32,102.90 $46,346.28 $34,061.33 2026-07-15
402 LOCAL Traumatic Spinal Cord Injury M >=47.50 And M <56.50 None A 132 27 $33,873.69 $33,873.69 $30,323.41 $38,656.69 $33,873.69 2026-07-15
2003 LOCAL Miscellaneous M >=46.50 And M <55.50 None A 244 32 $42,107.80 $33,836.42 $29,749.30 $43,803.80 $33,836.42 2026-07-15
503 LOCAL Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50 None A 160 32 $35,306.48 $34,330.99 $30,738.46 $45,384.46 $33,355.50 2026-07-15
1303 LOCAL Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50 Tier 3 D 160 32 $34,849.18 $34,056.37 $30,944.74 $42,146.09 $33,263.55 2026-07-15
74055402 NDC Humira(Cf) Pen 71 32 $33,228.58 $33,228.58 $33,228.58 $33,228.58 $33,228.58 2026-07-15
2144511 NDC Taltz Autoinjector 71 32 $33,195.46 $33,195.46 $5.00 $33,195.46 $33,195.46 2026-07-15
903 LOCAL Other Orthopedic M >=44.50 And M <51.50 None A 188 32 $35,577.38 $34,369.51 $30,340.81 $44,420.16 $33,161.65 2026-07-15
81426 CPT Genome Sequence Analysis 72 33 $32,723.25 $32,723.25 $25,885.35 $32,723.25 $32,723.25 2026-07-15
1102 LOCAL Amputation Non-lower Extremity M >=52.50 And M <58.50 None A 99 27 $32,130.24 $32,130.24 $31,481.57 $39,971.43 $32,130.24 2026-07-15
1403 LOCAL Cardiac M >=45.50 And M <55.50 None A 216 32 $43,522.95 $33,083.36 24% off $29,334.25 $43,522.95 $31,879.22 2026-07-15
1502 LOCAL Pulmonary M >=56.50 And M <68.50 None A 132 27 $31,626.96 $31,626.96 $28,678.13 $40,162.80 $31,626.96 2026-07-15
1603 LOCAL Pain Syndrome M >=43.50 And M <58.50 Tier 3 D 160 32 $34,975.93 $33,294.61 $29,264.66 $47,089.39 $31,613.29 2026-07-15
103 LOCAL Stroke M >=50.50 And M <63.50 None A 217 32 $34,513.66 $33,026.19 $28,677.38 $39,794.97 $31,538.73 2026-07-15
25682000101 NDC Soliris 71 32 $31,310.40 $31,310.40 $31,310.40 $31,310.40 $31,310.40 2026-07-15
804 LOCAL Replacement Of Lower-extremity Joint M >=42.50 And M <51.50 None A 188 32 $34,275.07 $32,762.75 $29,145.37 $42,715.23 $31,250.44 2026-07-15
203 LOCAL Traumatic Brain Injury M >=49.50 And M <61.50 None A 216 32 $40,733.10 $32,437.18 20% off $29,070.81 $41,276.22 $30,877.64 2026-07-15
55513019201 NDC Neulasta Onpro 71 32 $30,806.35 $30,806.35 $30,806.35 $30,806.35 $30,806.35 2026-07-15
55513019001 NDC Neulasta 6 Mg 71 32 $30,806.35 $30,806.35 $30,806.35 $30,806.35 $30,806.35 2026-07-15
1902 LOCAL Guillain-barr� M >=51.50 And M <66.50 None A 132 27 $30,740.94 $30,740.94 $29,162.77 $41,368.18 $30,740.94 2026-07-15
81520 CPT Onc Breast Mrna 58 Genes 72 33 $30,311.70 $30,311.70 $24,512.25 $30,533.31 $30,311.70 2026-07-15
502 LOCAL Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50 None A 188 32 $30,800.59 $29,950.61 $26,814.14 $39,593.66 $29,950.61 2026-07-15
1302 LOCAL Rheumatoid Other Arthritis M >=51.50 And M <62.50 None A 132 27 $29,935.70 $29,935.70 $27,199.36 $37,046.21 $29,935.70 2026-07-15
1702 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50… 188 32 $32,092.96 $30,907.46 $26,965.74 $41,286.17 $29,721.96 2026-07-15
81443 CPT Genetic Tstg Severe Inh Cond 72 33 $29,566.50 $29,566.50 $6,279.00 $41,716.17 $29,566.50 2026-07-15
81412 CPT Ashkenazi Jewish Assoc Dis 72 33 $29,566.50 $29,566.50 $5,299.20 $29,566.50 $29,566.50 2026-07-15
1202 LOCAL Osteoarthritis M >=49.50 And M <61.50 None A 132 27 $29,423.72 $29,423.72 $26,033.75 $39,949.06 $29,423.72 2026-07-15
602 LOCAL Neurological M >=52.50 And M <64.50 None A 216 32 $41,508.60 $30,317.20 27% off $26,401.57 $41,885.13 $29,274.61 2026-07-15
1002 LOCAL Amputation Lower Extremity M >=55.50 And M <64.50 None A 216 32 $38,127.32 $30,168.08 21% off $25,805.10 $38,127.32 $28,804.88 2026-07-15
2101 LOCAL Burns M >=52.50 None A 99 27 $28,419.65 $28,419.65 $24,271.65 $37,401.61 $28,419.65 2026-07-15
81427 CPT Genome Re-evaluation 72 33 $28,227.90 $28,227.90 $28,227.90 $29,566.50 $28,227.90 2026-07-15
702 LOCAL Fracture Of Lower Extremity M >=52.50 And M <61.50 None A 216 32 $29,784.10 $28,998.74 $26,066.05 $38,502.60 $28,213.37 2026-07-15
68982085005 NDC Octagam 71 32 $27,972.00 $27,972.00 $123.72 $27,972.00 $27,972.00 2026-07-15
803 LOCAL Replacement Of Lower-extremity Joint M >=51.50 And M <57.50 None A 160 32 $30,594.31 $29,243.54 $26,016.35 $38,127.32 $27,892.77 2026-07-15
902 LOCAL Other Orthopedic M >=51.50 And M <63.50 None A 216 32 $32,928.50 $28,781.27 $25,407.44 $37,197.81 $27,768.50 2026-07-15
202 LOCAL Traumatic Brain Injury M >=61.50 And M <73.50 Tier 2 C 160 32 $27,298.77 $26,046.17 $23,344.63 $33,144.25 $27,298.77 2026-07-15
2002 LOCAL Miscellaneous M >=55.50 And M <66.50 None A 216 32 $27,293.80 $28,255.62 $24,843.28 $36,578.97 $27,293.80 2026-07-15
1802 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=55.50 And M <67.50 T… 160 32 $28,203.43 $27,490.15 $24,825.88 $35,353.70 $26,776.86 2026-07-15
1602 LOCAL Pain Syndrome M >=58.50 And M <65.50 None A 132 27 $26,364.29 $26,364.29 $23,173.14 $37,287.28 $26,364.29 2026-07-15
1402 LOCAL Cardiac M >=55.50 And M <68.50 None A 188 32 $28,022.00 $27,037.82 $23,973.41 $35,569.93 $26,053.63 2026-07-15
81442 CPT Noonan Spectrum Disorders 72 33 $25,885.35 $25,885.35 $10,833.00 $28,615.74 $25,885.35 2026-07-15
401 LOCAL Traumatic Spinal Cord Injury M >=56.50 None A 160 32 $26,655.08 $26,264.88 $23,511.14 $29,972.98 $25,874.68 2026-07-15
1101 LOCAL Amputation Non-lower Extremity M >=58.50 None A 99 27 $25,273.24 $25,273.24 $24,763.75 $31,439.32 $25,273.24 2026-07-15
802 LOCAL Replacement Of Lower-extremity Joint M >=57.50 And M <63.50 None A 216 32 $33,232.60 $26,273.58 21% off $23,371.97 $34,255.19 $25,059.50 2026-07-15
1501 LOCAL Pulmonary M >=68.50 None A 132 27 $24,931.51 $24,931.51 $22,606.49 $31,660.51 $24,931.51 2026-07-15
81551 CPT Onc Prostate 3 Genes 72 33 $24,512.25 $24,512.25 $57.21 $30,268.97 $24,512.25 2026-07-15
102 LOCAL Stroke M >=63.50 And M <72.50 None A 188 32 $25,622.43 $25,622.43 $23,319.77 $30,875.15 $24,467.99 2026-07-15
1201 LOCAL Osteoarthritis M >=61.50 None A 132 27 $24,303.97 $24,303.97 $21,503.00 $32,997.62 $24,303.97 2026-07-15
81408 CPT Mopath Procedure Level 9 72 33 $24,150.00 $24,150.00 $19,623.60 $28,615.74 $24,150.00 2026-07-15
1701 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=57.50 None A 160 32 $25,829.95 $24,876.83 $21,704.31 $33,231.24 $23,923.71 2026-07-15
501 LOCAL Non-traumatic Spinal Cord Injury M >=60.50 None A 132 27 $23,874.00 $23,874.00 $21,373.77 $31,561.10 $23,874.00 2026-07-15
801 LOCAL Replacement Of Lower-extremity Joint M >=63.50 None A 132 27 $23,174.38 $23,174.38 $20,615.74 $30,214.06 $23,174.38 2026-07-15
601 LOCAL Neurological M >=64.50 None A 160 32 $23,081.18 $23,902.58 $20,817.06 $33,022.47 $23,081.18 2026-07-15
1601 LOCAL Pain Syndrome M >=65.50 None A 132 27 $23,007.86 $23,007.86 $20,223.06 $32,537.83 $23,007.86 2026-07-15
50633012011 NDC Digifab 71 32 $22,958.40 $22,958.40 $22,958.40 $22,958.40 $22,958.40 2026-07-15
701 LOCAL Fracture Of Lower Extremity M >=61.50 None A 160 32 $24,112.59 $23,477.59 $21,105.35 $31,170.91 $22,842.59 2026-07-15
1001 LOCAL Amputation Lower Extremity M >=64.50 Tier 3 D 160 32 $24,890.50 $23,814.35 $20,369.70 $30,097.25 $22,738.21 2026-07-15
901 LOCAL Other Orthopedic M >=63.50 None A 160 32 $23,921.22 $23,108.52 $20,399.52 $29,866.11 $22,295.82 2026-07-15
78081881 NDC SandoSTATIN Lar Depot 71 32 $22,158.24 $22,158.24 $4,648.90 $22,158.24 $22,158.24 2026-07-15
81162 CPT Brca1&2 Gen Full Seq Dup/del 72 33 $22,035.15 $22,035.15 $3,639.75 $31,496.58 $22,035.15 2026-07-15
1301 LOCAL Rheumatoid Other Arthritis M >=62.50 None A 132 27 $21,898.17 $21,898.17 $19,897.49 $27,102.43 $21,898.17 2026-07-15
301 LOCAL Testosterone Free And Total 230 54 $21,895.68 $21,895.68 $96.60 $29,791.55 $21,895.68 2026-07-15
2001 LOCAL Miscellaneous M >=66.50 Tier 3 D 160 32 $23,434.10 $22,662.40 $19,924.82 $29,336.74 $21,890.71 2026-07-15
2840001 NDC Forteo 71 32 $20,591.47 $20,591.47 $5.18 $20,591.47 $20,591.47 2026-07-15
1401 LOCAL Cardiac M >=68.50 None A 160 32 $22,094.51 $21,319.09 $18,903.36 $28,046.86 $20,543.67 2026-07-15
1801 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=67.50 None A 132 27 $20,488.99 $20,488.99 $18,503.22 $26,351.87 $20,488.99 2026-07-15
101 LOCAL Stroke M >=72.50 None A 132 27 $20,193.24 $20,193.24 $18,376.47 $24,331.30 $20,193.24 2026-07-15
201 LOCAL Traumatic Brain Injury M >=73.50 None A 132 27 $19,917.37 $19,917.37 $17,849.58 $25,345.31 $19,917.37 2026-07-15
81430 CPT Hearing Loss Sequence Analys 72 33 $19,623.60 $19,623.60 $7,220.85 $56,554.95 $19,623.60 2026-07-15
1901 LOCAL Guillain-barr� M >=66.50 None A 132 27 $19,210.29 $19,210.29 $18,224.86 $25,852.32 $19,210.29 2026-07-15
50458060901 NDC Invega Trinza 71 32 $19,046.87 $19,046.87 $19,046.87 $19,046.87 $19,046.87 2026-07-15
68982085004 NDC Octagam 71 32 $18,648.00 $18,648.00 $18,648.00 $18,648.00 $18,648.00 2026-07-15
55513003201 NDC Aranesp 71 32 $18,576.00 $18,576.00 $18,576.00 $18,576.00 $18,576.00 2026-07-15
81509 CPT Ftl Cgen Abnor 3 Proteins 72 33 $17,960.70 $17,960.70 $17,960.70 $56,554.95 $17,960.70 2026-07-15
78063998 NDC Cosentyx 71 32 $17,781.50 $17,781.50 $17,781.50 $17,781.50 $17,781.50 2026-07-15
173089201 NDC Mepolizumab Injection 71 32 $17,706.38 $17,706.38 $17,706.38 $17,706.38 $17,706.38 2026-07-15
44206043820 NDC Privigen 10% 71 32 $17,379.84 $17,379.84 $17,379.84 $17,379.84 $17,379.84 2026-07-15
78081181 NDC SandoSTATIN Lar Depot 71 32 $16,912.46 $16,912.46 $16,912.46 $16,912.46 $16,912.46 2026-07-15
50458056401 NDC Invega Sustenna 234 Mg 71 32 $16,697.76 $16,697.76 $16,697.76 $16,697.76 $16,697.76 2026-07-15
74379902 NDC Humira 71 32 $16,614.29 $16,614.29 $16,614.29 $16,614.29 $16,614.29 2026-07-15
81411 CPT Aortic Dysfunction/dilation 72 33 $16,304.70 $16,304.70 $8,200.65 $30,533.31 $16,304.70 2026-07-15
944270006 NDC Gammagard Liquid 71 32 $16,273.92 $16,273.92 $16,273.92 $16,273.92 $16,273.92 2026-07-15
31626 CPT Bronch Ins Rad Mark 71 32 $16,215.15 $16,215.15 $4,489.00 $16,215.15 $16,215.15 2026-07-15
55513073001 NDC Denosumab 120 mg/1.7mL 71 32 $15,770.26 $15,770.26 $15,770.26 $15,770.26 $15,770.26 2026-07-15
81460 CPT Whole Mitochondrial Genome 72 33 $15,542.25 $15,542.25 $669.30 $28,615.74 $15,542.25 2026-07-15
51759063010 NDC risperiDONE ER Inj 125 Mg/0.35 71 32 $15,375.36 $15,375.36 $15,375.36 $15,375.36 $15,375.36 2026-07-15
24201040002 NDC Calcitonin,salmon Inj 400 Unit 71 32 $15,028.80 $15,028.80 $15,028.80 $15,028.80 $15,028.80 2026-07-15
42367054032 NDC Ryanodex 71 32 $14,040.84 $14,040.84 $2,590.29 $14,040.84 $14,040.84 2026-07-15
81277 CPT Cytogenomic Neo Microra Alys 72 33 $14,007.00 $14,007.00 $3,998.55 $34,475.99 $14,007.00 2026-07-15
81229 CPT Cytogen M Array Copy No&snp 72 33 $14,007.00 $14,007.00 $1,840.00 $21,415.88 $14,007.00 2026-07-15
59148001971 NDC Abilify Maintena 71 32 $13,535.23 $13,535.23 $13,535.23 $13,535.23 $13,535.23 2026-07-15
59148007280 NDC Abilify Maintena 400 Mg 71 32 $13,535.23 $13,535.23 $13,535.23 $13,535.23 $13,535.23 2026-07-15
67457067502 NDC Miacalcin 71 32 $12,974.72 $12,974.72 $12,974.72 $12,974.72 $12,974.72 2026-07-15
70539000102 NDC Tymlos 71 32 $12,801.60 $12,801.60 $102.10 $12,801.60 $12,801.60 2026-07-15
81493 CPT Cor Artery Disease Mrna 72 33 $12,678.75 $12,678.75 $12,678.75 $31,496.58 $12,678.75 2026-07-15
55513022101 NDC Nplate 250 Mcg 71 32 $12,585.22 $12,585.22 $12,585.22 $12,585.22 $12,585.22 2026-07-15
31653 CPT Bronch Ebus 3 Or > Stat 71 32 $12,329.50 $12,329.50 $203.75 $12,329.50 $12,329.50 2026-07-15
31652 CPT Bronch Ebus 1 Or 2 Stat 71 32 $12,329.50 $12,329.50 $140.67 $12,329.50 $12,329.50 2026-07-15
31629 CPT Bronch Trnsbronch Ndl Asp 71 32 $12,329.50 $12,329.50 $12,329.50 $12,329.50 $12,329.50 2026-07-15
31628 CPT Transbronch Lung Biopsy Sgl 71 32 $12,329.50 $12,329.50 $12,329.50 $12,329.50 $12,329.50 2026-07-15
81465 CPT Whole Mitochondrial Genome 72 33 $11,302.20 $11,302.20 $1,852.65 $31,496.58 $11,302.20 2026-07-15
55513011101 NDC Aranesp 71 32 $11,145.60 $11,145.60 $11,145.60 $11,145.60 $11,145.60 2026-07-15
50458056301 NDC Invega Sustenna 156 Mg 71 32 $11,132.11 $11,132.11 $11,132.11 $11,132.11 $11,132.11 2026-07-15
50458056101 NDC Invega Sustenna 71 32 $11,131.49 $11,131.49 $11,131.49 $11,131.49 $11,131.49 2026-07-15
50458056001 NDC Invega Sustenna 71 32 $11,131.01 $11,131.01 $11,131.01 $11,131.01 $11,131.01 2026-07-15
81470 CPT X-linked Intellectual Dblt 72 33 $11,036.55 $11,036.55 $838.35 $31,496.58 $11,036.55 2026-07-15
81471 CPT X-linked Intellectual Dblt 72 33 $11,036.55 $11,036.55 $11,036.55 $46,768.20 $11,036.55 2026-07-15
31600 CPT Percutaneous Tracheostomy 71 32 $11,022.90 $11,022.90 $11,022.90 $16,215.15 $11,022.90 2026-07-15
81228 CPT Cytogen Micrarray Copy Nmbr 72 33 $10,867.50 $10,867.50 $3,318.90 $28,615.74 $10,867.50 2026-07-15
81503 CPT Onco (ovar) Five Proteins 72 33 $10,833.00 $10,833.00 $10,833.00 $46,768.20 $10,833.00 2026-07-15
944265804 NDC Gammagard S-d 10 Gram 71 32 $10,764.48 $10,764.48 $10,764.48 $10,764.48 $10,764.48 2026-07-15
81185 CPT Cacna1a Gene Full Gene Seq 72 33 $10,218.90 $10,218.90 $1,656.00 $42,316.53 $10,218.90 2026-07-15
81407 CPT Mopath Procedure Level 8 72 33 $10,218.90 $10,218.90 $10,218.90 $28,615.74 $10,218.90 2026-07-15
61953000405 NDC Flebogamma Dif 71 32 $10,164.48 $10,164.48 $10,164.48 $10,164.48 $10,164.48 2026-07-15
59148004580 NDC Abilify Maintena 71 32 $10,151.42 $10,151.42 $10,151.42 $10,151.42 $10,151.42 2026-07-15
81490 CPT Autoimmune Rheumatoid Arthr 72 33 $10,149.90 $10,149.90 $10,149.90 $46,768.20 $10,149.90 2026-07-15
67457083306 NDC Pegfilgrastim-jmdb 71 32 $10,020.00 $10,020.00 $10,020.00 $10,020.00 $10,020.00 2026-07-15
74364203 NDC Lupron Depot 71 32 $9,811.68 $9,811.68 $22.68 $9,811.68 $9,811.68 2026-07-15
80412 CPT Crh Stimulation Panel 72 33 $9,680.70 $9,680.70 $1,790.55 $42,316.53 $9,680.70 2026-07-15
81507 CPT Fetal Aneuploidy Trisom Risk 72 33 $9,601.35 $9,601.35 $6,996.60 $21,415.88 $9,601.35 2026-07-15
81201 CPT Apc Gene Full Sequence 72 33 $9,418.50 $9,418.50 $5,313.00 $28,615.74 $9,418.50 2026-07-15
68982085003 NDC Octagam 10% 71 32 $9,324.00 $9,324.00 $9,324.00 $9,324.00 $9,324.00 2026-07-15
81325 CPT Pmp22 Gene Full Sequence 72 33 $9,294.30 $9,294.30 $2,235.60 $40,031.57 $9,294.30 2026-07-15
81539 CPT Oncology Prostate Prob Score 72 33 $9,177.00 $9,177.00 $203.55 $56,554.95 $9,177.00 2026-07-15
81450 CPT Targeted Genomic Seq Analys 72 33 $9,170.10 $9,170.10 $655.50 $34,072.76 $9,170.10 2026-07-15
81422 CPT Fetal Chrmoml Microdeltj 72 33 $9,166.65 $9,166.65 $7,062.15 $32,500.17 $9,166.65 2026-07-15
81420 CPT Fetal Chrmoml Aneuploidy 72 33 $9,166.65 $9,166.65 $5,299.20 $32,500.17 $9,166.65 2026-07-15
81324 CPT Pmp22 Gene Dup/delet 72 33 $9,156.30 $9,156.30 $3,639.75 $28,615.74 $9,156.30 2026-07-15
58406003204 NDC EnbreL Sureclick 71 32 $9,148.70 $9,148.70 $132.82 $9,148.70 $9,148.70 2026-07-15
24591401 NDC Dupixent Syringe 71 32 $9,127.68 $9,127.68 $237.34 $9,127.68 $9,127.68 2026-07-15
44206043710 NDC Privigen 10% 71 32 $8,689.92 $8,689.92 $84.91 $8,689.92 $8,689.92 2026-07-15
31641 CPT Bronch Dest Grth Lung 71 32 $8,633.10 $8,633.10 $4,308.48 $8,633.10 $8,633.10 2026-07-15
55513071001 NDC Prolia 71 32 $8,573.38 $8,573.38 $34.81 $8,573.38 $8,573.38 2026-07-15
57970010001 NDC Dalbavancin Hcl 71 32 $8,539.82 $8,539.82 $8,539.82 $8,539.82 $8,539.82 2026-07-15
28005 CPT Incision, Bone Cortex, Foot 71 32 $8,491.00 $8,491.00 $149.50 $8,491.00 $8,491.00 2026-07-15
50458056201 NDC Invega Sustenna 117 Mg 71 32 $8,348.78 $8,348.78 $8,348.78 $8,348.78 $8,348.78 2026-07-15
81431 CPT Hearing Loss Dup/del Analys 72 33 $8,204.10 $8,204.10 $7,062.15 $28,615.74 $8,204.10 2026-07-15
81432 CPT Hrdtry Brst Ca-rlatd Dsordrs 72 33 $8,200.65 $8,200.65 $8,200.65 $28,615.74 $8,200.65 2026-07-15
81317 CPT Pms2 Gene Full Seq Analysis 72 33 $8,169.60 $8,169.60 $2,111.40 $32,500.17 $8,169.60 2026-07-15
81175 CPT Asxl1 Full Gene Sequence 72 33 $8,169.60 $8,169.60 $1,656.00 $34,628.32 $8,169.60 2026-07-15
81292 CPT Mlh1 Gene Full Seq 72 33 $8,155.80 $8,155.80 $1,449.00 $42,316.53 $8,155.80 2026-07-15
944270005 NDC Gammagard Liquid 10% 71 32 $8,136.96 $8,136.96 $8,136.96 $8,136.96 $8,136.96 2026-07-15
64842072709 NDC Decitabine/Cedazuridine 35/100 71 32 $7,931.30 $7,931.30 $7,931.30 $7,931.30 $7,931.30 2026-07-15
65757030001 NDC VivitroL 71 32 $7,877.33 $7,877.33 $1.50 $7,877.33 $7,877.33 2026-07-15
31627 CPT Electromag Nav Bronch 71 32 $7,754.15 $7,754.15 $7,754.15 $8,633.10 $7,754.15 2026-07-15
81298 CPT Msh6 Gene Full Seq 72 33 $7,748.70 $7,748.70 $3,318.90 $42,316.53 $7,748.70 2026-07-15
50474070062 NDC Cimzia 71 32 $7,649.53 $7,649.53 $7,649.53 $7,649.53 $7,649.53 2026-07-15
86891 CPT Autologous Blood Op Salvage 71 32 $7,586.55 $7,586.55 $3,422.40 $7,586.55 $7,586.55 2026-07-15
89280 CPT Assist Oocyte Fertilization 71 32 $7,586.55 $7,586.55 $3,422.40 $7,586.55 $7,586.55 2026-07-15
88348 CPT Electron Microscopy 71 32 $7,586.55 $7,586.55 $62.10 $7,586.55 $7,586.55 2026-07-15
89258 CPT Cryopreservation Embryo(s) 71 32 $7,586.55 $7,586.55 $124.20 $7,586.55 $7,586.55 2026-07-15
88362 CPT Nerve Teasing Preparations 71 32 $7,586.55 $7,586.55 $53.25 $7,586.55 $7,586.55 2026-07-15
89272 CPT Extended Culture Of Oocytes 69 32 $7,586.55 $7,586.55 $7,586.55 $7,586.55 $7,586.55 2026-07-15
88333 CPT Intraop Cyto Path Consult 1 69 32 $7,586.55 $7,586.55 $7,586.55 $7,586.55 $7,586.55 2026-07-15
88319 CPT Enzyme Histochemistry 69 32 $7,586.55 $7,586.55 $7,586.55 $7,586.55 $7,586.55 2026-07-15
55513000601 NDC Aranesp 71 32 $7,430.40 $7,430.40 $7,430.40 $7,430.40 $7,430.40 2026-07-15
55513002801 NDC Aranesp 71 32 $7,430.40 $7,430.40 $7,430.40 $7,430.40 $7,430.40 2026-07-15
15275 CPT Wc Apply High Cost Ss Foot 71 32 $7,332.00 $7,332.00 $1,486.00 $7,332.00 $7,332.00 2026-07-15
15271 CPT Wc Apply High Cost Ss Leg 71 32 $7,332.00 $7,332.00 $835.00 $7,332.00 $7,332.00 2026-07-15
15115 CPT Wc Epdrml Autogrft Ft 1st 100 71 32 $7,332.00 $7,332.00 $835.00 $7,332.00 $7,332.00 2026-07-15
15110 CPT Wc Epdrml Autogrft Leg 1st 100 71 32 $7,332.00 $7,332.00 $7,332.00 $7,332.00 $7,332.00 2026-07-15
81321 CPT Pten Gene Full Sequence 72 33 $7,245.00 $7,245.00 $1,656.00 $28,615.74 $7,245.00 2026-07-15
81259 CPT Hba1/hba2 Full Gene Sequence 72 33 $7,245.00 $7,245.00 $369.32 $42,316.53 $7,245.00 2026-07-15
81249 CPT G6pd Full Gene Sequence 72 33 $7,245.00 $7,245.00 $476.10 $56,554.95 $7,245.00 2026-07-15
81238 CPT F9 Full Gene Sequence 72 33 $7,245.00 $7,245.00 $7,245.00 $56,554.95 $7,245.00 2026-07-15
81434 CPT Hereditary Retinal Disorders 72 33 $7,220.85 $7,220.85 $7,220.85 $28,615.74 $7,220.85 2026-07-15
81445 CPT Targeted Genomic Seq Analys 72 33 $7,220.85 $7,220.85 $831.45 $21,415.88 $7,220.85 2026-07-15
59676082001 NDC Monovisc 71 32 $7,200.00 $7,200.00 $7,200.00 $7,200.00 $7,200.00 2026-07-15
9029703 NDC Gelfilm 25x50mm 71 32 $7,140.96 $7,140.96 $7,140.96 $7,140.96 $7,140.96 2026-07-15
74485 CPT Xr Dilation Urtr/urt Rs&i 71 32 $7,130.00 $7,130.00 $733.70 $7,130.00 $7,130.00 2026-07-15
81448 CPT Hrdtry Perph Neurphy Panel 72 33 $7,062.15 $7,062.15 $7,062.15 $21,415.88 $7,062.15 2026-07-15
81413 CPT Car Ion Chnnlpath Inc 10 Gns 72 33 $7,062.15 $7,062.15 $7,062.15 $42,907.93 $7,062.15 2026-07-15
81436 CPT Hereditary Colon Ca Dsordrs 72 33 $7,062.15 $7,062.15 $7,062.15 $42,316.53 $7,062.15 2026-07-15
81414 CPT Car Ion Chnnlpath Inc 2 Gns 72 33 $7,062.15 $7,062.15 $7,062.15 $32,217.91 $7,062.15 2026-07-15
81435 CPT Hereditary Colon Ca Dsordrs 72 33 $7,062.15 $7,062.15 $7,062.15 $21,415.88 $7,062.15 2026-07-15
81439 CPT Hrdtry Cardmypy Gene Panel 72 33 $7,062.15 $7,062.15 $7,062.15 $46,940.21 $7,062.15 2026-07-15
81164 CPT Brca1&2 Gen Ful Dup/del Alys 72 33 $7,055.25 $7,055.25 $7,055.25 $36,317.39 $7,055.25 2026-07-15
81535 CPT Oncology Gynecologic 72 33 $6,996.60 $6,996.60 $89.36 $30,533.31 $6,996.60 2026-07-15
80418 CPT Pituitary Evaluation Panel 72 33 $6,996.60 $6,996.60 $1,245.45 $21,415.88 $6,996.60 2026-07-15
517065001 NDC Injectafer 71 32 $6,862.56 $6,862.56 $6,862.56 $6,862.56 $6,862.56 2026-07-15
3218811 NDC Orencia 71 32 $6,834.32 $6,834.32 $6,834.32 $6,834.32 $6,834.32 2026-07-15
13533080071 NDC Gamunex-c 71 32 $6,804.00 $6,804.00 $10.74 $6,804.00 $6,804.00 2026-07-15
43231 CPT Eso Flx W/end US Exm 71 32 $6,768.95 $6,768.95 $644.61 $6,768.95 $6,768.95 2026-07-15
43214 CPT Eso Flx W/dil Balloon 30mm Dia 71 32 $6,768.95 $6,768.95 $644.61 $6,768.95 $6,768.95 2026-07-15
65162091322 NDC Voriconazole Oral Susp (bulk) 71 32 $6,753.68 $6,753.68 $231.45 $6,753.68 $6,753.68 2026-07-15
4026129 NDC Cellcept (160ml Bottle) 71 32 $6,628.18 $6,628.18 $6,628.18 $6,628.18 $6,628.18 2026-07-15
50484081015 NDC Regranex 71 32 $6,526.56 $6,526.56 $105.89 $6,526.56 $6,526.56 2026-07-15
11044 CPT Wc Debride Subq/musc/bone Bx/b 71 32 $6,511.00 $6,511.00 $199.00 $6,511.00 $6,511.00 2026-07-15
62935022305 NDC Leuprolide Acetate 71 32 $6,504.34 $6,504.34 $6,504.34 $6,504.34 $6,504.34 2026-07-15
31624 CPT Bronch W/alveolar Lavage 71 32 $6,439.65 $6,439.65 $6,439.65 $12,329.50 $6,439.65 2026-07-15
31623 CPT Bronch W/brushing 71 32 $6,439.65 $6,439.65 $6,439.65 $12,329.50 $6,439.65 2026-07-15
81302 CPT Mecp2 Gene Full Seq 72 33 $6,375.60 $6,375.60 $3,080.85 $21,415.88 $6,375.60 2026-07-15
31722062921 NDC Atovaquone (Bulk Bottle) 71 32 $6,307.16 $6,307.16 $6,307.16 $6,307.16 $6,307.16 2026-07-15
55513022301 NDC Romiplostim 71 32 $6,292.70 $6,292.70 $6,292.70 $6,292.70 $6,292.70 2026-07-15
78043561 NDC Reclast 5 Mg 71 32 $6,283.44 $6,283.44 $6,283.44 $6,283.44 $6,283.44 2026-07-15
81504 CPT Oncology Tissue Of Origin 72 33 $6,279.00 $6,279.00 $6,279.00 $41,021.72 $6,279.00 2026-07-15
23392102 NDC Botox 71 32 $6,201.60 $6,201.60 $6,201.60 $6,201.60 $6,201.60 2026-07-15
81528 CPT Oncology Colorectal Scr 72 33 $6,144.45 $6,144.45 $33.75 $39,296.80 $6,144.45 2026-07-15
78492 CPT PET Mycard Rst/str 71 32 $6,105.70 $6,105.70 $1,481.20 $6,105.70 $6,105.70 2026-07-15
81410 CPT Aortic Dysfunction/dilation 72 33 $6,085.80 $6,085.80 $6,085.80 $42,907.93 $6,085.80 2026-07-15
81223 CPT Cftr Gene Full Sequence 72 33 $6,027.15 $6,027.15 $1,656.00 $56,554.95 $6,027.15 2026-07-15
44146 CPT Colec Part W Colopros W/colost 71 32 $5,934.18 $5,934.18 $142.37 $5,934.18 $5,934.18 2026-07-15
50458030811 NDC RisperDAL Consta 50 Mg 71 32 $5,900.21 $5,900.21 $5,900.21 $5,900.21 $5,900.21 2026-07-15
87903 CPT Phenotype DNA HIV W/culture 71 32 $5,899.50 $5,899.50 $193.20 $5,899.50 $5,899.50 2026-07-15
59338077501 NDC Feraheme 510 Mg 71 32 $5,729.38 $5,729.38 $521.60 $5,729.38 $5,729.38 2026-07-15
81163 CPT Brca1&2 Gene Full Seq Alys 72 33 $5,651.10 $5,651.10 $2,235.60 $28,615.74 $5,651.10 2026-07-15
78459 CPT PET Myocard Metabolic 71 32 $5,650.87 $5,650.87 $1,899.80 $5,650.87 $5,650.87 2026-07-15
43246 CPT Peg 71 32 $5,606.25 $5,606.25 $5,584.11 $5,606.25 $5,606.25 2026-07-15
57894003001 NDC Remicade 100 Mg 71 32 $5,605.54 $5,605.54 $4,279.44 $5,605.54 $5,605.54 2026-07-15
44208 CPT Laparosc, Surg Colectomy, Part 71 32 $5,584.11 $5,584.11 $142.37 $5,584.11 $5,584.11 2026-07-15
55513002704 NDC Aranesp 71 32 $5,572.80 $5,572.80 $5,572.80 $5,572.80 $5,572.80 2026-07-15
81226 CPT Cyp2d6 Gene Com Variants 72 33 $5,444.10 $5,444.10 $2,118.30 $5,444.10 $5,444.10 2026-07-15
61958180101 NDC Harvoni 71 32 $5,400.00 $5,400.00 $5,400.00 $5,400.00 $5,400.00 2026-07-15
944265603 NDC Gammagard S-d 5 Gram 71 32 $5,382.24 $5,382.24 $110.78 $5,382.24 $5,382.24 2026-07-15
82154044901 NDC Peginterferon Alfa-2a 71 32 $5,344.42 $5,344.42 $5,344.42 $5,344.42 $5,344.42 2026-07-15
81212 CPT Brca1&2 185&5385&6174 Vrnt 72 33 $5,313.00 $5,313.00 $2,038.95 $5,313.00 $5,313.00 2026-07-15
81433 CPT Hrdtry Brst Ca-rlatd Dsordrs 72 33 $5,299.20 $5,299.20 $5,299.20 $35,255.55 $5,299.20 2026-07-15
81437 CPT Heredtry Nurondcrn Tum Dsrdr 72 33 $5,299.20 $5,299.20 $5,299.20 $28,615.74 $5,299.20 2026-07-15
81438 CPT Heredtry Nurondcrn Tum Dsrdr 72 33 $5,299.20 $5,299.20 $5,299.20 $28,615.74 $5,299.20 2026-07-15
81222 CPT Cftr Gene Dup/delet Variants 72 33 $5,254.35 $5,254.35 $2,118.30 $5,254.35 $5,254.35 2026-07-15
78812 CPT PET Scan-skull To Thigh 71 32 $5,252.97 $5,252.97 $955.65 $5,252.97 $5,252.97 2026-07-15
78608 CPT PET Brain Metab 71 32 $5,145.79 $5,145.79 $1,481.20 $5,145.79 $5,145.79 2026-07-15
59676034001 NDC Procrit 71 32 $5,131.20 $5,131.20 $5,131.20 $5,131.20 $5,131.20 2026-07-15
78110 CPT Nm Plasma Volume Single 71 32 $5,120.95 $5,120.95 $1,481.20 $5,120.95 $5,120.95 2026-07-15
78111 CPT Nm Plasma Volume Multiple 71 32 $5,120.95 $5,120.95 $1,481.20 $5,120.95 $5,120.95 2026-07-15
78201 CPT Nm Liver Imaging 71 32 $5,120.95 $5,120.95 $1,481.20 $5,120.95 $5,120.95 2026-07-15
78802 CPT Nm Rp Loclzj Tum Whbdy 1 D Img 71 32 $5,120.95 $5,120.95 $616.12 $5,120.95 $5,120.95 2026-07-15
78469 CPT Nm Heart Infarct Image (3d) 71 32 $5,120.95 $5,120.95 $244.95 $5,120.95 $5,120.95 2026-07-15
78075 CPT Nm Adrenal Cortex & Medulla IM 71 32 $5,120.95 $5,120.95 $1,481.20 $5,120.95 $5,120.95 2026-07-15
78202 CPT Nm Liver Imaging With Flow 71 32 $5,120.95 $5,120.95 $1,481.20 $5,120.95 $5,120.95 2026-07-15
78457 CPT Nm Venous Thrombosis Imaging 71 32 $5,120.95 $5,120.95 $1,481.20 $5,120.95 $5,120.95 2026-07-15
78456 CPT Nm Acute Venous Thrombus Image 71 32 $5,120.95 $5,120.95 $1,481.20 $5,120.95 $5,120.95 2026-07-15
78803 CPT Nm Rp Loclzj Tum Spect 1 Area 71 32 $5,120.95 $5,120.95 $1,481.20 $5,120.95 $5,120.95 2026-07-15
78804 CPT Nm Rp Loclzj Tum Whbdy 2+d Img 71 32 $5,120.95 $5,120.95 $955.65 $5,120.95 $5,120.95 2026-07-15
78453 CPT Nm Ht Muscle Image Planar Sing 71 32 $5,120.95 $5,120.95 $1,899.80 $5,120.95 $5,120.95 2026-07-15
78454 CPT Nm Ht Musc Image Planar Mult 71 32 $5,120.95 $5,120.95 $5,120.95 $5,120.95 $5,120.95 2026-07-15
78650 CPT Nm Csf Leakage Imaging 71 32 $5,120.95 $5,120.95 $1,845.61 $5,120.95 $5,120.95 2026-07-15
87507 CPT Iadna-dna/rna Probe Tq 12-25 71 32 $5,033.55 $5,033.55 $265.65 $5,033.55 $5,033.55 2026-07-15
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