Price Transparency 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

Ballard Rehabilitation Hospital

San Bernardino, CA · CCN 053037 · Rates published

6,294 distinct procedures filed
103 distinct payers
974,067 rate rows
2026-05-23 last MRF observed
Data quality

946,623 of 974,067 rate rows are consumer-grade (97.2%)

27,444 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
template filing: same amount across many unrelated codes — excluded 26,407
exceeds 10× this hospital's gross charge — excluded from medians 792
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 135
per-diem day rate — not a per-procedure price 110
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 Latest re-check couldn't be parsed — showing last good data · 2026-05-18
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
OTHER 		Gattex 43 $77.80 $241,461.00 $99,999.99 nat. median
$100,000
1.0× median
407
OTHER 		Traumatic Spinal Cord Injury M <24.50 And A >=61.50 Tier 3 D 53 $4,640.00 $261,356.98 $90,706.79 nat. median
$21,233
outlier · 4.3×
406
OTHER 		Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 Tier 1 B 47 $23,371.97 $76,858.58 $66,348.15 nat. median
$27,791
outlier · 2.4×
404
OTHER 		Traumatic Spinal Cord Injury M <31.50 And A <61.50 Tier 1 B 47 $30,214.06 $75,742.67 $65,386.33 nat. median
$3,927
outlier · 16.7×
1904
OTHER 		Guillain-barr� M <38.50 Tier 1 B 45 $57,686.80 $90,920.53 $65,224.78 nat. median
$120,174
0.5× median
1806
OTHER 		Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 None A 51 $54,049.78 $171,225.70 $64,772.46 nat. median
$52,047
1.2× median
81425
OTHER 		Genome Sequence Analysis 44 $77.80 $241,461.00 $60,751.05 nat. median
$5,031
outlier · 12.1×
81415
OTHER 		Exome Sequence Analysis 44 $77.80 $241,461.00 $57,718.50 nat. median
$4,780
outlier · 12.1×
106
OTHER 		Stroke M <41.50 And A <84.50 Tier 1 B 53 $10,400.00 $105,074.43 $57,246.90 nat. median
$41,618
1.4× median
505
OTHER 		Non-traumatic Spinal Cord Injury M <39.50 Tier 1 B 53 $6,308.20 $114,399.30 $55,097.10 nat. median
$17,169
outlier · 3.2×
405
OTHER 		Traumatic Spinal Cord Injury M >=31.50 And M <41.50 None A 53 $20,615.74 $60,234.26 $51,997.90 nat. median
$49,246
1.1× median
55292070255
OTHER 		Hemin For Injection 43 $77.80 $241,461.00 $51,333.70 nat. median
$51,334
1.0× median
205
OTHER 		Traumatic Brain Injury M <35.50 Tier2 C 53 $36,539.20 $151,054.26 $51,076.90 nat. median
$17,709
outlier · 2.9×
1705
OTHER 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50 Tier 2 C 53 $24,271.65 $91,874.73 $50,653.34 nat. median
$3
outlier · 18760.5×
105
OTHER 		Stroke M <41.50 And A >=84.50 None A 53 $20,741.59 $76,858.58 $50,330.25 nat. median
$2
outlier · 30689.2×
81522
OTHER 		Onc Breast Mrna 12 Genes 44 $77.80 $241,461.00 $46,768.20 nat. median
$3,873
outlier · 12.1×
81521
OTHER 		Onc Breast Mrna 70 Genes 44 $77.80 $241,461.00 $46,768.20 nat. median
$3,873
outlier · 12.1×
81519
OTHER 		Oncology Breast Mrna 44 $77.80 $241,461.00 $46,768.20 nat. median
$3,873
outlier · 12.1×
81541
OTHER 		Onc Prostate Mrna 46 Genes 44 $77.80 $241,461.00 $46,768.20 nat. median
$3,873
outlier · 12.1×
81518
OTHER 		Onc Brst Mrna 11 Genes 44 $77.80 $241,461.00 $46,768.20 nat. median
$3,873
outlier · 12.1×
1805
OTHER 		Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50 T… 51 $38,058.97 $194,374.90 $45,608.14 nat. median
$38,125
1.2× median
81540
OTHER 		Oncology Tum Unknown Origin 44 $77.80 $241,461.00 $45,281.25 nat. median
$3,750
outlier · 12.1×
1903
OTHER 		Guillain-barr� M >=38.50 And M <51.50 None A 51 $39,600.12 $81,879.54 $44,775.56 nat. median
$119,935
outlier · 0.4×
2102
OTHER 		Burns M <52.50 Tier 2 C 51 $29,960.30 $65,362.62 $43,769.00 nat. median
$34,079
1.3× median
305
OTHER 		Non-traumatic Brain Injury M <42.50 And A <78.50 Tier 2 C 53 $31,170.91 $104,103.30 $43,552.78 nat. median
$56
outlier · 774.3×
81545
OTHER 		Oncology Thyroid 44 $49.85 $241,461.00 $43,470.00 nat. median
$3,715
outlier · 11.7×
604
OTHER 		Neurological M <43.50 Tier 2 C 53 $6,502.17 $66,392.16 $43,259.51 nat. median
$14,914
outlier · 2.9×
1004
OTHER 		Amputation Lower Extremity M <47.50 Tier 1 B 53 $31,660.51 $81,371.00 $43,204.83 nat. median
$35,360
1.2× median
1504
OTHER 		Pulmonary M <45.50 Tier 3 D 53 $18,224.86 $82,861.10 $43,147.67 nat. median
$259
outlier · 166.8×
704
OTHER 		Fracture Of Lower Extremity M <41.50 Tier 3 D 53 $24,978.80 $57,840.89 $42,384.68 nat. median
$334
outlier · 127.0×
1305
OTHER 		Rheumatoid Other Arthritis M <51.50 And A <64.50 Tier 1 B 53 $33,681.58 $89,819.96 $42,143.60 nat. median
$30,688
1.4× median
1304
OTHER 		Rheumatoid Other Arthritis M <44.50 And A >=64.50 Tier 1 B 47 $32,043.25 $55,529.54 $42,006.91 nat. median
$35,295
1.2× median
403
OTHER 		Traumatic Spinal Cord Injury M >=41.50 And M <47.50 None A 53 $32,055.68 $58,878.08 $41,877.67 nat. median
$105
outlier · 398.5×
2005
OTHER 		Miscellaneous M <46.50 And A <77.50 Tier 1 B 51 $20,549.09 $72,950.21 $41,191.72 nat. median
$34,071
1.2× median
104
OTHER 		Stroke M >=41.50 And M <50.50 Tier 3 D 53 $22,360.19 $67,357.19 $40,249.79 nat. median
$5
outlier · 7770.2×
81440
OTHER 		Mitochondrial Gene 44 $77.80 $241,461.00 $40,137.30 nat. median
$3,324
outlier · 12.1×
1103
OTHER 		Amputation Non-lower Extremity M <52.50 Tier 1 B 47 $32,592.51 $56,526.16 $40,068.36 nat. median
$12,018
outlier · 3.3×
1704
OTHER 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 53 $11,550.10 $56,115.48 $39,973.92 nat. median
$2
outlier · 25461.1×
904
OTHER 		Other Orthopedic M <44.5 Tier 3 D 53 $28,046.86 $53,225.65 $39,735.32 nat. median
$29,273
1.4× median
59627033304
OTHER 		Avonex Pen 30 mcg/0.5mL 43 $77.80 $241,461.00 $39,676.03 nat. median
$39,676
1.0× median
59627022205
OTHER 		Avonex 43 $77.80 $241,461.00 $39,676.03 nat. median
$39,676
1.0× median
504
OTHER 		Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50 Tier 3 D 53 $25,407.44 $73,816.87 $39,650.82 nat. median
$18,399
outlier · 2.2×
304
OTHER 		Non-traumatic Brain Injury M <42.50 And A >=78.50 Tier 2 C 53 $24,960.00 $120,654.40 $39,491.76 nat. median
$9,034
outlier · 4.4×
74368303
OTHER 		Lupron Depot 43 $77.80 $241,461.00 $39,246.62 nat. median
$39,247
1.0× median
1604
OTHER 		Pain Syndrome M <43.50 Tier 1 B 47 $19,924.82 $58,342.93 $39,168.67 nat. median
$44,507
0.9× median
81595
OTHER 		Cardiology Hrt Trnspl Mrna 44 $75.90 $241,461.00 $39,123.00 nat. median
$3,240
outlier · 12.1×
2004
OTHER 		Miscellaneous M <46.50 And A >=77.50 Tier 1 B 51 $7,589.90 $52,373.19 $39,079.20 nat. median
$29,270
1.3× median
1404
OTHER 		Cardiac M <45.50 Tier 1 B 53 $16,654.31 $83,732.35 $39,061.80 nat. median
$14,506
outlier · 2.7×
1204
OTHER 		Osteoarthritis M <49.50 And A <74.50 Tier 1 B 47 $29,264.66 $58,342.93 $38,686.52 nat. median
$34,070
1.1× median
204
OTHER 		Traumatic Brain Injury M >=35.50 And M <49.50 Tier 3 D 53 $30,738.46 $64,599.99 $38,296.32 nat. median
$8,657
outlier · 4.4×

Other procedures at this hospital

Browse this hospital's 6,294 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
             
68875010201 OTHER Gattex 138 43 $99,999.99 $99,999.99 $77.80 $241,461.00 $99,999.99 2026-05-23
407 OTHER Traumatic Spinal Cord Injury M <24.50 And A >=61.50 Tier 3 D 330 53 $93,440.64 $92,073.71 $4,640.00 $261,356.98 $90,706.79 2026-05-23
406 OTHER Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 Tier 1 B 208 47 $67,348.49 $67,348.49 $23,371.97 $76,858.58 $66,348.15 2026-05-08
404 OTHER Traumatic Spinal Cord Injury M <31.50 And A <61.50 Tier 1 B 208 47 $66,371.76 $66,371.76 $30,214.06 $75,742.67 $65,386.33 2026-05-08
1904 OTHER Guillain-barr� M <38.50 Tier 1 B 200 45 $67,562.23 $67,562.23 $57,686.80 $90,920.53 $65,224.78 2026-05-08
1806 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 None A 262 51 $68,227.05 $66,499.76 $54,049.78 $171,225.70 $64,772.46 2026-05-23
81425 OTHER Genome Sequence Analysis 140 44 $60,751.05 $60,751.05 $77.80 $241,461.00 $60,751.05 2026-05-23
81415 OTHER Exome Sequence Analysis 140 44 $57,718.50 $57,718.50 $77.80 $241,461.00 $57,718.50 2026-05-23
106 OTHER Stroke M <41.50 And A <84.50 Tier 1 B 393 53 $72,233.39 $59,945.96 $10,400.00 $105,074.43 $57,246.90 2026-05-23
505 OTHER Non-traumatic Spinal Cord Injury M <39.50 Tier 1 B 387 53 $73,517.90 $56,708.83 23% off $6,308.20 $114,399.30 $55,097.10 2026-05-23
405 OTHER Traumatic Spinal Cord Injury M >=31.50 And M <41.50 None A 271 53 $53,566.14 $52,782.02 $20,615.74 $60,234.26 $51,997.90 2026-05-23
55292070255 OTHER Hemin For Injection 138 43 $51,333.70 $51,333.70 $77.80 $241,461.00 $51,333.70 2026-05-23
205 OTHER Traumatic Brain Injury M <35.50 Tier2 C 327 53 $65,575.21 $51,531.90 21% off $36,539.20 $151,054.26 $51,076.90 2026-05-23
1705 OTHER Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50 Tier 2 C 269 53 $50,653.34 $46,910.45 $24,271.65 $91,874.73 $50,653.34 2026-05-23
105 OTHER Stroke M <41.50 And A >=84.50 None A 272 53 $50,330.25 $52,703.74 $20,741.59 $76,858.58 $50,330.25 2026-05-23
81519 OTHER Oncology Breast Mrna 140 44 $46,768.20 $46,768.20 $77.80 $241,461.00 $46,768.20 2026-05-23
81541 OTHER Onc Prostate Mrna 46 Genes 140 44 $46,768.20 $46,768.20 $77.80 $241,461.00 $46,768.20 2026-05-23
81521 OTHER Onc Breast Mrna 70 Genes 140 44 $46,768.20 $46,768.20 $77.80 $241,461.00 $46,768.20 2026-05-23
81522 OTHER Onc Breast Mrna 12 Genes 140 44 $46,768.20 $46,768.20 $77.80 $241,461.00 $46,768.20 2026-05-23
81518 OTHER Onc Brst Mrna 11 Genes 140 44 $46,768.20 $46,768.20 $77.80 $241,461.00 $46,768.20 2026-05-23
1805 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50 T… 320 51 $60,221.83 $46,824.71 22% off $38,058.97 $194,374.90 $45,608.14 2026-05-23
81540 OTHER Oncology Tum Unknown Origin 140 44 $45,281.25 $45,281.25 $77.80 $241,461.00 $45,281.25 2026-05-23
1903 OTHER Guillain-barr� M >=38.50 And M <51.50 None A 263 51 $47,984.11 $46,379.83 $39,600.12 $81,879.54 $44,775.56 2026-05-23
2102 OTHER Burns M <52.50 Tier 2 C 214 51 $57,599.82 $43,769.00 24% off $29,960.30 $65,362.62 $43,769.00 2026-05-23
305 OTHER Non-traumatic Brain Injury M <42.50 And A <78.50 Tier 2 C 385 53 $47,412.48 $45,482.63 $31,170.91 $104,103.30 $43,552.78 2026-05-23
81545 OTHER Oncology Thyroid 140 44 $43,470.00 $43,470.00 $49.85 $241,461.00 $43,470.00 2026-05-23
604 OTHER Neurological M <43.50 Tier 2 C 386 53 $48,213.09 $44,799.17 $6,502.17 $66,392.16 $43,259.51 2026-05-23
1004 OTHER Amputation Lower Extremity M <47.50 Tier 1 B 329 53 $44,422.70 $45,251.50 $31,660.51 $81,371.00 $43,204.83 2026-05-23
1504 OTHER Pulmonary M <45.50 Tier 3 D 271 53 $45,879.04 $44,513.35 $18,224.86 $82,861.10 $43,147.67 2026-05-23
704 OTHER Fracture Of Lower Extremity M <41.50 Tier 3 D 326 53 $47,861.55 $42,384.68 $24,978.80 $57,840.89 $42,384.68 2026-05-23
1305 OTHER Rheumatoid Other Arthritis M <51.50 And A <64.50 Tier 1 B 269 53 $42,143.60 $41,185.51 $33,681.58 $89,819.96 $42,143.60 2026-05-23
1304 OTHER Rheumatoid Other Arthritis M <44.50 And A >=64.50 Tier 1 B 208 47 $43,007.25 $43,007.25 $32,043.25 $55,529.54 $42,006.91 2026-05-08
403 OTHER Traumatic Spinal Cord Injury M >=41.50 And M <47.50 None A 271 53 $43,140.22 $42,508.94 $32,055.68 $58,878.08 $41,877.67 2026-05-23
2005 OTHER Miscellaneous M <46.50 And A <77.50 Tier 1 B 381 51 $44,094.58 $42,643.15 $20,549.09 $72,950.21 $41,191.72 2026-05-23
104 OTHER Stroke M >=41.50 And M <50.50 Tier 3 D 334 53 $50,787.55 $42,147.33 $22,360.19 $67,357.19 $40,249.79 2026-05-23
81440 OTHER Mitochondrial Gene 140 44 $40,137.30 $40,137.30 $77.80 $241,461.00 $40,137.30 2026-05-23
1103 OTHER Amputation Non-lower Extremity M <52.50 Tier 1 B 158 47 $40,068.36 $40,068.36 $32,592.51 $56,526.16 $40,068.36 2026-05-08
1704 OTHER Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 329 53 $47,943.60 $41,568.25 $11,550.10 $56,115.48 $39,973.92 2026-05-23
904 OTHER Other Orthopedic M <44.5 Tier 3 D 329 53 $43,931.50 $41,183.02 $28,046.86 $53,225.65 $39,735.32 2026-05-23
59627033304 OTHER Avonex Pen 30 mcg/0.5mL 138 43 $39,676.03 $39,676.03 $77.80 $241,461.00 $39,676.03 2026-05-23
59627022205 OTHER Avonex 138 43 $39,676.03 $39,676.03 $77.80 $241,461.00 $39,676.03 2026-05-23
504 OTHER Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50 Tier 3 D 329 53 $53,948.88 $40,810.22 24% off $25,407.44 $73,816.87 $39,650.82 2026-05-23
304 OTHER Non-traumatic Brain Injury M <42.50 And A >=78.50 Tier 2 C 329 53 $53,735.14 $41,241.43 23% off $24,960.00 $120,654.40 $39,491.76 2026-05-23
74368303 OTHER Lupron Depot 138 43 $39,246.62 $39,246.62 $77.80 $241,461.00 $39,246.62 2026-05-23
1604 OTHER Pain Syndrome M <43.50 Tier 1 B 208 47 $41,251.37 $41,251.37 $19,924.82 $58,342.93 $39,168.67 2026-05-08
81595 OTHER Cardiology Hrt Trnspl Mrna 140 44 $39,123.00 $39,123.00 $75.90 $241,461.00 $39,123.00 2026-05-23
2004 OTHER Miscellaneous M <46.50 And A >=77.50 Tier 1 B 433 51 $47,551.00 $40,456.07 $7,589.90 $52,373.19 $39,079.20 2026-05-23
1404 OTHER Cardiac M <45.50 Tier 1 B 386 53 $42,011.88 $40,536.84 $16,654.31 $83,732.35 $39,061.80 2026-05-23
1204 OTHER Osteoarthritis M <49.50 And A <74.50 Tier 1 B 208 47 $39,973.91 $39,973.91 $29,264.66 $58,342.93 $38,686.52 2026-05-08
204 OTHER Traumatic Brain Injury M >=35.50 And M <49.50 Tier 3 D 328 53 $42,165.97 $40,231.15 $30,738.46 $64,599.99 $38,296.32 2026-05-23
1703 OTHER Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50… 329 53 $49,060.25 $36,726.85 25% off $28,838.93 $84,412.38 $38,134.78 2026-05-23
81525 OTHER Oncology Colon Mrna 140 44 $37,625.70 $37,625.70 $1.15 $241,461.00 $37,625.70 2026-05-23
1804 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50 N… 263 51 $39,625.97 $38,621.90 $31,391.11 $106,026.90 $37,617.83 2026-05-23
805 OTHER Replacement Of Lower-extremity Joint M <42.50 None A 271 53 $41,107.22 $39,292.93 $19,897.49 $65,018.56 $37,478.65 2026-05-23
1203 OTHER Osteoarthritis M <49.50 And A >=74.50 Tier 3 D 328 53 $51,754.34 $38,118.62 26% off $23,173.14 $65,839.52 $36,892.12 2026-05-23
81455 OTHER Targeted Genomic Seq Analys 140 44 $35,255.55 $35,255.55 $77.80 $241,461.00 $35,255.55 2026-05-23
1503 OTHER Pulmonary M >=45.50 And M <56.50 Tier 3 D 271 53 $37,046.21 $35,943.97 $25,852.32 $75,091.02 $34,841.73 2026-05-23
703 OTHER Fracture Of Lower Extremity M >=41.50 And M <52.50 Tier 2 C 386 53 $47,347.86 $34,695.09 27% off $27,040.00 $62,128.86 $34,695.09 2026-05-23
81538 OTHER Oncology Lung 140 44 $34,669.05 $34,669.05 $77.80 $241,461.00 $34,669.05 2026-05-23
603 OTHER Neurological M >=43.50 And M <52.50 Tier 3 D 331 53 $34,493.78 $35,721.53 $25,805.10 $49,353.52 $34,493.78 2026-05-23
1803 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50 T… 263 51 $36,235.99 $35,318.90 $28,706.96 $70,265.76 $34,401.82 2026-05-23
1003 OTHER Amputation Lower Extremity M >=47.50 And M <55.50 Tier 1 B 329 53 $44,671.17 $35,346.24 21% off $27,212.78 $60,550.56 $34,287.50 2026-05-23
303 OTHER Non-traumatic Brain Injury M >=42.50 And M <52.50 Tier 2 C 387 53 $46,346.28 $35,569.93 23% off $26,401.57 $332,730.40 $34,061.33 2026-05-23
402 OTHER Traumatic Spinal Cord Injury M >=47.50 And M <56.50 Tier 1 B 208 47 $33,873.69 $33,873.69 $26,066.05 $47,347.86 $33,370.42 2026-05-08
503 OTHER Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50 None A 272 53 $35,306.48 $34,330.99 $20,399.52 $63,141.10 $33,355.50 2026-05-23
1303 OTHER Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50 Tier 3 D 271 53 $34,849.18 $34,056.37 $26,965.74 $55,756.38 $33,263.55 2026-05-23
74055402 OTHER Humira(Cf) Pen 138 43 $33,228.58 $33,228.58 $77.80 $241,461.00 $33,228.58 2026-05-23
2144511 OTHER Taltz Autoinjector 138 43 $33,195.46 $33,195.46 $5.00 $241,461.00 $33,195.46 2026-05-23
903 OTHER Other Orthopedic M >=44.50 And M <51.50 Tier 3 D 328 53 $44,420.16 $34,369.51 23% off $27,306.73 $63,728.67 $33,161.65 2026-05-23
81426 OTHER Genome Sequence Analysis 140 44 $32,723.25 $32,723.25 $77.80 $241,461.00 $32,723.25 2026-05-23
2003 OTHER Miscellaneous M >=46.50 And M <55.50 Tier 1 B 437 51 $43,803.80 $33,836.42 23% off $10,292.20 $60,345.99 $32,684.47 2026-05-23
1502 OTHER Pulmonary M >=56.50 And M <68.50 Tier 1 B 208 47 $31,626.96 $31,626.96 $25,810.32 $85,524.89 $32,597.48 2026-05-08
1102 OTHER Amputation Non-lower Extremity M >=52.50 And M <58.50 Tier 1 B 158 47 $32,130.24 $32,130.24 $28,333.41 $45,645.42 $32,130.24 2026-05-08
1403 OTHER Cardiac M >=45.50 And M <55.50 Tier 2 C 387 53 $43,522.95 $33,083.36 24% off $13,940.00 $64,027.21 $31,879.22 2026-05-23
1603 OTHER Pain Syndrome M >=43.50 And M <58.50 Tier 3 D 271 53 $34,975.93 $33,294.61 $26,338.20 $81,168.13 $31,613.29 2026-05-23
103 OTHER Stroke M >=50.50 And M <63.50 Tier 1 B 396 53 $34,513.66 $33,026.19 $16,640.00 $75,742.67 $31,538.73 2026-05-23
25682000101 OTHER Soliris 138 43 $31,310.40 $31,310.40 $77.80 $241,461.00 $31,310.40 2026-05-23
804 OTHER Replacement Of Lower-extremity Joint M >=42.50 And M <51.50 Tier 3 D 329 53 $42,715.23 $32,762.75 23% off $26,230.83 $51,633.84 $31,250.44 2026-05-23
203 OTHER Traumatic Brain Injury M >=49.50 And M <61.50 Tier 1 B 386 53 $40,733.10 $32,437.18 20% off $15,148.50 $71,201.97 $30,877.64 2026-05-23
55513019201 OTHER Neulasta Onpro 138 43 $30,806.35 $30,806.35 $77.80 $241,461.00 $30,806.35 2026-05-23
55513019001 OTHER Neulasta 6 Mg 138 43 $30,806.35 $30,806.35 $77.80 $241,461.00 $30,806.35 2026-05-23
502 OTHER Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50 Tier 2 C 328 53 $37,369.51 $29,950.61 $24,132.72 $41,680.26 $30,800.59 2026-05-23
81520 OTHER Onc Breast Mrna 58 Genes 140 44 $30,311.70 $30,311.70 $77.80 $241,461.00 $30,311.70 2026-05-23
1702 OTHER Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50… 329 53 $41,286.17 $30,907.46 25% off $24,269.17 $52,373.19 $29,721.96 2026-05-23
1902 OTHER Guillain-barr� M >=51.50 And M <66.50 Tier 1 B 200 45 $30,740.94 $30,740.94 $26,246.49 $41,368.18 $29,677.23 2026-05-08
81412 OTHER Ashkenazi Jewish Assoc Dis 140 44 $29,566.50 $29,566.50 $77.80 $241,461.00 $29,566.50 2026-05-23
81443 OTHER Genetic Tstg Severe Inh Cond 140 44 $29,566.50 $29,566.50 $77.80 $241,461.00 $29,566.50 2026-05-23
602 OTHER Neurological M >=52.50 And M <64.50 Tier 1 B 385 53 $41,508.60 $30,317.20 27% off $20,369.70 $41,885.13 $29,274.61 2026-05-23
1302 OTHER Rheumatoid Other Arthritis M >=51.50 And M <62.50 Tier 1 B 208 47 $29,935.70 $29,935.70 $21,704.31 $41,286.17 $29,239.81 2026-05-08
1002 OTHER Amputation Lower Extremity M >=55.50 And M <64.50 Tier 1 B 385 53 $38,127.32 $30,168.08 21% off $19,620.00 $43,716.91 $28,804.88 2026-05-23
1202 OTHER Osteoarthritis M >=49.50 And M <61.50 Tier 1 B 208 47 $29,423.72 $29,423.72 $20,223.06 $39,949.06 $28,476.82 2026-05-08
2101 OTHER Burns M >=52.50 Tier 1 B 150 45 $28,419.65 $28,419.65 $21,844.49 $37,401.61 $28,419.65 2026-05-08
81427 OTHER Genome Re-evaluation 140 44 $28,227.90 $28,227.90 $77.80 $241,461.00 $28,227.90 2026-05-23
702 OTHER Fracture Of Lower Extremity M >=52.50 And M <61.50 Tier 2 C 383 53 $29,784.10 $28,213.37 $15,671.91 $39,971.43 $28,213.37 2026-05-23
68982085005 OTHER Octagam 138 43 $27,972.00 $27,972.00 $77.80 $241,461.00 $27,972.00 2026-05-23
803 OTHER Replacement Of Lower-extremity Joint M >=51.50 And M <57.50 None A 273 53 $30,594.31 $29,243.54 $18,088.90 $54,271.97 $27,892.77 2026-05-23
902 OTHER Other Orthopedic M >=51.50 And M <63.50 Tier 2 C 388 53 $32,928.50 $28,781.27 $16,640.00 $53,225.65 $27,768.50 2026-05-23
1602 OTHER Pain Syndrome M >=58.50 And M <65.50 Tier 1 B 208 47 $26,364.29 $26,364.29 $20,855.83 $90,920.53 $27,696.43 2026-05-08
202 OTHER Traumatic Brain Injury M >=61.50 And M <73.50 Tier 2 C 271 53 $27,298.77 $26,046.17 $21,010.16 $71,425.08 $27,298.77 2026-05-23
2002 OTHER Miscellaneous M >=55.50 And M <66.50 Tier 1 B 377 51 $27,293.80 $28,255.62 $7,322.84 $36,578.97 $27,293.80 2026-05-23
1802 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury M >=55.50 And M <67.50 T… 263 51 $28,203.43 $27,490.15 $22,343.29 $35,353.70 $26,776.86 2026-05-23
1402 OTHER Cardiac M >=55.50 And M <68.50 Tier 3 D 329 53 $35,569.93 $27,037.82 24% off $18,503.22 $41,234.39 $26,053.63 2026-05-23
81442 OTHER Noonan Spectrum Disorders 140 44 $25,885.35 $25,885.35 $77.80 $241,461.00 $25,885.35 2026-05-23
401 OTHER Traumatic Spinal Cord Injury M >=56.50 None A 270 53 $26,655.08 $26,264.88 $21,105.35 $53,445.65 $25,874.68 2026-05-23
1501 OTHER Pulmonary M >=68.50 Tier 1 B 208 47 $24,931.51 $24,931.51 $20,345.84 $60,221.83 $25,695.74 2026-05-08
1101 OTHER Amputation Non-lower Extremity M >=58.50 Tier 1 B 158 47 $25,273.24 $25,273.24 $22,287.37 $40,162.80 $25,273.24 2026-05-08
1201 OTHER Osteoarthritis M >=61.50 Tier 1 B 208 47 $24,303.97 $24,303.97 $19,352.70 $45,879.04 $25,086.84 2026-05-08
802 OTHER Replacement Of Lower-extremity Joint M >=57.50 And M <63.50 Tier 2 C 385 53 $33,232.60 $26,273.58 21% off $21,034.77 $70,526.44 $25,059.50 2026-05-23
501 OTHER Non-traumatic Spinal Cord Injury M >=60.50 Tier 1 B 208 47 $23,874.00 $23,874.00 $19,236.39 $51,229.94 $24,552.49 2026-05-08
81551 OTHER Onc Prostate 3 Genes 140 44 $24,512.25 $24,512.25 $57.21 $241,461.00 $24,512.25 2026-05-23
102 OTHER Stroke M >=63.50 And M <72.50 Tier 3 D 328 53 $26,776.86 $25,622.43 $14,463.06 $48,511.00 $24,467.99 2026-05-23
1601 OTHER Pain Syndrome M >=65.50 Tier 1 B 208 47 $23,007.86 $23,007.86 $18,200.76 $62,416.37 $24,169.75 2026-05-08
81408 OTHER Mopath Procedure Level 9 140 44 $24,150.00 $24,150.00 $77.80 $241,461.00 $24,150.00 2026-05-23
1701 OTHER Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=57.50 None A 270 53 $25,829.95 $24,876.83 $19,533.88 $51,520.08 $23,923.71 2026-05-23
601 OTHER Neurological M >=64.50 None A 271 53 $23,081.18 $23,902.58 $3,475.70 $42,630.72 $23,081.18 2026-05-23
801 OTHER Replacement Of Lower-extremity Joint M >=63.50 Tier 1 B 208 47 $23,174.38 $23,174.38 $18,554.17 $39,949.06 $23,032.10 2026-05-08
50633012011 OTHER Digifab 138 43 $22,958.40 $22,958.40 $77.80 $52,815.65 $22,958.40 2026-05-23
701 OTHER Fracture Of Lower Extremity M >=61.50 None A 272 53 $24,112.59 $23,477.59 $18,720.00 $47,298.16 $22,842.59 2026-05-23
1001 OTHER Amputation Lower Extremity M >=64.50 Tier 3 D 271 53 $24,890.50 $23,814.35 $18,332.73 $35,569.93 $22,738.21 2026-05-23
1301 OTHER Rheumatoid Other Arthritis M >=62.50 Tier 1 B 208 47 $21,898.17 $21,898.17 $17,907.74 $43,334.07 $22,407.66 2026-05-08
901 OTHER Other Orthopedic M >=63.50 None A 271 53 $23,921.22 $23,108.52 $18,359.57 $42,146.09 $22,295.82 2026-05-23
78081881 OTHER SandoSTATIN Lar Depot 138 43 $22,158.24 $22,158.24 $77.80 $52,815.65 $22,158.24 2026-05-23
81162 OTHER Brca1&2 Gen Full Seq Dup/del 140 44 $22,035.15 $22,035.15 $77.80 $52,815.65 $22,035.15 2026-05-23
301 OTHER Testosterone Free And Total 407 84 $21,895.68 $21,895.68 $77.80 $58,320.56 $21,895.68 2026-05-23
2001 OTHER Miscellaneous M >=66.50 Tier 3 D 263 51 $23,434.10 $22,662.40 $17,932.34 $57,100.76 $21,890.71 2026-05-23
101 OTHER Stroke M >=72.50 Tier 1 B 208 47 $20,193.24 $20,193.24 $16,538.82 $38,656.69 $21,102.87 2026-05-08
201 OTHER Traumatic Brain Injury M >=73.50 Tier 1 B 208 47 $19,917.37 $19,917.37 $16,064.62 $93,440.64 $20,874.22 2026-05-08
2840001 OTHER Forteo 138 43 $20,591.47 $20,591.47 $5.18 $52,815.65 $20,591.47 2026-05-23
1401 OTHER Cardiac M >=68.50 None A 271 53 $22,094.51 $21,319.09 $17,013.02 $50,653.34 $20,543.67 2026-05-23
1801 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury M >=67.50 Tier 1 B 206 47 $19,957.13 $19,957.13 $4,249.90 $43,769.00 $19,963.47 2026-05-08
81430 OTHER Hearing Loss Sequence Analys 140 44 $19,623.60 $19,623.60 $77.80 $56,554.95 $19,623.60 2026-05-23
50458060901 OTHER Invega Trinza 138 43 $19,046.87 $19,046.87 $77.80 $52,815.65 $19,046.87 2026-05-23
68982085004 OTHER Octagam 138 43 $18,648.00 $18,648.00 $77.80 $52,815.65 $18,648.00 2026-05-23
55513003201 OTHER Aranesp 138 43 $18,576.00 $18,576.00 $77.80 $52,815.65 $18,576.00 2026-05-23
1901 OTHER Guillain-barr� M >=66.50 Tier 1 B 200 45 $19,210.29 $19,210.29 $16,402.38 $25,852.32 $18,545.47 2026-05-08
81509 OTHER Ftl Cgen Abnor 3 Proteins 140 44 $17,960.70 $17,960.70 $77.80 $56,554.95 $17,960.70 2026-05-23
78063998 OTHER Cosentyx 138 43 $17,781.50 $17,781.50 $77.80 $52,815.65 $17,781.50 2026-05-23
173089201 OTHER Mepolizumab Injection 138 43 $17,706.38 $17,706.38 $77.80 $52,815.65 $17,706.38 2026-05-23
44206043820 OTHER Privigen 10% 138 43 $17,379.84 $17,379.84 $77.80 $52,815.65 $17,379.84 2026-05-23
78081181 OTHER SandoSTATIN Lar Depot 138 43 $16,912.46 $16,912.46 $77.80 $52,815.65 $16,912.46 2026-05-23
50458056401 OTHER Invega Sustenna 234 Mg 138 43 $16,697.76 $16,697.76 $77.80 $52,815.65 $16,697.76 2026-05-23
74379902 OTHER Humira 138 43 $16,614.29 $16,614.29 $77.80 $52,815.65 $16,614.29 2026-05-23
81411 OTHER Aortic Dysfunction/dilation 140 44 $16,304.70 $16,304.70 $77.80 $52,815.65 $16,304.70 2026-05-23
944270006 OTHER Gammagard Liquid 138 43 $16,273.92 $16,273.92 $77.80 $52,815.65 $16,273.92 2026-05-23
31626 OTHER Bronch Ins Rad Mark 138 43 $16,215.15 $16,215.15 $77.80 $52,815.65 $16,215.15 2026-05-23
55513073001 OTHER Denosumab 120 mg/1.7mL 138 43 $15,770.26 $15,770.26 $77.80 $52,815.65 $15,770.26 2026-05-23
81460 OTHER Whole Mitochondrial Genome 140 44 $15,542.25 $15,542.25 $77.80 $52,815.65 $15,542.25 2026-05-23
51759063010 OTHER risperiDONE ER Inj 125 Mg/0.35 138 43 $15,375.36 $15,375.36 $77.80 $52,815.65 $15,375.36 2026-05-23
24201040002 OTHER Calcitonin,salmon Inj 400 Unit 138 43 $15,028.80 $15,028.80 $77.80 $52,815.65 $15,028.80 2026-05-23
42367054032 OTHER Ryanodex 138 43 $14,040.84 $14,040.84 $77.80 $52,815.65 $14,040.84 2026-05-23
81277 OTHER Cytogenomic Neo Microra Alys 140 44 $14,007.00 $14,007.00 $77.80 $52,815.65 $14,007.00 2026-05-23
81229 OTHER Cytogen M Array Copy No&snp 140 44 $14,007.00 $14,007.00 $77.80 $52,815.65 $14,007.00 2026-05-23
59148001971 OTHER Abilify Maintena 138 43 $13,535.23 $13,535.23 $77.80 $52,815.65 $13,535.23 2026-05-23
59148007280 OTHER Abilify Maintena 400 Mg 138 43 $13,535.23 $13,535.23 $77.80 $52,815.65 $13,535.23 2026-05-23
67457067502 OTHER Miacalcin 138 43 $12,974.72 $12,974.72 $77.80 $52,815.65 $12,974.72 2026-05-23
70539000102 OTHER Tymlos 138 43 $12,801.60 $12,801.60 $77.80 $52,815.65 $12,801.60 2026-05-23
81493 OTHER Cor Artery Disease Mrna 140 44 $12,678.75 $12,678.75 $77.80 $52,815.65 $12,678.75 2026-05-23
55513022101 OTHER Nplate 250 Mcg 138 43 $12,585.22 $12,585.22 $77.80 $52,815.65 $12,585.22 2026-05-23
31653 OTHER Bronch Ebus 3 Or > Stat 138 43 $12,329.50 $12,329.50 $77.80 $52,815.65 $12,329.50 2026-05-23
31629 OTHER Bronch Trnsbronch Ndl Asp 138 43 $12,329.50 $12,329.50 $77.80 $52,815.65 $12,329.50 2026-05-23
31628 OTHER Transbronch Lung Biopsy Sgl 138 43 $12,329.50 $12,329.50 $77.80 $52,815.65 $12,329.50 2026-05-23
31652 OTHER Bronch Ebus 1 Or 2 Stat 138 43 $12,329.50 $12,329.50 $77.80 $52,815.65 $12,329.50 2026-05-23
81465 OTHER Whole Mitochondrial Genome 140 44 $11,302.20 $11,302.20 $77.80 $52,815.65 $11,302.20 2026-05-23
55513011101 OTHER Aranesp 138 43 $11,145.60 $11,145.60 $77.80 $52,815.65 $11,145.60 2026-05-23
50458056301 OTHER Invega Sustenna 156 Mg 138 43 $11,132.11 $11,132.11 $77.80 $52,815.65 $11,132.11 2026-05-23
50458056101 OTHER Invega Sustenna 138 43 $11,131.49 $11,131.49 $77.80 $52,815.65 $11,131.49 2026-05-23
50458056001 OTHER Invega Sustenna 138 43 $11,131.01 $11,131.01 $77.80 $52,815.65 $11,131.01 2026-05-23
81470 OTHER X-linked Intellectual Dblt 140 44 $11,036.55 $11,036.55 $77.80 $52,815.65 $11,036.55 2026-05-23
81471 OTHER X-linked Intellectual Dblt 140 44 $11,036.55 $11,036.55 $77.80 $52,815.65 $11,036.55 2026-05-23
31600 OTHER Percutaneous Tracheostomy 138 43 $11,022.90 $11,022.90 $77.80 $52,815.65 $11,022.90 2026-05-23
81228 OTHER Cytogen Micrarray Copy Nmbr 140 44 $10,867.50 $10,867.50 $77.80 $52,815.65 $10,867.50 2026-05-23
81503 OTHER Onco (ovar) Five Proteins 140 44 $10,833.00 $10,833.00 $77.80 $52,815.65 $10,833.00 2026-05-23
944265804 OTHER Gammagard S-d 10 Gram 138 43 $10,764.48 $10,764.48 $77.80 $52,815.65 $10,764.48 2026-05-23
81407 OTHER Mopath Procedure Level 8 140 44 $10,218.90 $10,218.90 $77.80 $52,815.65 $10,218.90 2026-05-23
81185 OTHER Cacna1a Gene Full Gene Seq 140 44 $10,218.90 $10,218.90 $77.80 $52,815.65 $10,218.90 2026-05-23
61953000405 OTHER Flebogamma Dif 138 43 $10,164.48 $10,164.48 $77.80 $52,815.65 $10,164.48 2026-05-23
59148004580 OTHER Abilify Maintena 138 43 $10,151.42 $10,151.42 $77.80 $52,815.65 $10,151.42 2026-05-23
81490 OTHER Autoimmune Rheumatoid Arthr 140 44 $10,149.90 $10,149.90 $77.80 $52,815.65 $10,149.90 2026-05-23
67457083306 OTHER Pegfilgrastim-jmdb 138 43 $10,020.00 $10,020.00 $77.80 $52,815.65 $10,020.00 2026-05-23
74364203 OTHER Lupron Depot 138 43 $9,811.68 $9,811.68 $22.68 $52,815.65 $9,811.68 2026-05-23
80412 OTHER Crh Stimulation Panel 140 44 $9,680.70 $9,680.70 $77.80 $52,815.65 $9,680.70 2026-05-23
81507 OTHER Fetal Aneuploidy Trisom Risk 140 44 $9,601.35 $9,601.35 $77.80 $52,815.65 $9,601.35 2026-05-23
81201 OTHER Apc Gene Full Sequence 140 44 $9,418.50 $9,418.50 $77.80 $52,815.65 $9,418.50 2026-05-23
68982085003 OTHER Octagam 10% 138 43 $9,324.00 $9,324.00 $77.80 $52,815.65 $9,324.00 2026-05-23
81325 OTHER Pmp22 Gene Full Sequence 140 44 $9,294.30 $9,294.30 $77.80 $52,815.65 $9,294.30 2026-05-23
81539 OTHER Oncology Prostate Prob Score 140 44 $9,177.00 $9,177.00 $77.80 $56,554.95 $9,177.00 2026-05-23
81450 OTHER Targeted Genomic Seq Analys 140 44 $9,170.10 $9,170.10 $77.80 $52,815.65 $9,170.10 2026-05-23
81420 OTHER Fetal Chrmoml Aneuploidy 140 44 $9,166.65 $9,166.65 $77.80 $52,815.65 $9,166.65 2026-05-23
81422 OTHER Fetal Chrmoml Microdeltj 140 44 $9,166.65 $9,166.65 $77.80 $52,815.65 $9,166.65 2026-05-23
81324 OTHER Pmp22 Gene Dup/delet 140 44 $9,156.30 $9,156.30 $77.80 $52,815.65 $9,156.30 2026-05-23
58406003204 OTHER EnbreL Sureclick 138 43 $9,148.70 $9,148.70 $77.80 $52,815.65 $9,148.70 2026-05-23
24591401 OTHER Dupixent Syringe 138 43 $9,127.68 $9,127.68 $77.80 $52,815.65 $9,127.68 2026-05-23
44206043710 OTHER Privigen 10% 138 43 $8,689.92 $8,689.92 $77.80 $52,815.65 $8,689.92 2026-05-23
31641 OTHER Bronch Dest Grth Lung 138 43 $8,633.10 $8,633.10 $77.80 $52,815.65 $8,633.10 2026-05-23
55513071001 OTHER Prolia 138 43 $8,573.38 $8,573.38 $34.81 $52,815.65 $8,573.38 2026-05-23
57970010001 OTHER Dalbavancin Hcl 138 43 $8,539.82 $8,539.82 $77.80 $52,815.65 $8,539.82 2026-05-23
28005 OTHER Incision, Bone Cortex, Foot 138 43 $8,491.00 $8,491.00 $77.80 $52,815.65 $8,491.00 2026-05-23
50458056201 OTHER Invega Sustenna 117 Mg 138 43 $8,348.78 $8,348.78 $77.80 $52,815.65 $8,348.78 2026-05-23
81431 OTHER Hearing Loss Dup/del Analys 140 44 $8,204.10 $8,204.10 $77.80 $52,815.65 $8,204.10 2026-05-23
81432 OTHER Hrdtry Brst Ca-rlatd Dsordrs 140 44 $8,200.65 $8,200.65 $77.80 $52,815.65 $8,200.65 2026-05-23
81175 OTHER Asxl1 Full Gene Sequence 140 44 $8,169.60 $8,169.60 $77.80 $52,815.65 $8,169.60 2026-05-23
81317 OTHER Pms2 Gene Full Seq Analysis 140 44 $8,169.60 $8,169.60 $77.80 $52,815.65 $8,169.60 2026-05-23
81292 OTHER Mlh1 Gene Full Seq 140 44 $8,155.80 $8,155.80 $77.80 $52,815.65 $8,155.80 2026-05-23
944270005 OTHER Gammagard Liquid 10% 138 43 $8,136.96 $8,136.96 $77.80 $52,815.65 $8,136.96 2026-05-23
64842072709 OTHER Decitabine/Cedazuridine 35/100 138 43 $7,931.30 $7,931.30 $77.80 $52,815.65 $7,931.30 2026-05-23
65757030001 OTHER VivitroL 138 43 $7,877.33 $7,877.33 $1.50 $52,815.65 $7,877.33 2026-05-23
31627 OTHER Electromag Nav Bronch 138 43 $7,754.15 $7,754.15 $77.80 $52,815.65 $7,754.15 2026-05-23
81298 OTHER Msh6 Gene Full Seq 140 44 $7,748.70 $7,748.70 $77.80 $52,815.65 $7,748.70 2026-05-23
50474070062 OTHER Cimzia 138 43 $7,649.53 $7,649.53 $77.80 $52,815.65 $7,649.53 2026-05-23
88348 OTHER Electron Microscopy 138 43 $7,586.55 $7,586.55 $62.10 $52,815.65 $7,586.55 2026-05-23
88333 OTHER Intraop Cyto Path Consult 1 134 43 $7,586.55 $7,586.55 $77.80 $52,815.65 $7,586.55 2026-05-23
88362 OTHER Nerve Teasing Preparations 138 43 $7,586.55 $7,586.55 $53.25 $52,815.65 $7,586.55 2026-05-23
88319 OTHER Enzyme Histochemistry 134 43 $7,586.55 $7,586.55 $77.80 $52,815.65 $7,586.55 2026-05-23
89272 OTHER Extended Culture Of Oocytes 134 43 $7,586.55 $7,586.55 $77.80 $52,815.65 $7,586.55 2026-05-23
89258 OTHER Cryopreservation Embryo(s) 138 43 $7,586.55 $7,586.55 $77.80 $52,815.65 $7,586.55 2026-05-23
89280 OTHER Assist Oocyte Fertilization 138 43 $7,586.55 $7,586.55 $77.80 $52,815.65 $7,586.55 2026-05-23
86891 OTHER Autologous Blood Op Salvage 138 43 $7,586.55 $7,586.55 $77.80 $52,815.65 $7,586.55 2026-05-23
55513000601 OTHER Aranesp 138 43 $7,430.40 $7,430.40 $77.80 $52,815.65 $7,430.40 2026-05-23
55513002801 OTHER Aranesp 138 43 $7,430.40 $7,430.40 $77.80 $52,815.65 $7,430.40 2026-05-23
15275 OTHER Wc Apply High Cost Ss Foot 138 43 $7,332.00 $7,332.00 $77.80 $52,815.65 $7,332.00 2026-05-23
15271 OTHER Wc Apply High Cost Ss Leg 138 43 $7,332.00 $7,332.00 $77.80 $52,815.65 $7,332.00 2026-05-23
15115 OTHER Wc Epdrml Autogrft Ft 1st 100 138 43 $7,332.00 $7,332.00 $77.80 $52,815.65 $7,332.00 2026-05-23
15110 OTHER Wc Epdrml Autogrft Leg 1st 100 138 43 $7,332.00 $7,332.00 $77.80 $52,815.65 $7,332.00 2026-05-23
81249 OTHER G6pd Full Gene Sequence 140 44 $7,245.00 $7,245.00 $77.80 $56,554.95 $7,245.00 2026-05-23
81321 OTHER Pten Gene Full Sequence 140 44 $7,245.00 $7,245.00 $77.80 $52,815.65 $7,245.00 2026-05-23
81238 OTHER F9 Full Gene Sequence 140 44 $7,245.00 $7,245.00 $77.80 $56,554.95 $7,245.00 2026-05-23
81259 OTHER Hba1/hba2 Full Gene Sequence 140 44 $7,245.00 $7,245.00 $77.80 $52,815.65 $7,245.00 2026-05-23
81445 OTHER Targeted Genomic Seq Analys 140 44 $7,220.85 $7,220.85 $77.80 $52,815.65 $7,220.85 2026-05-23
81434 OTHER Hereditary Retinal Disorders 140 44 $7,220.85 $7,220.85 $77.80 $52,815.65 $7,220.85 2026-05-23
59676082001 OTHER Monovisc 138 43 $7,200.00 $7,200.00 $77.80 $52,815.65 $7,200.00 2026-05-23
9029703 OTHER Gelfilm 25x50mm 138 43 $7,140.96 $7,140.96 $77.80 $52,815.65 $7,140.96 2026-05-23
74485 OTHER Xr Dilation Urtr/urt Rs&i 138 43 $7,130.00 $7,130.00 $77.80 $52,815.65 $7,130.00 2026-05-23
81413 OTHER Car Ion Chnnlpath Inc 10 Gns 140 44 $7,062.15 $7,062.15 $77.80 $52,815.65 $7,062.15 2026-05-23
81435 OTHER Hereditary Colon Ca Dsordrs 140 44 $7,062.15 $7,062.15 $77.80 $52,815.65 $7,062.15 2026-05-23
81439 OTHER Hrdtry Cardmypy Gene Panel 140 44 $7,062.15 $7,062.15 $77.80 $52,815.65 $7,062.15 2026-05-23
81448 OTHER Hrdtry Perph Neurphy Panel 140 44 $7,062.15 $7,062.15 $77.80 $52,815.65 $7,062.15 2026-05-23
81414 OTHER Car Ion Chnnlpath Inc 2 Gns 140 44 $7,062.15 $7,062.15 $77.80 $52,815.65 $7,062.15 2026-05-23
81436 OTHER Hereditary Colon Ca Dsordrs 140 44 $7,062.15 $7,062.15 $77.80 $52,815.65 $7,062.15 2026-05-23
81164 OTHER Brca1&2 Gen Ful Dup/del Alys 140 44 $7,055.25 $7,055.25 $77.80 $52,815.65 $7,055.25 2026-05-23
80418 OTHER Pituitary Evaluation Panel 140 44 $6,996.60 $6,996.60 $77.80 $52,815.65 $6,996.60 2026-05-23
81535 OTHER Oncology Gynecologic 140 44 $6,996.60 $6,996.60 $77.80 $52,815.65 $6,996.60 2026-05-23
517065001 OTHER Injectafer 138 43 $6,862.56 $6,862.56 $77.80 $52,815.65 $6,862.56 2026-05-23
3218811 OTHER Orencia 138 43 $6,834.32 $6,834.32 $77.80 $52,815.65 $6,834.32 2026-05-23
13533080071 OTHER Gamunex-c 138 43 $6,804.00 $6,804.00 $10.74 $52,815.65 $6,804.00 2026-05-23
43231 OTHER Eso Flx W/end US Exm 138 43 $6,768.95 $6,768.95 $77.80 $52,815.65 $6,768.95 2026-05-23
43214 OTHER Eso Flx W/dil Balloon 30mm Dia 138 43 $6,768.95 $6,768.95 $77.80 $52,815.65 $6,768.95 2026-05-23
65162091322 OTHER Voriconazole Oral Susp (bulk) 138 43 $6,753.68 $6,753.68 $77.80 $52,815.65 $6,753.68 2026-05-23
4026129 OTHER Cellcept (160ml Bottle) 138 43 $6,628.18 $6,628.18 $77.80 $52,815.65 $6,628.18 2026-05-23
50484081015 OTHER Regranex 138 43 $6,526.56 $6,526.56 $77.80 $52,815.65 $6,526.56 2026-05-23
11044 OTHER Wc Debride Subq/musc/bone Bx/b 138 43 $6,511.00 $6,511.00 $77.80 $52,815.65 $6,511.00 2026-05-23
62935022305 OTHER Leuprolide Acetate 138 43 $6,504.34 $6,504.34 $77.80 $52,815.65 $6,504.34 2026-05-23
31623 OTHER Bronch W/brushing 138 43 $6,439.65 $6,439.65 $77.80 $52,815.65 $6,439.65 2026-05-23
31624 OTHER Bronch W/alveolar Lavage 138 43 $6,439.65 $6,439.65 $77.80 $52,815.65 $6,439.65 2026-05-23
81302 OTHER Mecp2 Gene Full Seq 140 44 $6,375.60 $6,375.60 $77.80 $52,815.65 $6,375.60 2026-05-23
31722062921 OTHER Atovaquone (Bulk Bottle) 138 43 $6,307.16 $6,307.16 $77.80 $52,815.65 $6,307.16 2026-05-23
55513022301 OTHER Romiplostim 138 43 $6,292.70 $6,292.70 $77.80 $52,815.65 $6,292.70 2026-05-23
78043561 OTHER Reclast 5 Mg 138 43 $6,283.44 $6,283.44 $77.80 $52,815.65 $6,283.44 2026-05-23
81504 OTHER Oncology Tissue Of Origin 140 44 $6,279.00 $6,279.00 $77.80 $52,815.65 $6,279.00 2026-05-23
23392102 OTHER Botox 138 43 $6,201.60 $6,201.60 $77.80 $52,815.65 $6,201.60 2026-05-23
81528 OTHER Oncology Colorectal Scr 140 44 $6,144.45 $6,144.45 $33.75 $52,815.65 $6,144.45 2026-05-23
78492 OTHER PET Mycard Rst/str 138 43 $6,105.70 $6,105.70 $77.80 $52,815.65 $6,105.70 2026-05-23
81410 OTHER Aortic Dysfunction/dilation 140 44 $6,085.80 $6,085.80 $77.80 $52,815.65 $6,085.80 2026-05-23
81223 OTHER Cftr Gene Full Sequence 140 44 $6,027.15 $6,027.15 $77.80 $56,554.95 $6,027.15 2026-05-23
44146 OTHER Colec Part W Colopros W/colost 138 43 $5,934.18 $5,934.18 $77.80 $52,815.65 $5,934.18 2026-05-23
50458030811 OTHER RisperDAL Consta 50 Mg 138 43 $5,900.21 $5,900.21 $77.80 $52,815.65 $5,900.21 2026-05-23
87903 OTHER Phenotype DNA HIV W/culture 138 43 $5,899.50 $5,899.50 $77.80 $52,815.65 $5,899.50 2026-05-23
59338077501 OTHER Feraheme 510 Mg 138 43 $5,729.38 $5,729.38 $77.80 $52,815.65 $5,729.38 2026-05-23
81163 OTHER Brca1&2 Gene Full Seq Alys 140 44 $5,651.10 $5,651.10 $77.80 $52,815.65 $5,651.10 2026-05-23
78459 OTHER PET Myocard Metabolic 138 43 $5,650.87 $5,650.87 $77.80 $52,815.65 $5,650.87 2026-05-23
43246 OTHER Peg 138 43 $5,606.25 $5,606.25 $77.80 $52,815.65 $5,606.25 2026-05-23
57894003001 OTHER Remicade 100 Mg 138 43 $5,605.54 $5,605.54 $77.80 $52,815.65 $5,605.54 2026-05-23
44208 OTHER Laparosc, Surg Colectomy, Part 138 43 $5,584.11 $5,584.11 $77.80 $52,815.65 $5,584.11 2026-05-23
55513002704 OTHER Aranesp 138 43 $5,572.80 $5,572.80 $77.80 $52,815.65 $5,572.80 2026-05-23
81226 OTHER Cyp2d6 Gene Com Variants 140 44 $5,444.10 $5,444.10 $77.80 $52,815.65 $5,444.10 2026-05-23
61958180101 OTHER Harvoni 138 43 $5,400.00 $5,400.00 $77.80 $52,815.65 $5,400.00 2026-05-23
944265603 OTHER Gammagard S-d 5 Gram 138 43 $5,382.24 $5,382.24 $77.80 $52,815.65 $5,382.24 2026-05-23
82154044901 OTHER Peginterferon Alfa-2a 138 43 $5,344.42 $5,344.42 $77.80 $52,815.65 $5,344.42 2026-05-23
81212 OTHER Brca1&2 185&5385&6174 Vrnt 140 44 $5,313.00 $5,313.00 $77.80 $52,815.65 $5,313.00 2026-05-23
81433 OTHER Hrdtry Brst Ca-rlatd Dsordrs 140 44 $5,299.20 $5,299.20 $77.80 $52,815.65 $5,299.20 2026-05-23
81437 OTHER Heredtry Nurondcrn Tum Dsrdr 140 44 $5,299.20 $5,299.20 $77.80 $52,815.65 $5,299.20 2026-05-23
81438 OTHER Heredtry Nurondcrn Tum Dsrdr 140 44 $5,299.20 $5,299.20 $77.80 $52,815.65 $5,299.20 2026-05-23
81222 OTHER Cftr Gene Dup/delet Variants 140 44 $5,254.35 $5,254.35 $77.80 $45,664.93 $5,254.35 2026-05-23
78812 OTHER PET Scan-skull To Thigh 138 43 $5,252.97 $5,252.97 $77.80 $45,664.93 $5,252.97 2026-05-23
78608 OTHER PET Brain Metab 138 43 $5,145.79 $5,145.79 $77.80 $45,664.93 $5,145.79 2026-05-23
59676034001 OTHER Procrit 138 43 $5,131.20 $5,131.20 $77.80 $45,664.93 $5,131.20 2026-05-23
78202 OTHER Nm Liver Imaging With Flow 138 43 $5,120.95 $5,120.95 $77.80 $45,664.93 $5,120.95 2026-05-23
78453 OTHER Nm Ht Muscle Image Planar Sing 138 43 $5,120.95 $5,120.95 $77.80 $45,664.93 $5,120.95 2026-05-23
78456 OTHER Nm Acute Venous Thrombus Image 138 43 $5,120.95 $5,120.95 $77.80 $45,664.93 $5,120.95 2026-05-23
78650 OTHER Nm Csf Leakage Imaging 138 43 $5,120.95 $5,120.95 $77.80 $45,664.93 $5,120.95 2026-05-23
78454 OTHER Nm Ht Musc Image Planar Mult 138 43 $5,120.95 $5,120.95 $77.80 $45,664.93 $5,120.95 2026-05-23
78804 OTHER Nm Rp Loclzj Tum Whbdy 2+d Img 138 43 $5,120.95 $5,120.95 $77.80 $45,664.93 $5,120.95 2026-05-23
78201 OTHER Nm Liver Imaging 138 43 $5,120.95 $5,120.95 $77.80 $45,664.93 $5,120.95 2026-05-23
78802 OTHER Nm Rp Loclzj Tum Whbdy 1 D Img 138 43 $5,120.95 $5,120.95 $77.80 $45,664.93 $5,120.95 2026-05-23
78110 OTHER Nm Plasma Volume Single 138 43 $5,120.95 $5,120.95 $77.80 $45,664.93 $5,120.95 2026-05-23
78457 OTHER Nm Venous Thrombosis Imaging 138 43 $5,120.95 $5,120.95 $77.80 $45,664.93 $5,120.95 2026-05-23
78111 OTHER Nm Plasma Volume Multiple 138 43 $5,120.95 $5,120.95 $77.80 $45,664.93 $5,120.95 2026-05-23
78075 OTHER Nm Adrenal Cortex & Medulla IM 138 43 $5,120.95 $5,120.95 $77.80 $45,664.93 $5,120.95 2026-05-23
78469 OTHER Nm Heart Infarct Image (3d) 138 43 $5,120.95 $5,120.95 $77.80 $45,664.93 $5,120.95 2026-05-23
78803 OTHER Nm Rp Loclzj Tum Spect 1 Area 138 43 $5,120.95 $5,120.95 $77.80 $45,664.93 $5,120.95 2026-05-23
87507 OTHER Iadna-dna/rna Probe Tq 12-25 138 43 $5,033.55 $5,033.55 $77.80 $45,664.93 $5,033.55 2026-05-23
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