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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

493,595 of 494,741 rate rows are consumer-grade (99.8%)

1,146 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
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 · 2026-08-12
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 nat. median
$100,000
1.0× median
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 nat. median
$82,421
1.1× median
1904
LOCAL 		Guillain-barr� M <38.50 None A 27 $64,096.45 $90,920.53 $67,562.23 nat. median
$64,096
1.1× median
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 nat. median
$66,348
1.0× median
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 nat. median
$65,386
1.0× median
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 nat. median
$64,772
1.0× median
81425
CPT 		Genome Sequence Analysis 33 $32,217.91 $60,751.05 $60,751.05 nat. median
$5,132
outlier · 11.8×
81415
CPT 		Exome Sequence Analysis 33 $7,062.15 $57,718.50 $57,718.50 nat. median
$4,923
outlier · 11.7×
106
LOCAL 		Stroke M <41.50 And A <84.50 None A 32 $54,555.30 $72,233.39 $57,246.90 nat. median
$57,247
1.0× median
505
LOCAL 		Non-traumatic Spinal Cord Injury M <39.50 None A 32 $50,772.64 $74,964.76 $55,097.10 nat. median
$55,097
1.0× median
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 nat. median
$47,248
1.1× median
205
LOCAL 		Traumatic Brain Injury M <35.50 None A 32 $46,184.73 $65,575.21 $51,531.90 nat. median
$2,527
outlier · 20.4×
55292070255
NDC 		Hemin For Injection 32 $51,333.70 $51,333.70 $51,333.70 nat. median
$18,308
outlier · 2.8×
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 nat. median
$50,653
1.0× median
105
LOCAL 		Stroke M <41.50 And A >=84.50 None A 32 $47,966.71 $63,507.43 $50,330.25 nat. median
$47,967
1.0× median
81521
CPT 		Onc Breast Mrna 70 Genes 33 $30,533.31 $46,768.20 $46,768.20 nat. median
$4,067
outlier · 11.5×
81541
CPT 		Onc Prostate Mrna 46 Genes 33 $310.50 $46,768.20 $46,768.20 nat. median
$4,067
outlier · 11.5×
81522
CPT 		Onc Breast Mrna 12 Genes 33 $872.85 $56,554.95 $46,768.20 nat. median
$4,067
outlier · 11.5×
81518
CPT 		Onc Brst Mrna 11 Genes 33 $172.50 $46,768.20 $46,768.20 nat. median
$4,067
outlier · 11.5×
81519
CPT 		Oncology Breast Mrna 33 $43,470.00 $56,554.95 $46,768.20 nat. median
$4,067
outlier · 11.5×
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 nat. median
$45,608
1.0× median
81540
CPT 		Oncology Tum Unknown Origin 33 $369.90 $56,554.95 $45,281.25 nat. median
$3,938
outlier · 11.5×
1004
LOCAL 		Amputation Lower Extremity M <47.50 Tier 1 B 32 $38,708.89 $57,189.74 $45,251.50 nat. median
$43,205
1.0× median
1903
LOCAL 		Guillain-barr� M >=38.50 And M <51.50 None A 32 $44,000.14 $62,416.37 $44,775.56 nat. median
$44,000
1.0× median
2102
LOCAL 		Burns M <52.50 Tier 2 C 32 $37,379.24 $57,599.82 $43,769.00 nat. median
$43,769
1.0× median
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 nat. median
$43,553
1.0× median
81545
CPT 		Oncology Thyroid 33 $49.85 $43,470.00 $43,470.00 nat. median
$3,063
outlier · 14.2×
604
LOCAL 		Neurological M <43.50 None A 32 $39,014.58 $61,894.45 $43,259.51 nat. median
$43,260
1.0× median
1504
LOCAL 		Pulmonary M <45.50 Tier 3 D 32 $40,361.63 $56,526.16 $43,147.67 nat. median
$43,148
1.0× median
1304
LOCAL 		Rheumatoid Other Arthritis M <44.50 And A >=64.50 None A 27 $39,079.20 $53,225.65 $43,007.25 nat. median
$42,007
1.0× median
704
LOCAL 		Fracture Of Lower Extremity M <41.50 None A 32 $39,158.73 $57,840.89 $42,384.68 nat. median
$2,406
outlier · 17.6×
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 nat. median
$40,227
1.0× median
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 nat. median
$41,878
1.0× median
1604
LOCAL 		Pain Syndrome M <43.50 None A 27 $36,258.36 $58,342.93 $41,251.37 nat. median
$39,169
1.1× median
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 nat. median
$3,062
outlier · 13.5×
2005
LOCAL 		Miscellaneous M <46.50 And A <77.50 None A 32 $37,493.56 $55,203.97 $41,191.72 nat. median
$41,192
1.0× median
2004
LOCAL 		Miscellaneous M <46.50 And A >=77.50 None A 32 $35,569.93 $52,373.19 $40,456.07 nat. median
$686
outlier · 58.9×
104
LOCAL 		Stroke M >=41.50 And M <50.50 None A 32 $38,358.46 $50,787.55 $40,249.79 nat. median
$38,358
1.0× median
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 nat. median
$40,068
1.0× median
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 nat. median
$39,974
1.0× median
1204
LOCAL 		Osteoarthritis M <49.50 And A <74.50 None A 27 $35,368.61 $54,271.97 $39,973.91 nat. median
$35,369
1.1× median
904
LOCAL 		Other Orthopedic M <44.5 None A 32 $36,355.29 $53,225.65 $39,735.32 nat. median
$2,705
outlier · 14.7×
59627033304
NDC 		Avonex Pen 30 mcg/0.5mL 32 $39,676.03 $39,676.03 $39,676.03 nat. median
$16,909
outlier · 2.3×
59627022205
NDC 		Avonex 32 $39,676.03 $39,676.03 $39,676.03 nat. median
$4,464
outlier · 8.9×
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 nat. median
$39,651
1.0× median
74368303
NDC 		Lupron Depot 32 $39,246.62 $39,246.62 $39,246.62 nat. median
$39,247
1.0× median
81595
CPT 		Cardiology Hrt Trnspl Mrna 33 $75.90 $56,554.95 $39,123.00 nat. median
$3,370
outlier · 11.6×
1404
LOCAL 		Cardiac M <45.50 None A 32 $35,942.72 $53,330.03 $39,061.80 nat. median
$1,325
outlier · 29.5×
204
LOCAL 		Traumatic Brain Injury M >=35.50 And M <49.50 None A 32 $36,057.05 $51,192.66 $38,296.32 nat. median
$38,296
1.0× median

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.

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
             
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
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
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
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
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
102 LOCAL Stroke M >=63.50 And M <72.50 Tier 3 D 188 32 $25,622.43 $25,622.43 $23,319.77 $30,875.15 $24,467.99 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
13533080071 NDC Gamunex-c 71 32 $6,804.00 $6,804.00 $10.74 $6,804.00 $6,804.00 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
173089201 NDC Mepolizumab Injection 71 32 $17,706.38 $17,706.38 $17,706.38 $17,706.38 $17,706.38 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
2144511 NDC Taltz Autoinjector 71 32 $33,195.46 $33,195.46 $5.00 $33,195.46 $33,195.46 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
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
24591401 NDC Dupixent Syringe 71 32 $9,127.68 $9,127.68 $237.34 $9,127.68 $9,127.68 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
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
2840001 NDC Forteo 71 32 $20,591.47 $20,591.47 $5.18 $20,591.47 $20,591.47 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
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
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
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
31600 CPT Percutaneous Tracheostomy 71 32 $11,022.90 $11,022.90 $11,022.90 $16,215.15 $11,022.90 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
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
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
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
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
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
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
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
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
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
3218811 NDC Orencia 71 32 $6,834.32 $6,834.32 $6,834.32 $6,834.32 $6,834.32 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
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
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
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
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
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
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
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
42367054032 NDC Ryanodex 71 32 $14,040.84 $14,040.84 $2,590.29 $14,040.84 $14,040.84 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
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
43246 CPT Peg 71 32 $5,606.25 $5,606.25 $5,584.11 $5,606.25 $5,606.25 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
44206043710 NDC Privigen 10% 71 32 $8,689.92 $8,689.92 $84.91 $8,689.92 $8,689.92 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
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
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
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
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
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
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
50458056001 NDC Invega Sustenna 71 32 $11,131.01 $11,131.01 $11,131.01 $11,131.01 $11,131.01 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
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
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
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
50458060901 NDC Invega Trinza 71 32 $19,046.87 $19,046.87 $19,046.87 $19,046.87 $19,046.87 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
50484081015 NDC Regranex 71 32 $6,526.56 $6,526.56 $105.89 $6,526.56 $6,526.56 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
50633012011 NDC Digifab 71 32 $22,958.40 $22,958.40 $22,958.40 $22,958.40 $22,958.40 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
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
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
55513000601 NDC Aranesp 71 32 $7,430.40 $7,430.40 $7,430.40 $7,430.40 $7,430.40 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
55513002801 NDC Aranesp 71 32 $7,430.40 $7,430.40 $7,430.40 $7,430.40 $7,430.40 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
55513011101 NDC Aranesp 71 32 $11,145.60 $11,145.60 $11,145.60 $11,145.60 $11,145.60 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
55513019201 NDC Neulasta Onpro 71 32 $30,806.35 $30,806.35 $30,806.35 $30,806.35 $30,806.35 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
55513022301 NDC Romiplostim 71 32 $6,292.70 $6,292.70 $6,292.70 $6,292.70 $6,292.70 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
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
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
57970010001 NDC Dalbavancin Hcl 71 32 $8,539.82 $8,539.82 $8,539.82 $8,539.82 $8,539.82 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
59148001971 NDC Abilify Maintena 71 32 $13,535.23 $13,535.23 $13,535.23 $13,535.23 $13,535.23 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
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
59338077501 NDC Feraheme 510 Mg 71 32 $5,729.38 $5,729.38 $521.60 $5,729.38 $5,729.38 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
59676034001 NDC Procrit 71 32 $5,131.20 $5,131.20 $5,131.20 $5,131.20 $5,131.20 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
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
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
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
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
61953000405 NDC Flebogamma Dif 71 32 $10,164.48 $10,164.48 $10,164.48 $10,164.48 $10,164.48 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
62935022305 NDC Leuprolide Acetate 71 32 $6,504.34 $6,504.34 $6,504.34 $6,504.34 $6,504.34 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
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
65757030001 NDC VivitroL 71 32 $7,877.33 $7,877.33 $1.50 $7,877.33 $7,877.33 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
67457083306 NDC Pegfilgrastim-jmdb 71 32 $10,020.00 $10,020.00 $10,020.00 $10,020.00 $10,020.00 2026-07-15
68875010201 NDC Gattex 71 32 $99,999.99 $99,999.99 $99,999.99 $99,999.99 $99,999.99 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
68982085004 NDC Octagam 71 32 $18,648.00 $18,648.00 $18,648.00 $18,648.00 $18,648.00 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
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
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
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
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
70539000102 NDC Tymlos 71 32 $12,801.60 $12,801.60 $102.10 $12,801.60 $12,801.60 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
74364203 NDC Lupron Depot 71 32 $9,811.68 $9,811.68 $22.68 $9,811.68 $9,811.68 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
74379902 NDC Humira 71 32 $16,614.29 $16,614.29 $16,614.29 $16,614.29 $16,614.29 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
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
78063998 NDC Cosentyx 71 32 $17,781.50 $17,781.50 $17,781.50 $17,781.50 $17,781.50 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
81440 CPT Mitochondrial Gene 72 33 $40,137.30 $40,137.30 $3,146.40 $40,137.30 $40,137.30 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
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
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
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
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
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
81460 CPT Whole Mitochondrial Genome 72 33 $15,542.25 $15,542.25 $669.30 $28,615.74 $15,542.25 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
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
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
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
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
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
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
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
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
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
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
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
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
81525 CPT Oncology Colon Mrna 72 33 $37,625.70 $37,625.70 $1.15 $39,296.80 $37,625.70 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
81535 CPT Oncology Gynecologic 72 33 $6,996.60 $6,996.60 $89.36 $30,533.31 $6,996.60 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
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
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
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
81545 CPT Oncology Thyroid 72 33 $43,470.00 $43,470.00 $49.85 $43,470.00 $43,470.00 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
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
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
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
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
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
88319 CPT Enzyme Histochemistry 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
88348 CPT Electron Microscopy 71 32 $7,586.55 $7,586.55 $62.10 $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
89258 CPT Cryopreservation Embryo(s) 71 32 $7,586.55 $7,586.55 $124.20 $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
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
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
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
9029703 NDC Gelfilm 25x50mm 71 32 $7,140.96 $7,140.96 $7,140.96 $7,140.96 $7,140.96 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
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
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
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
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
944270006 NDC Gammagard Liquid 71 32 $16,273.92 $16,273.92 $16,273.92 $16,273.92 $16,273.92 2026-07-15
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