BALLARD REHABILITATION HOSPITAL Hospital

Legal name: VIBRA HOSPITAL OF SAN BERNARDINO, LLC

SAN BERNARDINO, CA 924111160 (909) 473-1200 283X00000X

Published Procedure Prices

Procedure	CPT	Cash Price	Insurance Range
INF DISEASE 22 TGTS	0202U	$172	N/A
INF DNA/RN 21TGT SAR	0225U	$345	N/A
SVN SAR,ELISA,PL SER	0226U	$345	N/A
INF DIS PATH RNA 3TG	0240U	$443	N/A
INF DIS PATH RNA 4TG	0241U	$443	N/A
Pamidronate Disodium	03032	$198	N/A
metHOTREXate SODIUM	03035	$35	N/A
PT VIRTUAL GAIT TRN EA 15 MIN	0791T	$105	N/A
NEEDLE BIOPSY W US 1ST LESION	10005	$2,465	N/A
NEEDLE BIOP W/US EACH ADDL	10006	$198	N/A
WC DEBRIDE SUBQ BX/BS	11042	$1,486	N/A
WC DEBRIDE SUBQ/MUSC BX/BS	11043	$2,286	N/A
WC DEBRIDE SUBQ/MUSC/BONE BX/B	11044	$6,511	N/A
WC PUNCH BIOPSY	11104	$835	N/A
WC INCISION BIOPSY	11106	$1,486	N/A
WC DEBRIDEMENT NAILS 1-5	11720	$199	N/A
WC DEBRIDEMENT NAILS 6+	11721	$199	N/A
WC AVULSION NAIL	11730	$199	N/A
WC AVULSION NAIL EA ADDITIONAL	11732	$199	N/A
WC EXCSN NAIL MTRX PERMANENT	11750	$1,082	N/A
SMPL REP SUP WOUND 12.6 TO 20C	12005	$1,485	N/A
WC SCALP/TRUNK/LEG/ARM <2.5CM	12031	$1,486	N/A
WC SCALP/TRUNK/LEG/ARM 2.6-7.5	12032	$1,486	N/A
WC SCALP/TRUNK/LEG/AR 7.6-12.5	12034	$1,486	N/A
WC NECK/HANDS/FEET <2.5CM	12041	$1,486	N/A
WC NECK/HANDS/FEET 2.6-7.5CM	12042	$1,486	N/A
WC NECK/HANDS/FEET 7.6-12.5CM	12044	$2,286	N/A
WC FACE < 2.5CM	12051	$1,486	N/A
WC FACE 2.5-5.0 CM	12052	$1,486	N/A
WC FACE 5.1-7.5 CM	12053	$1,486	N/A

Prices shown are published rates from hospital chargemaster files and insurer rate data. Your actual cost depends on your insurance plan, deductible status, and services rendered.