Average Charges Billed to Insurance Companies
Effective 12/18. Prices are subject to change without notice.
Diagnostic Imaging (Xray/MRI), Laboratory Tests, Inpatient Room Rate and Surgery/Anesthesia Charges
| CHARGE DESCRIPTION | DEPARTMENT | RATE |
|---|---|---|
| Ultrasnd Guide Interscale | ANES | $603.64 |
| Ultrasnd Guide Needle Pla | ANES | $603.64 |
| Anesthesia 1st Hour | ANES | $1,091.09 |
| Anesthesia Ea Add 15 Min | ANES | $109.11 |
| Platelets, Pheresis, Lr | BB | $2,535.16 |
| Fresh Frozen Plasma/Unit | BB | $209.43 |
| Arc Blood / Prbc Lr | BB | $465.14 |
| Ekg | CARD | $123.50 |
| CT Abdomen W/O Contrast | CT | $1,444.25 |
| CT Neck Soft Tissue W/O Contrast | CT | $1,444.25 |
| CT Upper Extremity, Left, W/O Contrast | CT | $1,444.25 |
| CT Sinus/ Facial Bones W/O Contrast | CT | $1,444.25 |
| CT Upper Extremity, Left, W/ Contrast | CT | $1,444.25 |
| CT Upper Extremity, Right, W/ Contrast | CT | $1,444.25 |
| CT Lumbar Spine W/ Contrast | CT | $1,444.25 |
| CT Thoracic Spine W/ Contrast | CT | $1,444.25 |
| CT Temporal Bones/Orbits Bil W & W/O Con | CT | $1,920.85 |
| CT Lower Extremity, Right, W/ & W/O Cont | CT | $1,920.85 |
| CT Thoracic Spine W/ & W/O Contrast | CT | $1,920.85 |
| CT Lumbar Spine W/ & W/O Contrast | CT | $1,920.85 |
| CT Cervical Spine W/ & W/O Contrast | CT | $1,920.85 |
| CT Abdomen, W/ & W/O Contrast | CT | $1,920.85 |
| CT Chest, W/ & W/O Contrast | CT | $1,920.85 |
| CTA Chest W/ May Include W/O | CT | $2,501.30 |
| CTA Head W/ May Include W/O | CT | $2,501.30 |
| CTA Neck W/ May Include W/O | CT | $2,501.30 |
| CT Upper Extremity, Right, W/O Contrast | CT | $1,444.25 |
| CT Temporal Bones/Orbit Bil W/O Contrast | CT | $1,444.25 |
| CT Abdomen/Pelvis W/O Contrast | CT | $1,512.03 |
| CT Abdomen/Pelvis, W/ IV Contrast | CT | $2,338.52 |
| CT Brain, W/ & W/O Contrast | CT | $1,902.85 |
| CT Abdomen/Pelvis, W/ & W/O Contrast | CT | $2,607.07 |
| CT Chest, With IV Contrast | CT | $1,444.25 |
| CT Chest W/O Contrast | CT | $1,444.25 |
| CT Guided Needle Placement | CT | $1,980.73 |
| CT Pelvis W/O Contrast | CT | $1,444.25 |
| CT Thoracic Spine (Post Myelo) | CT | $1,980.73 |
| CT Thoracic Spine W/O Contrast | CT | $1,444.25 |
| CT Cervical Spine (Post Myelo) | CT | $1,980.73 |
| CT Brain W/O Contrast | CT | $1,444.25 |
| CT Lumbar Spine (Post Myelo) | CT | $1,980.73 |
| CT Lower Extremity, Right, W/O Contrast | CT | $1,444.25 |
| CT Cervical Spine W/O Contrast | CT | $1,444.25 |
| CT Lower Extremity, Left, W/O Contrast | CT | $1,444.25 |
| CT Lumbar Spine W/O Contrast | CT | $1,444.25 |
| IgE (Immunoglobulin E) | LAB | $60.96 |
| Complement, Total | LAB | $75.27 |
| Protein | LAB | $13.59 |
| Mitochondrial Ab | LAB | $117.19 |
| Amylase Serum | LAB | $65.82 |
| Anti-Dsdna | LAB | $139.50 |
| Anti-Smooth Muscle Ab | LAB | $122.43 |
| Lyme Disease Antibodies | LAB | $173.02 |
| Crystal (Fluid) | LAB | $72.62 |
| Dhea-Sulfate | LAB | $225.80 |
| Genital Culture | LAB | $87.43 |
| Lipase | LAB | $69.93 |
| Varicella Zoster IgG | LAB | $130.86 |
| Barbiturates | LAB | $46.74 |
| Cocaine/Metabolite | LAB | $38.01 |
| Csf Vdrl | LAB | $43.37 |
| Nicotine (Urine) | LAB | $75.96 |
| Cryptococcal Ag | LAB | $138.72 |
| Immunohistochem Ea, Morph | LAB | $495.39 |
| Anca | LAB | $61.47 |
| Nicotin- Metabolite Serum | LAB | $95.20 |
| Hla B27 | LAB | $255.49 |
| Shbg | LAB | $134.67 |
| Surgical Path Decal | LAB | $71.76 |
| Stain-Group I | LAB | $110.96 |
| Acute Hepatitis Panel | LAB | $483.69 |
| Albumin | LAB | $50.31 |
| Urine Albumin | LAB | $21.42 |
| Creatinine Ratio | LAB | $19.17 |
| Ferritin | LAB | $138.37 |
| Fsh | LAB | $188.75 |
| Fungus Id | LAB | $104.86 |
| Glucose | LAB | $39.82 |
| Igg Quant | LAB | $94.44 |
| Iron Binding . (Tibc) | LAB | $88.77 |
| Psa | LAB | $186.83 |
| Progesterone | LAB | $211.85 |
| Prolactin | LAB | $196.83 |
| Renal Function Panel | LAB | $88.21 |
| T3 Free | LAB | $172.09 |
| T4 | LAB | $69.86 |
| Testosterone Free | LAB | $258.61 |
| Amphetamine/Methamphe 1-2 | LAB | $63.45 |
| Csf Igg Quantive | LAB | $94.44 |
| Albumin (Csf) | LAB | $52.50 |
| Quantiferon Tb Test | LAB | $253.05 |
| Estrone | LAB | $83.16 |
| Body Fluid Protein | LAB | $44.64 |
| Body Fluid Glucose | LAB | $59.52 |
| Cortisol Plasma | LAB | $165.58 |
| Parathyroid Horm, Intact | LAB | $419.22 |
| Benzodiazepines;1-12 | LAB | $75.51 |
| Rheumatoid Factor; Quant | LAB | $57.68 |
| T4 Free Direct | LAB | $91.61 |
| Testosterone Total | LAB | $262.22 |
| Uric Acid | LAB | $45.92 |
| Vitamin B12 (Cobalamin) | LAB | $145.45 |
| Oligoclonal Banding (Csf) | LAB | $204.19 |
| Surgical Path Leveliii | LAB | $237.12 |
| Bilirubin Total | LAB | $50.94 |
| Body Fluid Cell Count | LAB | $55.98 |
| Wbc Count(Hematology) | LAB | $25.86 |
| Csf Glucose | LAB | $39.82 |
| Csf Cell Count | LAB | $55.98 |
| Csf Protein | LAB | $37.20 |
| Cannabinoids, natural | LAB | $46.77 |
| Ana | LAB | $122.72 |
| Bun | LAB | $40.03 |
| Estradiol | LAB | $283.83 |
| Hep B Surface Antibody | LAB | $109.11 |
| Acid Fast Bacilli Cult | LAB | $109.75 |
| Beta - Hcg: Serum Quant | LAB | $152.90 |
| Culture, Fungi | LAB | $141.70 |
| Liver Panel | LAB | $82.96 |
| Vancomycin | LAB | $137.66 |
| Arterial Puncture | LAB | $12.76 |
| Sgpt | LAB | $53.77 |
| Creatinine | LAB | $52.01 |
| Plt | LAB | $113.36 |
| Saccomanno Smear | LAB | $207.60 |
| Oxymorphone | LAB | $78.78 |
| Blood Gas I-Stat | LAB | $162.60 |
| Albumin 250ml 5% | LAB | $495.81 |
| Pregnancy Test(Serum) | LAB | $64.26 |
| Anaerobic Orgs. Id | LAB | $82.05 |
| Cbc With Manual Diff | LAB | $47.26 |
| Crp (Hs) | LAB | $141.70 |
| Hep B Surf. Ag | LAB | $104.93 |
| Hepatitis C Antibody | LAB | $144.96 |
| Lipid Panel | LAB | $136.10 |
| Vit D 25-Hydroxyl | LAB | $300.62 |
| Hiv-1 Antibodies | LAB | $141.70 |
| Surgical Path Level V | LAB | $366.73 |
| Tsh | LAB | $170.61 |
| Bleeding Time | LAB | $45.70 |
| Blood Culture | LAB | $104.86 |
| Sur(Immunocytochem) First | LAB | $99.87 |
| Crp | LAB | $21.12 |
| Opiates 1 Or More | LAB | $78.78 |
| Troponin I Istat | LAB | $99.90 |
| Hgb A1c | LAB | $98.63 |
| Surg Path Level Iv-Prosta | LAB | $237.12 |
| Coagulase Test | LAB | $51.37 |
| Surgical Path Level Iv | LAB | $237.12 |
| Drug Test Definit 1-7 Mcr | LAB | $116.31 |
| Aerobic Bact Id Except Ua | LAB | $82.05 |
| Sur(Immunocytochem) Addl | LAB | $99.87 |
| Sedimentation Rate | LAB | $36.00 |
| Sodium | LAB | $48.89 |
| Manual Diffential | LAB | $37.20 |
| Cult Bact Urine Routine | LAB | $81.97 |
| Hemogram With Platelets | LAB | $65.75 |
| Comp Test I.S. Technique | LAB | $212.55 |
| Comp. Test Antiglbn Tech | LAB | $191.30 |
| Comp. Test Incub. Techniq | LAB | $177.13 |
| Antibody Screen | LAB | $111.95 |
| Rho (D) | LAB | $73.69 |
| Blood Type; Abo | LAB | $30.33 |
| Antibiotic Sens Microtite | LAB | $87.78 |
| Drug Screen, Qualita, Mul | LAB | $296.88 |
| Potassium | LAB | $46.69 |
| Stone Analysis | LAB | $204.00 |
| Anaerobic Culture | LAB | $141.70 |
| Gram Stain | LAB | $43.37 |
| Aerobic Culture | LAB | $141.70 |
| Ptt | LAB | $60.94 |
| Ua Non-Auto W/Microscopy | LAB | $31.39 |
| Pregnancy Urine | LAB | $64.26 |
| Prothrombin Time | LAB | $39.89 |
| Urinalysis | LAB | $26.00 |
| Magnesium | LAB | $68.09 |
| Hematocrit | LAB | $24.09 |
| Hgb | LAB | $24.09 |
| Compreh Metab Panel | LAB | $141.70 |
| Cbc Auto Diff | LAB | $47.26 |
| Basic Metabolic | LAB | $86.02 |
| Venipuncture/Finger Stick | LAB | $21.26 |
| MRI Elbow Left W/O Contrast | MRI | $1,133.05 |
| MRI Humerus Right W/O Contrast | MRI | $1,133.05 |
| MRI Hand Right W/O Contrast | MRI | $1,133.05 |
| MRI Hand Left W/O Contrast | MRI | $1,133.05 |
| MRI Ankle Right W/O Contrast | MRI | $1,133.05 |
| MRI Foot Right W/O Contrast | MRI | $1,133.05 |
| MRI Foot Left W/ Contrast | MRI | $1,133.05 |
| MRI Humerus Right W/ & W/O Contrast | MRI | $1,506.96 |
| MRI Hand Left W/ & W/O Contrast | MRI | $1,506.96 |
| MRI Hip Left W/ & W/O Contrast | MRI | $1,506.96 |
| MRI Knee Right W/ & W/O Contrast | MRI | $1,506.96 |
| MRI Orbit/Face/ Neck W/O Contrast | MRI | $2,719.31 |
| MRI Chest W/O Contrast | MRI | $2,719.31 |
| MRI Lumbar Spine W/ Contrast | MRI | $2,719.31 |
| MRI Pelvis W/ Contrast | MRI | $2,719.31 |
| MRI Abdomen W/O Contrast | MRI | $2,719.31 |
| MRA Brain W/ Contrast | MRI | $2,719.31 |
| MRA Neck W/ Contrast | MRI | $2,719.31 |
| MRI Chest W/ & W/O Contrast | MRI | $3,616.68 |
| MRI Abdomen W/ & W/O Contrast | MRI | $3,616.68 |
| MRA Brain W/ & W/O Contrast | MRI | $3,616.68 |
| MRI Elbow Right W/O Contrast | MRI | $1,133.05 |
| MRI Wrist Right W/O Contrast | MRI | $1,133.05 |
| MRI Hip Right W/ & W/O Contrast | MRI | $1,506.96 |
| MRI Femur Left W/ & W/O Contrast | MRI | $1,506.96 |
| MRI Orbit/Face/Neck W/ & W/O Contrast | MRI | $3,616.68 |
| MRI Hip Right W/ Contrast | MRI | $1,133.05 |
| MRI Foot Left W/O Contrast | MRI | $1,133.05 |
| MRI Shoulder Right W/ Contrast | MRI | $1,133.05 |
| MRI Shoulder Left W/ Contrast | MRI | $1,133.05 |
| MRI Hip Left W/O Contrast | MRI | $1,133.05 |
| MRI Pelvis W/ & W/O Contrast | MRI | $3,616.68 |
| MRI Hip Right W/O Contrast | MRI | $1,133.05 |
| MRI Hip Left W/ Contrast | MRI | $1,133.05 |
| MRA Brain W/O Contrast | MRI | $2,719.31 |
| MRI Pelvis W/O Contrast | MRI | $2,719.31 |
| MRI Shoulder Left W/O Contrast | MRI | $1,133.05 |
| MRI Shoulder Right W/O Contrast | MRI | $1,133.05 |
| MRI Brain W/O Contrast | MRI | $2,719.31 |
| MRI Knee Left W/O Contrast | MRI | $1,133.05 |
| MRI Knee Right W/O Contrast | MRI | $1,133.05 |
| MRI Thoracic Spine W/ & W/O Contrast | MRI | $3,616.68 |
| MRI Thoracic Spine W/O Contrast | MRI | $2,719.31 |
| MRI Cervical Spine W/ & W/O Contrast | MRI | $3,616.68 |
| MRI Brain W/ & W/O Contrast | MRI | $3,918.49 |
| MRI Lumbar Spine W/ & W/O Contrast | MRI | $3,616.68 |
| MRI Cervical Spine W/O Contrast | MRI | $2,719.31 |
| MRI Lumbar Spine W/O Contrast | MRI | $2,719.31 |
| Myelogram Lumbar Spine, Different Physic | MYLO | $1,529.11 |
| Myelogram Thoracic Spine, Same Physician | MYLO | $1,679.52 |
| Myelogram Cervical/ Thoracic Spine, Same | MYLO | $1,679.52 |
| Myelogram Thoracic/ Lumbar Spine, Same P | MYLO | $1,679.52 |
| Myelogram Cerv/ Thor/ Lumb Spine Same P | MYLO | $1,679.52 |
| Myelogram Cervical/ Lumbar Spine, Same P | MYLO | $1,679.52 |
| Myelogram Cervical Spine, Same Physician | MYLO | $1,679.52 |
| Myelogram Lumbar Spine, Same Physician | MYLO | $1,679.52 |
| Iv Infus > 8 Hrs Portable/Implant Pump | NUR | $760.89 |
| Iv Push Ea Add Seq New Rx | NUR | $62.17 |
| Ther/Pro/Dx Ivp Sgl/Initi | NUR | $62.17 |
| Observation 1st Hr | NUR | $250.00 |
| Iv Push Ea Add Seq Sam Rx | NUR | $62.17 |
| Adm Influenza Vaccine | NUR | $162.60 |
| Obs Sub Day Add Hr | NUR | $41.25 |
| Obs 1st Day @ Add Hr | NUR | $41.25 |
| Adm Pneumococal Vaccine | NUR | $162.60 |
| Cpm Daily Charge | NUR | $75.00 |
| Foot Pump Daily | NUR | $45.90 |
| Pca Pump Daily | NUR | $56.95 |
| Iv Pump Daily | NUR | $22.62 |
| Med/Surg Private Room | NUR | $990.00 |
| Scd Pump Daily | NUR | $45.90 |
| Ot Eval, Mod Complexity | OT | $327.33 |
| Ot Eval, Low Complexity | OT | $297.57 |
| Aspiration Facet Joint Synovial Cyst | PAIN | $384.99 |
| Brachial Plexus | PAIN | $1,476.69 |
| Carpal Tunnel Inj Single | PAIN | $693.00 |
| Cervical Plexus Injection | PAIN | $1,482.84 |
| Destruct Neur Agt 2/3 Foramen Oval_Monit | PAIN | $4,394.94 |
| Intermed Jnt/Bursa Wo Us | PAIN | $384.99 |
| Intralesional < 7 Lesions | PAIN | $136.43 |
| Iv Push Ea Add Seq New Rx | PAIN | $62.17 |
| Liolinguinal Block | PAIN | $1,051.11 |
| Ppump Analysis Only | PAIN | $383.50 |
| Prudendal Nerve Block | PAIN | $1,051.11 |
| Single Inj/Baclofen W Image Guide | PAIN | $1,062.60 |
| Single Inj/Baclofen W/O Image Guide | PAIN | $1,062.60 |
| Snrb L/S Ea Add Lvl #1 | PAIN | $350.37 |
| Spinal Punct Lumb Diag | PAIN | $2,452.74 |
| Stim Trial Lead Revision | PAIN | $630.12 |
| Coccyx Injection | PAIN | $401.93 |
| Erector Spinae Plane Block | PAIN | $384.99 |
| RFA Trigeminal Nerv | PAIN | $1,834.20 |
| Sclatic Block | PAIN | $1,051.11 |
| Simple Ns Prog 1st Hour | PAIN | $229.48 |
| Stellate Gang (Cerv Symp) | PAIN | $1,051.11 |
| Celiac Piexus | PAIN | $1,476.69 |
| Femoral Nerve Block | PAIN | $1,051.11 |
| Intercostal, Multiple | PAIN | $1,051.11 |
| RFA Intercostal Nerve | PAIN | $1,476.69 |
| Seroma Aspiration | PAIN | $260.00 |
| Snrb L/S Single | PAIN | $1,051.11 |
| Transforaminal C/T Single | PAIN | $1,051.11 |
| 1 Ld Stim Trial Time 15 M | PAIN | $1,137.50 |
| Facet/MBNB C/T 3rd & add?l level(s) | PAIN | $492.25 |
| Ganglion Impar Symp Block | PAIN | $401.93 |
| Lumbar (Paravertebrl Sym) | PAIN | $1,051.11 |
| Major Joint/Bursa W/Ultrasound | PAIN | $602.88 |
| 1 Ld Stim Trial 1st 1/2 H | PAIN | $12,675.00 |
| Ppump Reprog W/ Analy | PAIN | $383.50 |
| Botox Inj Facial Cerv Bil | PAIN | $401.93 |
| Injection Hip Arthrogram | PAIN | $571.00 |
| Injection Shoulder Arthrogram | PAIN | $571.00 |
| Iv Inf Ther/Prop Ea Add | PAIN | $15.00 |
| Side Port Study Pain Mgmt | PAIN | $322.29 |
| Axillary Nerve Block | PAIN | $1,051.11 |
| Botox Injection-Cervical | PAIN | $401.93 |
| Trigeminat, Any Branch | PAIN | $384.99 |
| Cons Sedation Same Phy Add'L 15 Min | PAIN | $75.00 |
| Epidural Blood Patch | PAIN | $937.60 |
| Piriformis Block | PAIN | $1,051.11 |
| E & M Est Outpt - Detailed | PAIN | $192.00 |
| 2ld Stim Trial Time 15 Mi | PAIN | $2,275.00 |
| Ther/Pro/Dx Ivp Sgl/Initi | PAIN | $62.17 |
| Tpi, 3 Muscles #sites() | PAIN | $384.99 |
| Tendon Sheath Inj, Ligament | PAIN | $384.99 |
| Facet/MBNB L/S 3rd & add?l level(s) | PAIN | $492.25 |
| E & M Est Outpt - Expanded | PAIN | $162.00 |
| Interscalene Block | PAIN | $1,476.69 |
| Iv Inf Ther/Prop Ini 1 Hr | PAIN | $157.00 |
| Greater Occipital | PAIN | $602.88 |
| Epidural Steroid Inj W/Imag Guide Thor | PAIN | $1,062.60 |
| E & M Est Outpt - Focused | PAIN | $123.00 |
| Trnsfrmnl L/S Ea Add Lvl1 | PAIN | $350.37 |
| Epidural Steroid Inj W/Imag Guide Caudl | PAIN | $1,062.60 |
| Tpi, 1-2 Muscles #sites() | PAIN | $384.99 |
| Rfa Periph Nerv/Si Joint | PAIN | $1,476.69 |
| Facet/MBNB C/T 2nd level | PAIN | $492.25 |
| Discogram, Lumbar Rad Supervision Interp | PAIN | $4,355.03 |
| Omnipaque 240/20ML / ML | PAIN | $7.50 |
| Rfa Facet Cerv/Thor Singl | PAIN | $2,501.37 |
| Injection, Discogram Lumbar Ea Level | PAIN | $1,170.00 |
| Rfa Facet Cerv/Thor Ea Ad | PAIN | $880.00 |
| Omnipague 300/10ML / ML | PAIN | $7.50 |
| Sacroixac Joint Inj | PAIN | $2,301.65 |
| E & M Est Outpt - Minimal | PAIN | $114.65 |
| Facet/MBNB C/T single | PAIN | $1,476.69 |
| 2ld Stim Trial 1st 1/2 Hr | PAIN | $18,460.00 |
| Ppump Refill/Reprog Phys | PAIN | $767.00 |
| Major Joint/Bursa W/O Us | PAIN | $602.88 |
| Rfa Factet Lumbar Single | PAIN | $2,501.37 |
| Facet/MBNB L/S 2nd level | PAIN | $492.25 |
| Rfa Facet Lumbar Ea Addl | PAIN | $880.00 |
| Epidural Steroid Inj W/Imag Guide Cerv | PAIN | $1,062.60 |
| Facet/MBNB L/S single | PAIN | $1,476.69 |
| Transforaminal L/S Single | PAIN | $1,051.11 |
| Othr Peripheral Nrv Blck | PAIN | $401.93 |
| Cons Sedation Same Phy 5y 1st 15 Min | PAIN | $227.50 |
| Epidural Steroid Inj W/Imag Guide Lmbr | PAIN | $1,062.60 |
| Celiac Plexus Inj | PCTR | $2,299.80 |
| Conscious Sedation Same Phy 5y 1st 15min | PCTR | $257.58 |
| Office/Outpt High Complexity, New | PCTR | $449.38 |
| Paravertebral Facet W/Imag L/S 3+ Lev | PCTR | $621.30 |
| Sciatic Nerve Inj Single | PCTR | $1,825.57 |
| Spin/Brain Pump Refill/Main Req Skill Ph | PCTR | $847.70 |
| Tendon Sheath Inj, Ligament | PCTR | $846.80 |
| Tobacco Cessation Counseling <3 min to 1 | PCTR | $55.88 |
| Transforaminal Epid W Imag Gui C/T Addl | PCTR | $505.60 |
| Nurse Visit | PCTR | $140.54 |
| Us Guid Needle Plcmt Imag Superv/Interpr | PCTR | $747.42 |
| Office/Outpt Problem Focused, New | PCTR | $174.32 |
| Pudendal Nerve Injection | PCTR | $2,249.39 |
| Single Tendon Origin/Insertion | PCTR | $828.14 |
| Intercostal Nerve Inj Single | PCTR | $1,813.44 |
| Ilioinguinal, Iliohypogastric Nerves Inj | PCTR | $1,876.97 |
| Aspirat/Inj Intermed Joint/Bursa W/O Us | PCTR | $841.58 |
| Discogram, Lumbar Rad Supervisio/Interpr | PCTR | $5,339.70 |
| Inject For Discography Ea Level, Lumbar | PCTR | $1,588.10 |
| Greater Occipital Nerve Inj | PCTR | $901.33 |
| Perc Implant Neurostim Electrode, Epid | PCTR | $9,838.41 |
| Stellate Ganglion Inj | PCTR | $2,255.20 |
| Ther/Proph Dx Ing/Sub/Im | PCTR | $232.58 |
| Paravertebral Facet W/Imag C/T 3+ Lev | PCTR | $641.93 |
| Paravertebral Sympathetic Inj Lum/Thor | PCTR | $2,273.70 |
| Transforaminal Epid W Imag Gui C/T, Sgl | PCTR | $2,396.75 |
| Transforaminal Epid W Imag Gui L/S Addl | PCTR | $478.05 |
| Office/Outpt Moerate Complexity, New | PCTR | $373.52 |
| Intercostal Nerve Inj Multiple | PCTR | $2,301.20 |
| Rfa Intercostal Nerve | PCTR | $2,597.54 |
| Trigger Point Inj 1-2 Muscles | PCTR | $843.28 |
| Pump Reprog W/Analysis | PCTR | $907.15 |
| Rfa Facet Cerv/Thor Ea Addl | PCTR | $1,047.88 |
| Fluoroguide For Spine/Therapeu Inject | PCTR | $824.14 |
| Rfa Peripheral Nerve/Si Joint | PCTR | $2,300.85 |
| Sacroiliac Joint Inj | PCTR | $955.53 |
| Office/Outpt Expand Problem Foc, New | PCTR | $220.36 |
| Fluoroguide Needle Plcmt | PCTR | $820.97 |
| Aspirat/Inj Major Joint/Bursa W/O Us | PCTR | $862.70 |
| Paravertebral Facet W/Imag C/T 2 Lev | PCTR | $640.30 |
| Rfa Facet Lumbar Ea Addl | PCTR | $1,026.68 |
| Rfa Facet Lumbar Sgl | PCTR | $5,624.64 |
| Rfa Facet Cerv/Thor Sgl | PCTR | $5,632.22 |
| Trigger Point Inj 3+ Muscles | PCTR | $856.00 |
| Other Peripheral Nerve Branch Inj | PCTR | $1,772.66 |
| Paravertebral Facet W/Imag L/S 2 Lev | PCTR | $619.68 |
| Paravertebral Facet W/Imag L/S 1 Lev | PCTR | $2,297.67 |
| Transforaminal Epid W Imag Gui L/S, Sgl | PCTR | $2,350.00 |
| Office/Outpt Expand Problem Foc Estab | PCTR | $171.90 |
| Office/Outpt Problem Focused, Establish | PCTR | $140.54 |
| Paravertebral Facet W/Imag C/T 1 Lev | PCTR | $2,336.07 |
| Office/Outpt Low Complexity, New | PCTR | $270.46 |
| Office/Outpt Moderate Complexity, Estab | PCTR | $275.22 |
| Epidural Steroid Inj/W Imag Gu Cerv/Thor | PCTR | $1,916.84 |
| Epidural Steroid Inj/W Imag Guid Lumbar | PCTR | $1,893.77 |
| Office/Outpt Low Complexity, Establish | PCTR | $221.48 |
| Abdominal Wound Pocket Revision | PCTR - HSP | $229.55 |
| Destruct Neur Agt 2/3 Foramen Oval_Monit | PCTR - HSP | $1,155.23 |
| Hospital Discharge Day Management | PCTR - HSP | $142.06 |
| Intralesional < 7 Lesions | PCTR - HSP | $76.10 |
| Ppump Analysis Only | PCTR - HSP | $62.38 |
| Removal Spinal Neuro Stim Electrode Perc | PCTR - HSP | $784.08 |
| Removal Subcutaneous Reservoir/Pump Intr | PCTR - HSP | $708.25 |
| Simple Ns Prog 1st Hour | PCTR - HSP | $100.30 |
| Stim Trial Lead Revision | PCTR - HSP | $170.55 |
| Carpal Tunnel Injection | PCTR - HSP | $139.08 |
| Fluoroguide Needle Plcmt | PCTR - HSP | $217.33 |
| Implant Neurostimulator Elect Array Perc | PCTR - HSP | $826.60 |
| Intercostal Nerve Inj Single | PCTR - HSP | $165.08 |
| Office/Outpt Problem Focused, New | PCTR - HSP | $51.72 |
| Revise/Remove Spine Neuro Stim Gen/ Rec | PCTR - HSP | $888.13 |
| RFA Trigeminal Nerv | PCTR - HSP | $542.23 |
| Pudendal Nerve Injection | PCTR - HSP | $198.43 |
| Single Tendon Origin/Insertion | PCTR - HSP | $104.73 |
| Stellate Ganglion Inj | PCTR - HSP | $178.68 |
| Tendon Sheath Inj, Ligament | PCTR - HSP | $96.05 |
| Aspirat/Inj Small Joint/Bursa W/O Us | PCTR - HSP | $86.83 |
| Ganglion Impar Symp Block | PCTR - HSP | $170.55 |
| Ilioinguinal, Iliohypogastric Nerves Inj | PCTR - HSP | $228.60 |
| Major Joint/Bursa W/Ultrasound | PCTR - HSP | $149.38 |
| Perc Vertebral Augmentation T/L Ea Addl | PCTR - HSP | $545.88 |
| Perc Vertebral Augmentation, Lumbar | PCTR - HSP | $1,174.78 |
| Seroma Aspiration | PCTR - HSP | $229.55 |
| Aspirat/Inj Intermed Joint/Bursa W/O Us | PCTR - HSP | $90.83 |
| Celiac Plexus Inj | PCTR - HSP | $223.28 |
| Transforaminal Epid W Imag Gui C/T, Sgl | PCTR - HSP | $320.23 |
| Sciatic Nerve Inj Single | PCTR - HSP | $177.20 |
| Botox Inj Facial Cerv Bil | PCTR - HSP | $294.63 |
| RFA Intercostal Nerve | PCTR - HSP | $412.95 |
| Chemodenervation Musc Neck Dystonia | PCTR - HSP | $259.08 |
| Trigeminal Nerve Inj, Any Branch | PCTR - HSP | $170.55 |
| Perc Vertebral Augmentation, Thoracic | PCTR - HSP | $1,262.35 |
| Office/Outpt Moerate Complexity, New | PCTR - HSP | $250.92 |
| Pump Reprog W/Analysis | PCTR - HSP | $86.10 |
| Epidural Blood Patch Inj | PCTR - HSP | $278.65 |
| Implant/Revise Of Cath Via Pump wo Lami | PCTR - HSP | $960.78 |
| Paravertebral Sympathetic Inj Lum/Thor | PCTR - HSP | $197.18 |
| Implant/Replace Dev Program Inc Prepare | PCTR - HSP | $920.78 |
| Paravertebral Facet W/Imag C/T 3+ Lev | PCTR - HSP | $149.68 |
| Discogram, Lumbar Rad Supervisio/Interpr | PCTR - HSP | $105.58 |
| Intercostal Nerve Inj Multiple | PCTR - HSP | $224.68 |
| Office/Outpt Expand Problem Foc, New | PCTR - HSP | $97.76 |
| Greater Occipital Nerve Inj | PCTR - HSP | $150.58 |
| Paravertebral Facet W/Imag L/S 3+ Lev | PCTR - HSP | $129.05 |
| Laminectomy Implant Neurostim Elect Plat | PCTR - HSP | $1,964.25 |
| Transforaminal Epid W Imag Gui L/S Addl | PCTR - HSP | $127.68 |
| Trigger Point Inj 1-2 Muscles | PCTR - HSP | $92.53 |
| Insrt/Redo Spine Neuro Stim Generator | PCTR - HSP | $874.10 |
| Rfa Facet Cerv/Thor Ea Addl | PCTR - HSP | $167.88 |
| Inject For Discography Ea Level, Lumbar | PCTR - HSP | $418.10 |
| Trigger Point Inj 3+ Muscles | PCTR - HSP | $105.25 |
| Rfa Peripheral Nerve/Si Joint | PCTR - HSP | $224.33 |
| Paravertebral Facet W/Imag C/T 2 Lev | PCTR - HSP | $148.05 |
| Rfa Facet Cerv/Thor Sgl | PCTR - HSP | $551.10 |
| Anl Sp Inf Pmp W/Mdreprg & Fil | PCTR - HSP | $113.83 |
| Office/Outpt Problem Focused, Establish | PCTR - HSP | $17.94 |
| Aspirat/Inj Major Joint/Bursa W/O Us | PCTR - HSP | $111.95 |
| Office/Outpt Low Complexity, New | PCTR - HSP | $147.86 |
| Sacroiliac Joint Inj | PCTR - HSP | $204.78 |
| Rfa Facet Lumbar Sgl | PCTR - HSP | $543.53 |
| Other Peripheral Nerve Branch Inj | PCTR - HSP | $124.29 |
| Office/Outpt Expand Problem Foc Estab | PCTR - HSP | $49.30 |
| Perc Implant Neurostim Electrode, Epid | PCTR - HSP | $1,005.20 |
| Rfa Facet Lumbar Ea Addl | PCTR - HSP | $146.68 |
| Paravertebral Facet W/Imag C/T 1 Lev | PCTR - HSP | $259.55 |
| Office/Outpt Moderate Complexity, Estab | PCTR - HSP | $152.62 |
| Paravertebral Facet W/Imag L/S 2 Lev | PCTR - HSP | $127.43 |
| Paravertebral Facet W/Imag L/S 1 Lev | PCTR - HSP | $221.15 |
| Conscious Sedation Same Phy 5y 1st 15min | PCTR - HSP | $30.08 |
| Epidural Steroid Inj/W Imag Gu Cerv/Thor | PCTR - HSP | $268.48 |
| Transforaminal Epid W Imag Gui L/S, Sgl | PCTR - HSP | $273.48 |
| Office/Outpt Low Complexity, Establish | PCTR - HSP | $98.88 |
| Epidural Steroid Inj/W Imag Guid Lumbar | PCTR - HSP | $245.40 |
| Extend Care Op Rad 1st Hr | PPOP | $195.00 |
| Extend Care Op Rad Ea Add | PPOP | $65.00 |
| Extended Recovery Rm 1 Hr | PPOP | $195.00 |
| Recovery Room 1st Hour | PPOP | $390.00 |
| Recovery Rm Ea Add 15 Min | PPOP | $39.00 |
| Extended Rec Rm Ea Add Hr | PPOP | $65.00 |
| Pt Crutch Training 1/4 Hr | PT | $73.69 |
| Pt Re-Evaluation | PT | $144.76 |
| Pt Eval, Mod Complexity | PT | $327.33 |
| Ot Ther Exercise 1/4 Hour | PT | $73.69 |
| Ot Adl Training 1/4 Hour | PT | $73.69 |
| Pt Gait Training 1/4 Hour | PT | $73.69 |
| Pt Ther Exercise 1/4 Hour | PT | $73.69 |
| Therapeutic Activ, 15 Min | PT | $105.33 |
| Pt Eval, Low Complexity | PT | $297.57 |
| XR Clavicle Left | RAD | $332.05 |
| XR Elbow Left 3 Views | RAD | $332.05 |
| XR Elbow Right 3 Views | RAD | $332.05 |
| XR Forearm Left 2 Views | RAD | $332.05 |
| XR Forearm Right 2 Views | RAD | $332.05 |
| XR Humerus Left 2+ Views | RAD | $332.05 |
| XR Humerus Right 2+ Views | RAD | $332.05 |
| XR Ribs Right W/ PA Chest 3+ Views | RAD | $332.05 |
| XR Tibia Fibula Right | RAD | $332.05 |
| XR Wrist Right 3+ Views | RAD | $332.05 |
| XR Elbow Right 2 Views | RAD | $332.05 |
| XR Foot Left 2 Views | RAD | $332.05 |
| XR Foot Right 2 Views | RAD | $332.05 |
| XR Hand Right 2 Views | RAD | $332.05 |
| XR Ribs Uniliateral 1 View LT-Mod 52 | RAD | $340.08 |
| XR Ribs Unilateral 1 View RT-Mod 52 | RAD | $340.08 |
| XR Hips Bilateral 3-4view May Inc Pelvis | RAD | $562.66 |
| XR Abdomen 3 + View | RAD | $332.05 |
| XR Foot Right 3 Views | RAD | $332.05 |
| XR Knee Left 4+ Views | RAD | $332.05 |
| XR Wrist Left 3+ Views | RAD | $332.05 |
| XR Ankle Right 2 Views | RAD | $332.05 |
| XR Clavicle Right | RAD | $332.05 |
| XR Hand Right 3 Views | RAD | $332.05 |
| XR Elbow Left 2 Views | RAD | $332.05 |
| XR Knee Right 4+ Views | RAD | $261.60 |
| XR Abdomen 2 view | RAD | $332.05 |
| XR Foot Left 3 Views | RAD | $332.05 |
| XR Wrist Left 2 Views | RAD | $332.05 |
| XR Sacroiliac Joints 3+ Views | RAD | $332.05 |
| XR Hand Left 3 Views | RAD | $332.05 |
| XR Knee Right 3 Views | RAD | $332.05 |
| XR Ankle Left 3 Views | RAD | $332.05 |
| XR Ankle Right 3 Views | RAD | $332.05 |
| XR Knee Left 3 Views | RAD | $332.05 |
| XR Eye Exam For Foreign Body | RAD | $332.05 |
| XR Knee 1-2 Views Bilateral | RAD | $332.05 |
| XR Hip Left 2-3 Views May Inc Pelvis | RAD | $332.05 |
| XR Thoracic Spine 3 Views | RAD | $332.05 |
| XR Ribs Unilateral 2 Views | RAD | $261.60 |
| XR Skull 1-3 Views | RAD | $332.05 |
| XR Shoulder Left 2+ Views | RAD | $332.05 |
| XR Wrist Right 2 Views | RAD | $332.05 |
| XR Hip Right 2-3 Views May Inc Pelvis | RAD | $332.05 |
| XR L-Spine 1 View - Addl 3 | RAD | $332.05 |
| XR Sacrum Coccyx 1 View | RAD | $332.05 |
| XR Thoracolumbar 1 View | RAD | $332.05 |
| XR Cervical Spine 6+ Views | RAD | $560.74 |
| XR Shoulder Right 2+ Views | RAD | $332.05 |
| XR Shoulder Right 1 View | RAD | $332.05 |
| XR Shoulder Left 1 View | RAD | $332.05 |
| XR Thoracic Spine 4+ Views | RAD | $332.05 |
| XR Ribs Uniliateral 1 View | RAD | $340.08 |
| XR Thoracolumbar 2+ Views | RAD | $332.05 |
| XR Lumbar Spine 6+ Views | RAD | $560.74 |
| XR Chest, 2 Views | RAD | $332.05 |
| XR Chest, 1 View | RAD | $332.05 |
| XR Cervical Spine 4+ Views | RAD | $560.74 |
| XR Hips Bilateral 2 Views May Inc Pelvis | RAD | $562.66 |
| XR Abdomen 1 view | RAD | $332.05 |
| XR Hip Left 1 View May Include Pelvis | RAD | $332.05 |
| XR Sacrum Coccyx 2+ Views | RAD | $332.05 |
| XR Hip Right 1 View May Include Pelvis | RAD | $332.05 |
| XR Sacroiliac Joints 1-2 Views | RAD | $332.05 |
| XR C-Spine 1 View - Addl 3 | RAD | $332.05 |
| XR Pelvis 1-2 Views | RAD | $332.05 |
| XR Thoracic Spine 2 Views | RAD | $332.05 |
| XR Lumbar Spine 4+ Views | RAD | $560.74 |
| XR Knee Right 1-2 Views | RAD | $332.05 |
| XR Knee Left 1-2 Views | RAD | $332.05 |
| XR Thoracic Spine 1 View | RAD | $332.05 |
| XR L-Spine 1 View - Addl 2 | RAD | $332.05 |
| XR C-Spine 1 View - Addl 2 | RAD | $332.05 |
| XR Cervical Spine 2-3 Views | RAD | $332.05 |
| XR Cervical Spine 1 View | RAD | $332.05 |
| XR Lumbar Spine 1 View | RAD | $332.05 |
| XR Lumbar Spine 2-3 Views | RAD | $332.05 |
| Fluoro Guided Needle Placement | RADF | $603.64 |
| Fluoro Guidance & Localization | RADF | $603.64 |
| Fluoro 1st Hour | RADF | $603.64 |
| Conscious Sedation 1st 15 Minutes | RADN | $227.50 |
| E & M Outpatient Focused | RADN | $123.00 |
| E & M Outpatient Expanded | RADN | $162.00 |
| E & M Outpatient Detailed | RADN | $192.00 |
| Conscious Sedation Each Add. 15 Minutes | RADN | $75.00 |
| E & M Outpatient Minimal | RADN | $114.65 |
| US Retroperitoneal Real Time w Image Do | RADP | $312.30 |
| Ultrasound, breast, unilateral complete | RADP | $324.03 |
| Flex Endoscop Eval Swallow Cine or Video | RADP | $199.86 |
| Venous Doppler Bilateral | RADP | $1,046.29 |
| Venous Doppler Right | RADP | $1,046.29 |
| Lumbar Puncture Diagnostic | RADP | $2,250.22 |
| Venous Doppler Left | RADP | $1,046.29 |
| Injection Shoulder Arthrogram | RADP | $571.00 |
| Injection Hip Arthrogram | RADP | $571.00 |
| Lumbar Puncture Theraputic | RADP | $2,250.22 |
| Fine Needle Aspiration W/ Imaging | RADP | $982.86 |
| Retrograde Pyelogram | RADP | $1,149.12 |
| Omniscan 5ML / ML | RADS | $7.50 |
| Gadavist (100) Injection, 0.1 ml | RADS | $3.36 |
| Vpaq 320/150ml / Ml | RADS | $7.50 |
| Gadavist (75) Injection, 0.1ml | RADS | $3.69 |
| Omnip 350/100ML / ML | RADS | $7.50 |
| Omnip 300/10ML / ML | RADS | $7.50 |
| Vpaq 320/100ml / Ml | RADS | $7.50 |
| Omnip 240/20ML / ML | RADS | $7.50 |
| Omniscan 20ML / ML | RADS | $7.50 |
| OR Level 1 First 30 Min | SURG | $2,125.50 |
| OR Level 1 Ea Add 15 Min | SURG | $531.38 |
| OR Level 2 1st 30 Minutes | SURG | $2,834.00 |
| OR Level 2 Ea Add 15 Min | SURG | $637.65 |
| OR Level 3 First 30 Min | SURG | $3,542.50 |
| OR Level 3 Ea Add 15 Min | SURG | $708.50 |
| OR Level 4 1st 30 Min | SURG | $3,542.50 |
| OR Level 4 Ea Add 15 Min | SURG | $708.50 |
| OR Level 5 1st 30 Min | SURG | $4,251.00 |
| OR Level 5 Ea Add 15 Min | SURG | $708.50 |
| OR Level 6 1st 30 Min | SURG | $4,251.00 |
| OR Level 6 Ea Add 15 Min | SURG | $850.20 |
| OR Level 7 1st 30 Min | SURG | $4,959.50 |
| OR Level 7 Ea Add 15 Min | SURG | $991.90 |
| OR Level 8 1st 30 Min | SURG | $4,959.50 |
| OR Level 8 Ea Add 15 Min | SURG | $991.90 |
| OR Level 9 1st 30 Min | SURG | $5,668.00 |
| OR Level 9 Ea Add 15 Min | SURG | $1,027.33 |
| OR Level 10 1st 30 Min | SURG | $6,376.50 |
| OR Level 10 Ea Add 15 | SURG | $1,062.75 |