Usual and Customary Base Fee Schedule

Please note that CPT Codes could change and/or all codes may not be quoted. The information below is an estimate.

The quoted rated is NOT a guarantee. The charge is based on the CPT code provided by the patient. If a different study is performed or additional studies are performed at the time of service, the rate will change.

If you (the patient) have any questions about the insurance allowable, please contact your insurance provider.

You can search this page by using the CTRL+F key shortcut. Press and hold the CTRL key on your keyboard, press the F key, and let go of both keys.


CPT

Description

Estimated Fee

0042T

CT PERFUSION W/CONTRAST CBF

$400.00

0042T

CT PERFUSION W/CONTRAST CBF

$400.00

0078T

ENDOVASC AORT REPR W/DEVICE

$9,608.00

0079T

ENDOVASC VISC EXTNSN REPR

$857.00

0080T

ENDOVASC AORT REPR RAD S&I

$932.00

0081T

ENDOVASC VISC EXTNSN S&I

$857.00

0159T

CAD BREAST MRI

$15.00

0346T

ULTRASOUND ELASTOGRAPHY

$253.00

0513F

ELEV BP PLAN OF CARE DOCD

$0.00

0521F

PLAN OF CARE 4 PAIN DOCD

$0.00

0526F

SUBS VISIT FOR EPISODE

$0.00

0540F

GLUCO MNGMNT PLAN DOCD

$0.00

0556F

PLAN CARE LIPID CONTROL DOCD

$0.00

0557F

PLAN CAREMNG ANGNL SYMPTDOCD

$0.00

0575F

HIV RNA PLAN CARE DOCD

$0.00

10022

FNA W/IMAGE

$287.00

10030

GUIDE CATHET FLUID DRAINAGE

$695.00

10035

PERQ DEV SOFT TISS 1ST IMAG

$386.00

10036

PERQ DEV SOFT TISS ADD IMAG

$195.00

10060

DRAINAGE OF SKIN ABSCESS

$416.00

1010F

SEVERITY ANGINA BY ACTVTY

$0.00

1011F

ANGINA PRESENT

$0.00

10120

REMOVE FOREIGN BODY

$472.00

1012F

ANGINA ABSENT

$0.00

10160

PUNCTURE DRAINAGE OF LESION

$425.00

1031F

SMOKING & 2ND HAND ASSESSED

$0.00

1032F

SMOKER/EXPOSED 2ND HND SMOKE

$0.00

1033F

TOBACCO NONSMOKER NOR 2NDHND

$0.00

1036F

TOBACCO NON-USER

$0.00

1038F

PERSISTENT ASTHMA

$0.00

1039F

INTERMITTENT ASTHMA

$0.00

1090F

PRES/ABSN URINE INCON ASSESS

$0.00

1125F

AMNT PAIN NOTED PAIN PRSNT

$0.00

1126F

AMNT PAIN NOTED NONE PRSNT

$0.00

1130F

BK PAIN & FXN ASSESSED

$0.00

1170F

FXNL STATUS ASSESSED

$0.00

1175F

FUNCTION STAT ASSESSED RVWD

$0.00

1181F

NEUROPSYCHIA SYMPTS ASSESSED

$0.00

12001

RPR S/N/AX/GEN/TRNK 2.5CM/<

$196.00

1400F

PRKNS DIAG RVIEWED

$0.00

1490F

DEM SEVERITY CLASSIFIED MILD

$0.00

1491F

DEM SEVERITY CLASSIFIED MOD

$0.00

1493F

DEM SEVERITY CLASS SEVERE

$0.00

1494F

COGNIT ASSESSED AND REVIEWED

$0.00

19000

DRAINAGE OF BREAST LESION

$193.00

19001

DRAIN BREAST LESION ADD-ON

$95.00

19030

INJECTION FOR BREAST X-RAY

$328.00

19081

BX BREAST 1ST LESION STRTCTC

$808.00

19081

BX BREAST 1ST LESION STRTCTC

$1,616.00

19082

BX BREAST ADD LESION STRTCTC

$385.00

19083

BX BREAST 1ST LESION US IMAG

$757.00

19084

BX BREAST ADD LESION US IMAG

$362.00

19085

BX BREAST 1ST LESION MR IMAG

$884.00

19086

BX BREAST ADD LESION MR IMAG

$395.00

19102

BX BREAST PERCUT W/IMAGE

$452.00

19103

BX BREAST PERCUT W/DEVICE

$845.00

19281

PERQ DEVICE BREAST 1ST IMAG

$453.00

19282

PERQ DEVICE BREAST EA IMAG

$217.00

19283

PERQ DEV BREAST 1ST STRTCTC

$457.00

19285

PERQ DEV BREAST 1ST US IMAG

$388.00

19286

PERQ DEV BREAST ADD US IMAG

$196.00

19287

PERQ DEV BREAST 1ST MR GUIDE

$631.00

19288

PERQ DEV BREAST ADD MR GUIDE

$280.00

19290

PLACE NEEDLE WIRE BREAST

$286.00

19291

PLACE NEEDLE WIRE BREAST

$140.00

19295

PLACE BREAST CLIP PERCUT

$436.00

2000F

BLOOD PRESSURE MEASURE

$0.00

2010F

VITAL SIGNS RECORDED

$0.00

2015F

ASTHMA IMPAIRMENT ASSESSED

$0.00

2016F

ASTHMA RISK ASSESSED

$0.00

20206

NEEDLE BIOPSY MUSCLE

$269.00

20220

BONE BIOPSY TROCAR/NEEDLE

$332.00

20225

BONE BIOPSY TROCAR/NEEDLE

$504.00

2022F

DIL RETINA EXAM INTERP REV

$0.00

2024F

7 FIELD PHOTO INTERP DOC REV

$0.00

2026F

EYE IMAGE VALID TO DX REV

$0.00

2028F

FOOT EXAM PERFORMED

$0.00

2040F

BK PN XM ON INIT VISIT DATE

$0.00

20500

INJECTION OF SINUS TRACT

$388.00

20501

INJECT SINUS TRACT FOR X-RAY

$171.00

20605

DRAIN/INJ JOINT/BURSA W/O US

$181.00

20606

DRAIN/INJ JOINT/BURSA W/US

$233.00

20610

DRAIN/INJ JOINT/BURSA W/O US

$221.00

20610

DRAIN/INJ JOINT/BURSA W/O US

$442.00

20611

DRAIN/INJ JOINT/BURSA W/US

$276.00

20611

DRAIN/INJ JOINT/BURSA W/US

$552.00

20612

ASPIRATE/INJ GANGLION CYST

$184.00

20982

ABLATE BONE TUMOR(S) PERQ

$1,710.00

22510

PERQ CERVICOTHORACIC INJECT

$1,960.00

22511

PERQ LUMBOSACRAL INJECTION

$1,840.00

22512

VERTEBROPLASTY ADDL INJECT

$935.00

22513

PERQ VERTEBRAL AUGMENTATION

$2,445.00

22514

PERQ VERTEBRAL AUGMENTATION

$2,279.00

22515

PERQ VERTEBRAL AUGMENTATION

$1,025.00

22520

PERCUT VERTEBROPLASTY THOR

$2,313.00

22523

PERCUT KYPHOPLASTY THOR

$2,605.00

22524

PERCUT KYPHOPLASTY LUMBAR

$2,505.00

22525

PERCUT KYPHOPLASTY ADD-ON

$1,161.00

23350

INJECTION FOR SHOULDER X-RAY

$226.00

23350

INJECTION FOR SHOULDER X-RAY

$452.00

24220

INJECTION FOR ELBOW X-RAY

$301.00

25246

INJECTION FOR WRIST X-RAY

$329.00

27093

INJECTION FOR HIP X-RAY

$309.00

27095

INJECTION FOR HIP X-RAY

$360.00

27096

INJECT SACROILIAC JOINT

$309.00

27096

INJECT SACROILIAC JOINT

$618.00

27370

INJECTION FOR KNEE X-RAY

$232.00

27648

INJECTION FOR ANKLE X-RAY

$230.00

3014F

SCREEN MAMMO DOC REV

$0.00

3016F

PT SCRND UNHLTHY OH USE

$0.00

3017F

COLORECTAL CA SCREEN DOC REV

$0.00

3021F

LVEF MOD/SEVER DEPRS SYST

$0.00

3022F

LVEF >/=40% SYSTOLIC

$0.00

3023F

SPIROM DOC REV

$0.00

3044F

HG A1C LEVEL LT 7.0%

$0.00

3045F

HG A1C LEVEL 7.0-9.0%

$0.00

3046F

HEMOGLOBIN A1C LEVEL > 9.0%

$0.00

3048F

LDL-C <100 MG/DL

$0.00

3049F

LDL-C 100-129 MG/DL

$0.00

3050F

LDL-C >/= 130 MG/DL

$0.00

3060F

POS MICROALBUMINURIA REV

$0.00

3061F

NEG MICROALBUMINURIA REV

$0.00

3062F

POS MACROALBUMINURIA REV

$0.00

3066F

NEPHROPATHY DOC TX

$0.00

3072F

LOW RISK FOR RETINOPATHY

$0.00

3100F

IMAGE TEST REF CAROT DIAM

$0.00

3110F

PRES/ABSN HMRHG/LESION DOCD

$0.00

3111F

CT/MRI BRAIN DONE W/IN 24HRS

$0.00

3112F

CT/MRI BRAIN DONE 24 HRS

$0.00

3120F

12-LEAD ECG PERFORMED

$0.00

3215F

PT IMMUNITY TO HEP A DOCD

$0.00

3216F

PT IMMUNITY TO HEP B DOCD

$0.00

3218F

RNA TSTNG HEP C DOCD DONE

$0.00

3220F

HEP C QUANT RNA TSTNG DOCD

$0.00

32400

NEEDLE BIOPSY CHEST LINING

$391.00

32405

PERCUT BX LUNG/MEDIASTINUM

$433.00

32421

THORACENTESIS FOR ASPIRATION

$339.00

32422

THORACENTESIS W/TUBE INSERT

$552.00

32550

INSERT PLEURAL CATH

$985.00

32551

INSERTION OF CHEST TUBE

$766.00

32552

REMOVE LUNG CATHETER

$737.00

32554

ASPIRATE PLEURA W/O IMAGING

$388.00

32555

ASPIRATE PLEURA W/ IMAGING

$484.00

32556

INSERT CATH PLEURA W/O IMAGE

$531.00

32557

INSERT CATH PLEURA W/ IMAGE

$714.00

32557

INSERT CATH PLEURA W/ IMAGE

$1,428.00

32560

TREAT PLEURODESIS W/AGENT

$354.00

32561

LYSE CHEST FIBRIN INIT DAY

$317.00

32562

LYSE CHEST FIBRIN SUBQ DAY

$275.00

3266F

HEPC GN TSTNG DOCD B/4TXMNT

$0.00

32994

ABLATE PULM TUMOR PERQ CRYBL

$2,159.00

32998

ABLATE PULM TUMOR PERQ RF

$1,233.00

3300F

AJCC STAGE DOCD B/4 THXPY

$0.00

3301F

CANCER STAGE DOCD METAST

$0.00

3315F

ER+ OR PR+ BREAST CANCER

$0.00

3316F

ER- OR PR- BREAST CANCER

$0.00

3340F

MAMMO ASSESS INC XRAY DOCD

$0.00

3341F

MAMMO ASSESS NEGATIVE DOCD

$0.00

3342F

MAMMO ASSESS BENGN DOCD

$0.00

3343F

MAMMO PROBABLY BENGN DOCD

$0.00

3344F

MAMMO ASSESS SUSP DOCD

$0.00

3345F

MAMMO ASSESS HGHLYMALIG DOC

$0.00

3350F

MAMMO BX PROVEN MALIG DOCD

$0.00

3370F

AJCC BRST CNCR STAGE 0 DOCD

$0.00

3372F

AJCC BRST CNCR STAGE 1 DOCD

$0.00

3374F

AJCC BRST CNCR STAGE 1 DOCD

$0.00

3376F

AJCC BRSTCNCR STAGE 2 DOCD

$0.00

3378F

AJCC BRSTCNCR STAGE 3 DOCD

$0.00

3380F

AJCC BRSTCNCR STAGE 4 DOCD

$0.00

3382F

AJCC CLN CNCR STAGE 0 DOCD

$0.00

3384F

AJCC CLN CNCR STAGE 1 DOCD

$0.00

3386F

AJCC CLN CNCR STAGE 2 DOCD

$0.00

3388F

AJCC CLN CNCR STAGE 3 DOCD

$0.00

3390F

AJCC CLN CNCR STAGE 4 DOCD

$0.00

3455F

TB SCRNG DONE-INTERPD 6MON

$0.00

34701

EVASC RPR A-AO NDGFT

$5,424.00

34702

EVASC RPR A-AO NDGFT RPT

$8,094.00

34703

EVASC RPR A-UNILAC NDGFT

$6,101.00

34704

EVASC RPR A-UNILAC NDGFT RPT

$10,137.00

34705

EVAC RPR A-BIILIAC NDGFT

$6,726.00

34706

EVASC RPR A-BIILIAC RPT

$10,112.00

34707

EVASC RPR ILIO-ILIAC NDGFT

$5,053.00

34708

EVASC RPR ILIO-ILIAC RPT

$8,120.00

34709

PLMT XTN PROSTH EVASC RPR

$1,415.00

3470F

RA DISEASE ACTIVITY LOW

$0.00

34710

DLYD PLMT XTN PROSTH 1ST VSL

$3,540.00

34711

DLYD PLMT XTN PROSTH EA ADDL

$1,306.00

34712

TCAT DLVR ENHNCD FIXJ DEV

$3,053.00

34713

PERQ ACCESS & CLSR FEM ART

$568.00

3471F

RA DISEASE ACTIVITY MOD

$0.00

3472F

RA DISEASE ACTIVITY HIGH

$0.00

3475F

DISEASE PROGN RA POOR DOCD

$0.00

3476F

DISEASE PROGN RA GOOD DOCD

$0.00

34803

ENDOVAS AAA REPR W/3-P PART

$6,053.00

34805

ENDOVAS AAA REPR W/LONG TUBE

$5,422.00

34825

ENDOVASC EXTEND PROSTH INIT

$3,191.00

3490F

HISTORY AIDS-DEFINING COND

$0.00

3492F

HISTORY CD4+ CELL COUNT <350

$0.00

3493F

NO HIST CD4+ CELL COUNT<350

$0.00

3494F

CD4+CELL COUNT <200CELLS/MM3

$0.00

3495F

CD4+CELL CNT 200-499 CELLS

$0.00

3496F

CD4+ CELL COUNT >= 500 CELLS

$0.00

3500F

CD4+CELL CNT/% DOCD AS DONE

$0.00

3502F

HIV RNA VRL LD <LMTS QUANTIF

$0.00

3503F

HIV RNA VRL LDNOT<LMTS QUNTF

$0.00

3510F

DOC TB SCRNG-RSLTS INTERPD

$0.00

3511F

CHLMYD/GONRH TSTS DOCD DONE

$0.00

3512F

SYPH SCRNG DOCD AS DONE

$0.00

3517F

HBV ASSESS&RESULTS INTRP 1YR

$0.00

35471

REPAIR ARTERIAL BLOCKAGE

$2,498.00

35475

REPAIR ARTERIAL BLOCKAGE

$2,245.00

35476

REPAIR VENOUS BLOCKAGE

$1,425.00

3570F

RPRT BONE SCINT XREF W XRAY

$0.00

36000

PLACE NEEDLE IN VEIN

$30.00

36002

PSEUDOANEURYSM INJECTION TRT

$476.00

36005

INJECTION EXT VENOGRAPHY

$222.00

36005

INJECTION EXT VENOGRAPHY

$444.00

36010

PLACE CATHETER IN VEIN

$554.00

36010

PLACE CATHETER IN VEIN

$1,108.00

36011

PLACE CATHETER IN VEIN

$706.00

36012

PLACE CATHETER IN VEIN

$813.00

36013

PLACE CATHETER IN ARTERY

$562.00

36014

PLACE CATHETER IN ARTERY

$660.00

36014

PLACE CATHETER IN ARTERY

$1,320.00

36015

PLACE CATHETER IN ARTERY

$765.00

36120

ESTABLISH ACCESS TO ARTERY

$451.00

36140

INTRO NDL ICATH UPR/LXTR ART

$477.00

36147

ACCESS AV DIAL GRFT FOR EVAL

$839.00

36148

ACCESS AV DIAL GRFT FOR PROC

$221.00

36160

ESTABLISH ACCESS TO AORTA

$569.00

36200

PLACE CATHETER IN AORTA

$713.00

36215

PLACE CATHETER IN ARTERY

$1,123.00

36216

PLACE CATHETER IN ARTERY

$1,271.00

36217

PLACE CATHETER IN ARTERY

$1,511.00

36218

PLACE CATHETER IN ARTERY

$240.00

36221

PLACE CATH THORACIC AORTA

$935.00

36222

PLACE CATH CAROTID/INOM ART

$1,269.00

36223

PLACE CATH CAROTID/INOM ART

$1,371.00

36224

PLACE CATH CAROTD ART

$1,495.00

36224

PLACE CATH CAROTD ART

$2,990.00

36225

PLACE CATH SUBCLAVIAN ART

$1,365.00

36226

PLACE CATH VERTEBRAL ART

$1,498.00

36227

PLACE CATH XTRNL CAROTID

$473.00

36227

PLACE CATH XTRNL CAROTID

$946.00

36228

PLACE CATH INTRACRANIAL ART

$964.00

36245

INS CATH ABD/L-EXT ART 1ST

$1,145.00

36246

INS CATH ABD/L-EXT ART 2ND

$1,258.00

36246

INS CATH ABD/L-EXT ART 2ND

$2,516.00

36247

INS CATH ABD/L-EXT ART 3RD

$1,499.00

36247

INS CATH ABD/L-EXT ART 3RD

$2,998.00

36248

INS CATH ABD/L-EXT ART ADDL

$237.00

36251

INS CATH REN ART 1ST UNILAT

$1,218.00

36252

INS CATH REN ART 1ST BILAT

$1,585.00

36253

INS CATH REN ART 2ND+ UNILAT

$1,692.00

36254

INS CATH REN ART 2ND+ BILAT

$1,825.00

36465

NJX NONCMPND SCLRSNT 1 VEIN

$524.00

36466

NJX NONCMPND SCLRSNT MLT VN

$667.00

36471

NJX SCLRSNT MLT INCMPTNT VN

$459.00

36476

ENDOVENOUS RF VEIN ADD-ON

$608.00

36478

ENDOVENOUS LASER 1ST VEIN

$1,605.00

36482

ENDOVEN THER CHEM ADHES 1ST

$777.00

36483

ENDOVEN THER CHEM ADHES SBSQ

$388.00

36556

INSERT NON-TUNNEL CV CATH

$534.00

36557

INSERT TUNNELED CV CATH

$1,353.00

36558

INSERT TUNNELED CV CATH

$1,279.00

36561

INSERT TUNNELED CV CATH

$1,601.00

36568

INSJ PICC <5 YR W/O IMAGING

$425.00

36569

INSJ PICC 5 YR+ W/O IMAGING

$416.00

36569

INSJ PICC 5 YR+ W/O IMAGING

$832.00

36571

INSERT PICVAD CATH

$1,467.00

36575

REPAIR TUNNELED CV CATH

$156.00

36576

REPAIR TUNNELED CV CATH

$882.00

36580

REPLACE CVAD CATH

$301.00

36581

REPLACE TUNNELED CV CATH

$909.00

36582

REPLACE TUNNELED CV CATH

$1,364.00

36584

COMPL RPLCMT PICC RS&I

$304.00

36589

REMOVAL TUNNELED CV CATH

$637.00

36590

REMOVAL TUNNELED CV CATH

$921.00

36593

DECLOT VASCULAR DEVICE

$139.00

36595

MECH REMOV TUNNELED CV CATH

$845.00

36596

MECH REMOV TUNNELED CV CATH

$203.00

36597

REPOSITION VENOUS CATHETER

$277.00

36598

INJ W/FLUOR EVAL CV DEVICE

$226.00

36620

INSERTION CATHETER ARTERY

$224.00

36870

PERCUT THROMBECT AV FISTULA

$1,391.00

36901

INTRO CATH DIALYSIS CIRCUIT

$646.00

36902

INTRO CATH DIALYSIS CIRCUIT

$961.00

36903

INTRO CATH DIALYSIS CIRCUIT

$1,314.00

36904

THRMBC/NFS DIALYSIS CIRCUIT

$1,513.00

36905

THRMBC/NFS DIALYSIS CIRCUIT

$1,899.00

36906

THRMBC/NFS DIALYSIS CIRCUIT

$2,215.00

36907

BALO ANGIOP CTR DIALYSIS SEG

$552.00

36908

STENT PLMT CTR DIALYSIS SEG

$827.00

36909

DIALYSIS CIRCUIT EMBOLJ

$920.00

3700F

PSYCH DISORDERS ASSESSED

$0.00

37182

INSERT HEPATIC SHUNT (TIPS)

$3,624.00

37183

REMOVE HEPATIC SHUNT (TIPS)

$1,767.00

37184

PRIM ART M-THRMBC 1ST VSL

$2,019.00

37184

PRIM ART M-THRMBC 1ST VSL

$4,038.00

37186

SEC ART THROMBECTOMY ADD-ON

$1,124.00

37187

VENOUS MECH THROMBECTOMY

$1,898.00

37187

VENOUS MECH THROMBECTOMY

$3,796.00

37188

VEN MECHNL THRMBC REPEAT TX

$1,357.00

37191

INS ENDOVAS VENA CAVA FILTR

$3,772.00

37192

REDO ENDOVAS VENA CAVA FILTR

$5,656.00

37193

REM ENDOVAS VENA CAVA FILTER

$5,656.00

37197

REMOVE INTRVAS FOREIGN BODY

$1,325.00

37200

TRANSCATHETER BIOPSY

$1,021.00

37201

TRANSCATHETER THERAPY INFUSE

$1,275.00

37202

TRANSCATHETER THERAPY INFUSE

$1,448.00

37203

TRANSCATHETER RETRIEVAL

$1,130.00

37204

TRANSCATHETER OCCLUSION

$4,111.00

37205

TRANSCATH IV STENT PERCUT

$2,006.00

37206

TRANSCATH IV STENT/PERC ADDL

$943.00

37209

CHANGE IV CATH AT THROMB TX

$518.00

3720F

COGNIT IMPAIRMENT ASSESSED

$0.00

37210

EMBOLIZATION UTERINE FIBROID

$2,427.00

37211

THROMBOLYTIC ART THERAPY

$1,748.00

37211

THROMBOLYTIC ART THERAPY

$3,496.00

37212

THROMBOLYTIC VENOUS THERAPY

$1,543.00

37212

THROMBOLYTIC VENOUS THERAPY

$3,086.00

37213

THROMBLYTIC ART/VEN THERAPY

$1,046.00

37213

THROMBLYTIC ART/VEN THERAPY

$2,092.00

37214

CESSJ THERAPY CATH REMOVAL

$637.00

37214

CESSJ THERAPY CATH REMOVAL

$1,274.00

37215

TRANSCATH STENT CCA W/EPS

$5,140.00

37220

ILIAC REVASC

$1,840.00

37221

ILIAC REVASC W/STENT

$2,316.00

37221

ILIAC REVASC W/STENT

$4,632.00

37223

ILIAC REVASC W/STENT ADD-ON

$981.00

37224

FEM/POPL REVAS W/TLA

$2,096.00

37225

FEM/POPL REVAS W/ATHER

$2,792.00

37226

FEM/POPL REVASC W/STENT

$2,328.00

37228

TIB/PER REVASC W/TLA

$2,561.00

37230

TIB/PER REVASC W/STENT

$3,071.00

37232

TIB/PER REVASC ADD-ON

$918.00

37236

OPEN/PERQ PLACE STENT 1ST

$2,052.00

37238

OPEN/PERQ PLACE STENT SAME

$1,453.00

37239

OPEN/PERQ PLACE STENT EA ADD

$675.00

37241

VASC EMBOLIZE/OCCLUDE VENOUS

$1,996.00

37242

VASC EMBOLIZE/OCCLUDE ARTERY

$2,229.00

37243

VASC EMBOLIZE/OCCLUDE ORGAN

$2,657.00

37244

VASC EMBOLIZE/OCCLUDE BLEED

$3,093.00

37246

TRLUML BALO ANGIOP 1ST ART

$1,575.00

37246

TRLUML BALO ANGIOP 1ST ART

$3,150.00

37248

TRLUML BALO ANGIOP 1ST VEIN

$1,355.00

37249

TRLUML BALO ANGIOP ADDL VEIN

$664.00

3725F

SCREEN DEPRESSION PERFORMED

$0.00

3750F

PTNOTRCVNGSTEROID>/=10MG/DAY

$0.00

37620

REVISION OF MAJOR VEIN

$2,970.00

37765

STAB PHLEB VEINS XTR 10-20

$2,106.00

37766

PHLEB VEINS – EXTREM 20+

$2,574.00

38220

DX BONE MARROW ASPIRATIONS

$264.00

38221

DX BONE MARROW BIOPSIES

$335.00

38222

DX BONE MARROW BX & ASPIR

$348.00

38505

NEEDLE BIOPSY LYMPH NODES

$326.00

38505

NEEDLE BIOPSY LYMPH NODES

$652.00

38550

REMOVAL NECK/ARMPIT LESION

$2,310.00

38792

RA TRACER ID OF SENTINL NODE

$183.00

4000F

TOBACCO USE TXMNT COUNSELING

$0.00

4001F

TOBACCO USE TXMNT PHARMACOL

$0.00

4004F

PT TOBACCO SCREEN RCVD TLK

$0.00

4010F

ACE/ARB THERAPY RXD/TAKEN

$0.00

4013F

STATIN THERAPY/CURRENTLY TKN

$0.00

4025F

INHALED BRONCHODILATOR RX

$0.00

4035F

INFLUENZA IMM REC

$0.00

4037F

INFLUENZA IMM ORDER/ADMIN

$0.00

4040F

PNEUMOC VAC/ADMIN/RCVD

$0.00

4041F

DOC ORDER CEFAZOLIN/CEFUROX

$0.00

4042F

DOC ANTIBIO NOT GIVEN

$0.00

4044F

DOC ORDER GIVEN VTE PROPHYLX

$0.00

4045F

EMPIRIC ANTIBIOTIC RX

$0.00

4046F

DOC ANTIBIO GIVEN B/4 SURG

$0.00

4049F

DOC ORDER GIVEN STOP ANTIBIO

$0.00

4084F

ASPIRIN RECVD W/IN 24 HRS

$0.00

4086F

ASPIRIN/CLOPIDOGREL RXD

$0.00

4110F

INT MAM ART USED FOR CABG

$0.00

4115F

BETA BLCKR ADMIN W/IN 24 HRS

$0.00

4130F

TOPICAL PREP RX AOE

$0.00

4131F

SYST ANTIMICROBIAL THX RX

$0.00

4132F

NO SYST ANTIMICROBIAL THX RX

$0.00

4140F

INHALED CORTICOSTEROIDS RXD

$0.00

4142F

CORTICOSTER SPARNG THRPY RXD

$0.00

4144F

ALT LONG-TERM CNTRL MED RXD

$0.00

4148F

HEP A VAC INJXN ADMIN/RECVD

$0.00

4149F

HEP B VAC INJXN ADMIN/RECVD

$0.00

4150F

PT RECVNG ANTIVIR TXMNT HEPC

$0.00

4151F

PT NOT RECVNG ANTIV HEP C

$0.00

4153F

COMBO PEGINTF/RIB RX

$0.00

4158F

PT EDU RE ALCOH DRNKNG DONE

$0.00

4159F

CONTRCP TALK B/4 ANTIV TXMNT

$0.00

4171F

PT RCVNG ESA THXPY

$0.00

4172F

PT NOT RCVNG ESA THXPY

$0.00

4175F

VIS 20/40/> W/IN 90 DAYS

$0.00

4179F

TAMOXIFEN/AI PRESCRIBED

$0.00

4187F

ANTI RHEUM DRUGTHXPYRXD/GVN

$0.00

4192F

PT NOT RCVNG GLUCOCO THXPY

$0.00

4193F

PT RCV <10MG DAILY PREDNISO

$0.00

4194F

PT RCV >=10MG DAILY PREDNISO

$0.00

4195F

PT RCVNG ANTI-RHEUM THXPY RA

$0.00

4196F

PTNOT RCVNG ANTI-RHM THXPYRA

$0.00

42400

BIOPSY OF SALIVARY GLAND

$258.00

4245F

PT INSTR NRML ACTIVITIES

$0.00

4248F

PT INSTR NO BD REST 4 DAYS/>

$0.00

4270F

PT RCVNG ANTI R-VIRAL THXPY

$0.00

4271F

PT RCVNG ANTI R-VIRAL THXPY

$0.00

4276F

POTENT ANTIVIR THXPY RXD

$0.00

4280F

PCP PROPHYLAX RXD 3MON LOW %

$0.00

4322F

CRGVR PROV W/ ED ADDL RSRCS

$0.00

4325F

MED TXMNT OPTIONS RVWD W/PT

$0.00

4328F

PT ASKED RE SLEEP DISTURB

$0.00

43752

NASAL/OROGASTRIC W/TUBE PLMT

$181.00

4400F

REHAB THXPY OPTIONS W/PT

$0.00

44500

INTRO GASTROINTESTINAL TUBE

$109.00

4525F

NEUROPSYCHIA INTERVEN ORDER

$0.00

4526F

NEUROPSYCHIA INTERVEN RCVD

$0.00

45327

PROCTOSIGMOIDOSCOPY W/STENT

$575.00

45387

COLONOSCOPY W/STENT

$1,557.00

45389

COLONOSCOPY W/STENT PLCMT

$1,324.00

47000

NEEDLE BIOPSY OF LIVER

$433.00

47011

PERCUT DRAIN LIVER LESION

$831.00

47382

PERCUT ABLATE LIVER RF

$3,590.00

47490

INCISION OF GALLBLADDER

$1,654.00

47500

INJECTION FOR LIVER X-RAYS

$425.00

47505

INJECTION FOR LIVER X-RAYS

$170.00

47510

INSERT CATHETER BILE DUCT

$2,156.00

47511

INSERT BILE DUCT DRAIN

$2,543.00

47525

CHANGE BILE DUCT CATHETER

$399.00

47531

INJECTION FOR CHOLANGIOGRAM

$270.00

47533

PLMT BILIARY DRAINAGE CATH

$1,372.00

47534

PLMT BILIARY DRAINAGE CATH

$1,137.00

47536

EXCHANGE BILIARY DRG CATH

$663.00

47537

REMOVAL BILIARY DRG CATH

$449.00

47538

PERQ PLMT BILE DUCT STENT

$1,064.00

47538

PERQ PLMT BILE DUCT STENT

$2,128.00

47540

PERQ PLMT BILE DUCT STENT

$1,979.00

47542

DILATE BILIARY DUCT/AMPULLA

$598.00

47543

ENDOLUMINAL BX BILIARY TREE

$754.00

47544

REMOVAL DUCT GLBLDR CALCULI

$964.00

47552

BILIARY ENDO PERQ DX W/SPECI

$1,345.00

47553

BILIARY ENDOSCOPY THRU SKIN

$1,372.00

47554

BILIARY ENDOSCOPY THRU SKIN

$2,162.00

47555

BILIARY ENDOSCOPY THRU SKIN

$1,625.00

47556

BILIARY ENDOSCOPY THRU SKIN

$1,841.00

48102

NEEDLE BIOPSY PANCREAS

$1,103.00

49021

DRAIN ABDOMINAL ABSCESS

$756.00

49041

DRAIN PERCUT ABDOM ABSCESS

$4,342.00

49061

DRAIN PERCUT RETROPER ABSC

$829.00

49080

PUNCTURE PERITONEAL CAVITY

$305.00

49083

ABD PARACENTESIS W/IMAGING

$453.00

49180

BIOPSY ABDOMINAL MASS

$389.00

49185

SCLEROTX FLUID COLLECTION

$553.00

49400

AIR INJECTION INTO ABDOMEN

$430.00

49405

IMAGE CATH FLUID COLXN VISC

$951.00

49406

IMAGE CATH FLUID PERI/RETRO

$952.00

49407

IMAGE CATH FLUID TRNS/VGNL

$1,015.00

49418

INSERT TUN IP CATH PERC

$1,000.00

49422

REMOVE TUNNELED IP CATH

$1,705.00

49423

EXCHANGE DRAINAGE CATHETER

$333.00

49424

ASSESS CYST CONTRAST INJECT

$176.00

49440

PLACE GASTROSTOMY TUBE PERC

$1,021.00

49441

PLACE DUOD/JEJ TUBE PERC

$1,148.00

49446

CHANGE G-TUBE TO G-J PERC

$746.00

49450

REPLACE G/C TUBE PERC

$300.00

49451

REPLACE DUOD/JEJ TUBE PERC

$420.00

49452

REPLACE G-J TUBE PERC

$646.00

49460

FIX G/COLON TUBE W/DEVICE

$210.00

49465

FLUORO EXAM OF G/COLON TUBE

$138.00

50021

RENAL ABSCESS PERCUT DRAIN

$725.00

50200

RENAL BIOPSY PERQ

$654.00

50382

CHANGE URETER STENT PERCUT

$1,220.00

50384

REMOVE URETER STENT PERCUT

$1,086.00

50387

CHANGE NEPHROURETERAL CATH

$453.00

50387

CHANGE NEPHROURETERAL CATH

$906.00

50389

REMOVE RENAL TUBE W/FLUORO

$247.00

50389

REMOVE RENAL TUBE W/FLUORO

$494.00

50390

DRAINAGE OF KIDNEY LESION

$439.00

50392

INSERT KIDNEY DRAIN

$815.00

50392

INSERT KIDNEY DRAIN

$1,630.00

50393

INSERT URETERAL TUBE

$991.00

50393

INSERT URETERAL TUBE

$1,982.00

50394

INJECTION FOR KIDNEY X-RAY

$230.00

50394

INJECTION FOR KIDNEY X-RAY

$460.00

50395

CREATE PASSAGE TO KIDNEY

$825.00

50398

CHANGE KIDNEY TUBE

$333.00

50398

CHANGE KIDNEY TUBE

$666.00

50430

NJX PX NFROSGRM &/URTRGRM

$752.00

50431

NJX PX NFROSGRM &/URTRGRM

$188.00

50431

NJX PX NFROSGRM &/URTRGRM

$376.00

50432

PLMT NEPHROSTOMY CATHETER

$992.00

50432

PLMT NEPHROSTOMY CATHETER

$1,984.00

50433

PLMT NEPHROURETERAL CATHETER

$764.00

50434

CONVERT NEPHROSTOMY CATHETER

$879.00

50435

EXCHANGE NEPHROSTOMY CATH

$287.00

50435

EXCHANGE NEPHROSTOMY CATH

$574.00

50592

PERC RF ABLATE RENAL TUMOR

$1,647.00

50593

PERC CRYO ABLATE RENAL TUM

$2,084.00

50688

CHANGE OF URETER TUBE/STENT

$354.00

50690

INJECTION FOR URETER X-RAY

$307.00

50693

PLMT URETERAL STENT PRQ

$981.00

50693

PLMT URETERAL STENT PRQ

$1,962.00

50694

PLMT URETERAL STENT PRQ

$1,206.00

50695

PLMT URETERAL STENT PRQ

$1,606.00

50706

BALLOON DILATE URTRL STRIX

$818.00

51102

DRAIN BL W/CATH INSERTION

$627.00

51600

INJECTION FOR BLADDER X-RAY

$200.00

51610

INJECTION FOR BLADDER X-RAY

$283.00

51705

CHANGE OF BLADDER TUBE

$225.00

51710

CHANGE OF BLADDER TUBE

$360.00

51798

US URINE CAPACITY MEASURE

$95.00

55000

DRAINAGE OF HYDROCELE

$375.00

55700

BIOPSY OF PROSTATE

$622.00

58340

CATHETER FOR HYSTEROGRAPHY

$261.00

58823

DRAIN PELVIC ABSCESS PERCUT

$765.00

60100

BIOPSY OF THYROID

$353.00

6010F

DYSPHAG TEST DONE B/4 EATING

$0.00

6015F

DYSPHAG TEST DONE B/4 EATING

$0.00

6020F

NPO (NOTHING-MOUTH) ORDERED

$0.00

60300

ASPIR/INJ THYROID CYST

$219.00

6030F

MAX STERILE BARRIERS FLWD

$0.00

6045F

RADXPS IN END RPRT4FLURO PXD

$0.00

6101F

SAFETY COUNSELING DEMENTIA

$0.00

6102F

SAFETY COUNSELING DEM ORDER

$0.00

61055

INJECTION INTO BRAIN CANAL

$606.00

61070

BRAIN CANAL SHUNT PROCEDURE

$379.00

6110F

COUNSEL PROV DRIVING RISKS

$0.00

6150F

PT NOTRCVNG1ST ANTITNF TXMNT

$0.00

61626

TRANSCATH OCCLUSION NON-CNS

$3,843.00

61630

INTRACRANIAL ANGIOPLASTY

$5,664.00

62267

INTERDISCAL PERQ ASPIR DX

$700.00

62270

SPINAL FLUID TAP DIAGNOSTIC

$347.00

62272

DRAIN CEREBRO SPINAL FLUID

$376.00

62273

INJECT EPIDURAL PATCH

$489.00

62284

INJECTION FOR MYELOGRAM

$386.00

62290

NJX PX DISCOGRAPHY LUMBAR

$754.00

62302

MYELOGRAPHY LUMBAR INJECTION

$550.00

62304

MYELOGRAPHY LUMBAR INJECTION

$551.00

62305

MYELOGRAPHY LUMBAR INJECTION

$580.00

62310

INJECT SPINE CERV/THORACIC

$455.00

62311

INJECT SPINE LUMBAR/SACRAL

$375.00

62323

NJX INTERLAMINAR LMBR/SAC

$449.00

64479

INJ FORAMEN EPIDURAL C/T

$580.00

64479

INJ FORAMEN EPIDURAL C/T

$1,160.00

64480

INJ FORAMEN EPIDURAL ADD-ON

$279.00

64483

INJ FORAMEN EPIDURAL L/S

$509.00

64483

INJ FORAMEN EPIDURAL L/S

$1,018.00

64484

INJ FORAMEN EPIDURAL ADD-ON

$233.00

64490

INJ PARAVERT F JNT C/T 1 LEV

$496.00

64493

INJ PARAVERT F JNT L/S 1 LEV

$418.00

64493

INJ PARAVERT F JNT L/S 1 LEV

$836.00

64510

N BLOCK STELLATE GANGLION

$309.00

64517

N BLOCK INJ HYPOGAS PLXS

$563.00

64999

NERVOUS SYSTEM SURGERY

$504.00

70030

X-RAY EYE FOR FOREIGN BODY

$37.00

70100

X-RAY EXAM OF JAW <4VIEWS

$40.00

70110

X-RAY EXAM OF JAW 4/> VIEWS

$54.00

70120

X-RAY EXAM OF MASTOIDS

$40.00

70130

X-RAY EXAM OF MASTOIDS

$73.00

70140

X-RAY EXAM OF FACIAL BONES

$43.00

70150

X-RAY EXAM OF FACIAL BONES

$57.00

70160

X-RAY EXAM OF NASAL BONES

$37.00

70200

X-RAY EXAM OF EYE SOCKETS

$61.00

70210

X-RAY EXAM OF SINUSES

$39.00

70220

X-RAY EXAM OF SINUSES

$54.00

70250

X-RAY EXAM OF SKULL

$54.00

7025F

PT INFOSYS ALARM 4 NXT MAMMO

$0.00

70260

X-RAY EXAM OF SKULL

$73.00

70330

X-RAY EXAM OF JAW JOINTS

$54.00

70336

MAGNETIC IMAGE JAW JOINT

$321.00

70360

X-RAY EXAM OF NECK

$37.00

70450

CT HEAD/BRAIN W/O DYE

$185.00

70460

CT HEAD/BRAIN W/DYE

$246.00

70470

CT HEAD/BRAIN W/O & W/DYE

$279.00

70480

CT ORBIT/EAR/FOSSA W/O DYE

$280.00

70481

CT ORBIT/EAR/FOSSA W/DYE

$302.00

70482

CT ORBIT/EAR/FOSSA W/O&W/DYE

$316.00

70486

CT MAXILLOFACIAL W/O DYE

$249.00

70487

CT MAXILLOFACIAL W/DYE

$284.00

70488

CT MAXILLOFACIAL W/O & W/DYE

$310.00

70490

CT SOFT TISSUE NECK W/O DYE

$280.00

70491

CT SOFT TISSUE NECK W/DYE

$301.00

70492

CT SFT TSUE NCK W/O & W/DYE

$316.00

70496

CT ANGIOGRAPHY HEAD

$384.00

70498

CT ANGIOGRAPHY NECK

$384.00

70540

MRI ORBIT/FACE/NECK W/O DYE

$295.00

70542

MRI ORBIT/FACE/NECK W/DYE

$354.00

70543

MRI ORBT/FAC/NCK W/O & W/DYE

$467.00

70544

MR ANGIOGRAPHY HEAD W/O DYE

$262.00

70545

MR ANGIOGRAPHY HEAD W/DYE

$262.00

70546

MR ANGIOGRAPH HEAD W/O&W/DYE

$394.00

70547

MR ANGIOGRAPHY NECK W/O DYE

$262.00

70548

MR ANGIOGRAPHY NECK W/DYE

$262.00

70549

MR ANGIOGRAPH NECK W/O&W/DYE

$393.00

70551

MRI BRAIN STEM W/O DYE

$323.00

70552

MRI BRAIN STEM W/DYE

$392.00

70553

MRI BRAIN STEM W/O & W/DYE

$517.00

70554

FMRI BRAIN BY TECH

$443.00

70557

MRI BRAIN W/O DYE

$648.00

70559

MRI BRAIN W/O & W/DYE

$714.00

71045

X-RAY EXAM CHEST 1 VIEW

$40.00

71046

X-RAY EXAM CHEST 2 VIEWS

$48.00

71047

X-RAY EXAM CHEST 3 VIEWS

$62.00

71048

X-RAY EXAM CHEST 4+ VIEWS

$72.00

71100

X-RAY EXAM RIBS UNI 2 VIEWS

$48.00

71101

X-RAY EXAM UNILAT RIBS/CHEST

$58.00

71110

X-RAY EXAM RIBS BIL 3 VIEWS

$58.00

71111

X-RAY EXAM RIBS/CHEST4/> VWS

$68.00

71120

X-RAY EXAM BREASTBONE 2/>VWS

$43.00

71130

X-RAY STRENOCLAVIC JT 3/>VWS

$48.00

71250

CT THORAX W/O DYE

$224.00

71260

CT THORAX W/DYE

$273.00

71270

CT THORAX W/O & W/DYE

$301.00

71275

CT ANGIOGRAPHY CHEST

$421.00

71550

MRI CHEST W/O DYE

$317.00

71551

MRI CHEST W/DYE

$365.00

71552

MRI CHEST W/O & W/DYE

$494.00

71555

MRI ANGIO CHEST W OR W/O DYE

$398.00

72010

X-RAY EXAM SPINE AP&LAT

$100.00

72020

X-RAY EXAM OF SPINE 1 VIEW

$34.00

72040

X-RAY EXAM NECK SPINE 2-3 VW

$52.00

72050

X-RAY EXAM NECK SPINE 4/5VWS

$70.00

72052

X-RAY EXAM NECK SPINE 6/>VWS

$80.00

72069

X-RAY EXAM TRUNK SPINE STAND

$52.00

72070

X-RAY EXAM THORAC SPINE 2VWS

$49.00

72072

X-RAY EXAM THORAC SPINE 3VWS

$48.00

72074

X-RAY EXAM THORAC SPINE4/>VW

$48.00

72080

X-RAY EXAM THORACOLMB 2/> VW

$52.00

72081

X-RAY EXAM ENTIRE SPI 1 VW

$59.00

72082

X-RAY EXAM ENTIRE SPI 2/3 VW

$71.00

72083

X-RAY EXAM ENTIRE SPI 4/5 VW

$77.00

72084

X-RAY EXAM ENTIRE SPI 6/> VW

$94.00

72090

X-RAY EXAM SCLOIOSIS ERECT

$67.00

72100

X-RAY EXAM L-S SPINE 2/3 VWS

$52.00

72110

X-RAY EXAM L-2 SPINE 4/>VWS

$70.00

72114

X-RAY EXAM L-S SPINE BENDING

$84.00

72120

X-RAY BEND ONLY L-S SPINE

$52.00

72125

CT NECK SPINE W/O DYE

$224.00

72126

CT NECK SPINE W/DYE

$266.00

72127

CT NECK SPINE W/O & W/DYE

$277.00

72128

CT CHEST SPINE W/O DYE

$224.00

72129

CT CHEST SPINE W/DYE

$268.00

72130

CT CHEST SPINE W/O & W/DYE

$277.00

72131

CT LUMBAR SPINE W/O DYE

$224.00

72132

CT LUMBAR SPINE W/DYE

$268.00

72133

CT LUMBAR SPINE W/O & W/DYE

$277.00

72141

MRI NECK SPINE W/O DYE

$351.00

72142

MRI NECK SPINE W/DYE

$420.00

72146

MRI CHEST SPINE W/O DYE

$351.00

72147

MRI CHEST SPINE W/DYE

$421.00

72148

MRI LUMBAR SPINE W/O DYE

$326.00

72149

MRI LUMBAR SPINE W/DYE

$392.00

72156

MRI NECK SPINE W/O & W/DYE

$564.00

72157

MRI CHEST SPINE W/O & W/DYE

$564.00

72158

MRI LUMBAR SPINE W/O & W/DYE

$519.00

72159

MR ANGIO SPINE W/O&W/DYE

$371.00

72170

X-RAY EXAM OF PELVIS

$42.00

72190

X-RAY EXAM OF PELVIS

$51.00

72191

CT ANGIOGRAPH PELV W/O&W/DYE

$399.00

72192

CT PELVIS W/O DYE

$237.00

72193

CT PELVIS W/DYE

$255.00

72194

CT PELVIS W/O & W/DYE

$266.00

72195

MRI PELVIS W/O DYE

$322.00

72196

MRI PELVIS W/DYE

$380.00

72197

MRI PELVIS W/O & W/DYE

$493.00

72198

MR ANGIO PELVIS W/O & W/DYE

$393.00

72200

X-RAY EXAM SI JOINTS

$37.00

72202

X-RAY EXAM SI JOINTS 3/> VWS

$42.00

72220

X-RAY EXAM SACRUM TAILBONE

$37.00

72240

MYELOGRAPHY NECK SPINE

$200.00

72265

MYELOGRAPHY L-S SPINE

$182.00

72270

MYELOGPHY 2/> SPINE REGIONS

$290.00

72291

PERQ VERTE/SACROPLSTY FLUOR

$319.00

72295

X-RAY OF LOWER SPINE DISK

$185.00

73000

X-RAY EXAM OF COLLAR BONE

$36.00

73010

X-RAY EXAM OF SHOULDER BLADE

$42.00

73020

X-RAY EXAM OF SHOULDER

$33.00

73030

X-RAY EXAM OF SHOULDER

$45.00

73040

CONTRAST X-RAY OF SHOULDER

$121.00

73050

X-RAY EXAM OF SHOULDERS

$49.00

73060

X-RAY EXAM OF HUMERUS

$39.00

73070

X-RAY EXAM OF ELBOW

$34.00

73080

X-RAY EXAM OF ELBOW

$37.00

73090

X-RAY EXAM OF FOREARM

$36.00

73092

X-RAY EXAM OF ARM INFANT

$36.00

73100

X-RAY EXAM OF WRIST

$40.00

73110

X-RAY EXAM OF WRIST

$39.00

73115

CONTRAST X-RAY OF WRIST

$124.00

73120

X-RAY EXAM OF HAND

$36.00

73130

X-RAY EXAM OF HAND

$37.00

73140

X-RAY EXAM OF FINGER(S)

$30.00

73200

CT UPPER EXTREMITY W/O DYE

$224.00

73201

CT UPPER EXTREMITY W/DYE

$255.00

73202

CT UPPR EXTREMITY W/O&W/DYE

$266.00

73206

CT ANGIO UPR EXTRM W/O&W/DYE

$395.00

73218

MRI UPPER EXTREMITY W/O DYE

$295.00