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.

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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
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
10120 REMOVE FOREIGN BODY $472.00
10160 PUNCTURE DRAINAGE OF
LESION
$425.00
12001 RPR S/N/AX/GEN/TRNK
2.5CM/<
$196.00
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
$1,616.00
19081 BX BREAST 1ST LESION
STRTCTC
$808.00
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
20206 NEEDLE BIOPSY MUSCLE $269.00
20220 BONE BIOPSY
TROCAR/NEEDLE
$332.00
20225 BONE BIOPSY
TROCAR/NEEDLE
$504.00
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
$442.00
20610 DRAIN/INJ JOINT/BURSA
W/O US
$221.00
20611 DRAIN/INJ JOINT/BURSA
W/US
$552.00
20611 DRAIN/INJ JOINT/BURSA
W/US
$276.00
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
$452.00
23350 INJECTION FOR
SHOULDER X-RAY
$226.00
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
$618.00
27096 INJECT SACROILIAC
JOINT
$309.00
27370 INJECTION FOR KNEE
X-RAY
$232.00
27648 INJECTION FOR ANKLE
X-RAY
$230.00
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
$1,428.00
32557 INSERT CATH PLEURA W/
IMAGE
$714.00
32560 TREAT PLEURODESIS
W/AGENT
$354.00
32561 LYSE CHEST FIBRIN
INIT DAY
$317.00
32562 LYSE CHEST FIBRIN
SUBQ DAY
$275.00
32994 ABLATE PULM TUMOR
PERQ CRYBL
$2,159.00
32998 ABLATE PULM TUMOR
PERQ RF
$1,233.00
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
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
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
35471 REPAIR ARTERIAL
BLOCKAGE
$2,498.00
35475 REPAIR ARTERIAL
BLOCKAGE
$2,245.00
35476 REPAIR VENOUS
BLOCKAGE
$1,425.00
36000 PLACE NEEDLE IN VEIN $30.00
36002 PSEUDOANEURYSM
INJECTION TRT
$476.00
36005 INJECTION EXT
VENOGRAPHY
$444.00
36005 INJECTION EXT
VENOGRAPHY
$222.00
36010 PLACE CATHETER IN
VEIN
$1,108.00
36010 PLACE CATHETER IN
VEIN
$554.00
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
$1,320.00
36014 PLACE CATHETER IN
ARTERY
$660.00
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 $2,990.00
36224 PLACE CATH CAROTD ART $1,495.00
36225 PLACE CATH SUBCLAVIAN
ART
$1,365.00
36226 PLACE CATH VERTEBRAL
ART
$1,498.00
36227 PLACE CATH XTRNL
CAROTID
$946.00
36227 PLACE CATH XTRNL
CAROTID
$473.00
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
$2,516.00
36246 INS CATH ABD/L-EXT
ART 2ND
$1,258.00
36247 INS CATH ABD/L-EXT
ART 3RD
$2,998.00
36247 INS CATH ABD/L-EXT
ART 3RD
$1,499.00
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
$832.00
36569 INSJ PICC 5 YR+ W/O
IMAGING
$416.00
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
37182 INSERT HEPATIC SHUNT
(TIPS)
$3,624.00
37183 REMOVE HEPATIC SHUNT
(TIPS)
$1,767.00
37184 PRIM ART M-THRMBC 1ST
VSL
$4,038.00
37184 PRIM ART M-THRMBC 1ST
VSL
$2,019.00
37186 SEC ART THROMBECTOMY
ADD-ON
$1,124.00
37187 VENOUS MECH
THROMBECTOMY
$3,796.00
37187 VENOUS MECH
THROMBECTOMY
$1,898.00
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
37210 EMBOLIZATION UTERINE
FIBROID
$2,427.00
37211 THROMBOLYTIC ART
THERAPY
$3,496.00
37211 THROMBOLYTIC ART
THERAPY
$1,748.00
37212 THROMBOLYTIC VENOUS
THERAPY
$3,086.00
37212 THROMBOLYTIC VENOUS
THERAPY
$1,543.00
37213 THROMBLYTIC ART/VEN
THERAPY
$2,092.00
37213 THROMBLYTIC ART/VEN
THERAPY
$1,046.00
37214 CESSJ THERAPY CATH
REMOVAL
$1,274.00
37214 CESSJ THERAPY CATH
REMOVAL
$637.00
37215 TRANSCATH STENT CCA
W/EPS
$5,140.00
37220 ILIAC REVASC $1,840.00
37221 ILIAC REVASC W/STENT $4,632.00
37221 ILIAC REVASC W/STENT $2,316.00
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
$3,150.00
37246 TRLUML BALO ANGIOP
1ST ART
$1,575.00
37248 TRLUML BALO ANGIOP
1ST VEIN
$1,355.00
37249 TRLUML BALO ANGIOP
ADDL VEIN
$664.00
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
$652.00
38505 NEEDLE BIOPSY LYMPH
NODES
$326.00
38550 REMOVAL NECK/ARMPIT
LESION
$2,310.00
38792 RA TRACER ID OF
SENTINL NODE
$183.00
42400 BIOPSY OF SALIVARY
GLAND
$258.00
43752 NASAL/OROGASTRIC
W/TUBE PLMT
$181.00
44500 INTRO
GASTROINTESTINAL TUBE
$109.00
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
$2,128.00
47538 PERQ PLMT BILE DUCT
STENT
$1,064.00
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
$906.00
50387 CHANGE NEPHROURETERAL
CATH
$453.00
50389 REMOVE RENAL TUBE
W/FLUORO
$494.00
50389 REMOVE RENAL TUBE
W/FLUORO
$247.00
50390 DRAINAGE OF KIDNEY
LESION
$439.00
50392 INSERT KIDNEY DRAIN $1,630.00
50392 INSERT KIDNEY DRAIN $815.00
50393 INSERT URETERAL TUBE $1,982.00
50393 INSERT URETERAL TUBE $991.00
50394 INJECTION FOR KIDNEY
X-RAY
$460.00
50394 INJECTION FOR KIDNEY
X-RAY
$230.00
50395 CREATE PASSAGE TO
KIDNEY
$825.00
50398 CHANGE KIDNEY TUBE $666.00
50398 CHANGE KIDNEY TUBE $333.00
50430 NJX PX NFROSGRM
&/URTRGRM
$752.00
50431 NJX PX NFROSGRM
&/URTRGRM
$376.00
50431 NJX PX NFROSGRM
&/URTRGRM
$188.00
50432 PLMT NEPHROSTOMY
CATHETER
$1,984.00
50432 PLMT NEPHROSTOMY
CATHETER
$992.00
50433 PLMT NEPHROURETERAL
CATHETER
$764.00
50434 CONVERT NEPHROSTOMY
CATHETER
$879.00
50435 EXCHANGE NEPHROSTOMY
CATH
$574.00
50435 EXCHANGE NEPHROSTOMY
CATH
$287.00
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
$1,962.00
50693 PLMT URETERAL STENT
PRQ
$981.00
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
60300 ASPIR/INJ THYROID
CYST
$219.00
61055 INJECTION INTO BRAIN
CANAL
$606.00
61070 BRAIN CANAL SHUNT
PROCEDURE
$379.00
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
$1,160.00
64479 INJ FORAMEN EPIDURAL
C/T
$580.00
64480 INJ FORAMEN EPIDURAL
ADD-ON
$279.00
64483 INJ FORAMEN EPIDURAL
L/S
$1,018.00
64483 INJ FORAMEN EPIDURAL
L/S
$509.00
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
$836.00
64493 INJ PARAVERT F JNT
L/S 1 LEV
$418.00
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
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
73219 MRI UPPER EXTREMITY
W/DYE
$343.00
73220 MRI UPPR EXTREMITY
W/O&W/DYE
$471.00
73221 MRI JOINT UPR EXTREM
W/O DYE
$301.00
73222 MRI JOINT UPR EXTREM
W/DYE
$356.00
73223 MRI JOINT UPR EXTR
W/O&W/DYE
$469.00
73225 MR ANGIO UPR EXTR
W/O&W/DYE
$380.00
73500 X-RAY EXAM OF HIP $42.00
73501 X-RAY EXAM HIP UNI 1
VIEW
$26.00
73502 X-RAY EXAM HIP UNI
2-3 VIEWS
$50.00
73503 X-RAY EXAM HIP UNI
4/> VIEWS
$64.00
73510 X-RAY EXAM OF HIP $51.00
73520 X-RAY EXAM OF HIPS $60.00
73521 X-RAY EXAM HIPS BI 2
VIEWS
$51.00
73522 X-RAY EXAM HIPS BI
3-4 VIEWS
$42.00
73523 X-RAY EXAM HIPS BI
5/> VIEWS
$45.00
73525 CONTRAST X-RAY OF HIP $124.00
73530 X-RAY EXAM OF HIP $65.00
73540 X-RAY EXAM OF PELVIS
& HIPS
$48.00
73550 X-RAY EXAM OF THIGH $40.00
73551 X-RAY EXAM OF FEMUR 1 $37.00
73552 X-RAY EXAM OF FEMUR
2/>
$42.00
73560 X-RAY EXAM OF KNEE 1
OR 2
$42.00
73562 X-RAY EXAM OF KNEE 3 $45.00
73564 X-RAY EXAM KNEE 4 OR
MORE
$52.00
73565 X-RAY EXAM OF KNEES $43.00
73580 CONTRAST X-RAY OF
KNEE JOINT
$129.00
73590 X-RAY EXAM OF LOWER
LEG
$37.00
73592 X-RAY EXAM OF LEG
INFANT
$36.00
73600 X-RAY EXAM OF ANKLE $36.00
73610 X-RAY EXAM OF ANKLE $37.00
73615 CONTRAST X-RAY OF
ANKLE
$124.00
73620 X-RAY EXAM OF FOOT $34.00
73630 X-RAY EXAM OF FOOT $37.00
73650 X-RAY EXAM OF HEEL $36.00
73660 X-RAY EXAM OF TOE(S) $28.00
73700 CT LOWER EXTREMITY
W/O DYE
$224.00
73701 CT LOWER EXTREMITY
W/DYE
$255.00
73702 CT LWR EXTREMITY
W/O&W/DYE
$268.00
73706 CT ANGIO LWR EXTR
W/O&W/DYE
$419.00
73718 MRI LOWER EXTREMITY
W/O DYE
$295.00
73719 MRI LOWER EXTREMITY
W/DYE
$354.00
73720 MRI LWR EXTREMITY
W/O&W/DYE
$469.00
73721 MRI JNT OF LWR EXTRE
W/O DYE
$299.00
73722 MRI JOINT OF LWR EXTR
W/DYE
$359.00
73723 MRI JOINT LWR EXTR
W/O&W/DYE
$469.00
73725 MR ANG LWR EXT W OR
W/O DYE
$398.00
74018 X-RAY EXAM ABDOMEN 1
VIEW
$40.00
74019 X-RAY EXAM ABDOMEN 2
VIEWS
$51.00
74021 X-RAY EXAM ABDOMEN 3+
VIEWS
$60.00
74022 X-RAY EXAM SERIES
ABDOMEN
$68.00
74150 CT ABDOMEN W/O DYE $261.00
74160 CT ABDOMEN W/DYE $279.00
74170 CT ABDOMEN W/O &
W/DYE
$307.00
74174 CT ANGIO ABD&PELV
W/O&W/DYE
$817.00
74175 CT ANGIO ABDOM W/O
& W/DYE
$418.00
74176 CT ABD & PELVIS
W/O CONTRAST
$370.00
74177 CT ABD & PELV
W/CONTRAST
$388.00
74178 CT ABD & PELV
1/> REGNS
$429.00