-
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.
| 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 |
