| CASH PRICE | ||
|
Cervical/Thoracic Epidural Steroid Injection |
62321 |
$290.00 |
|
Lumbar Epidural Steroid Injection |
62323 |
$286.00 |
|
|
|
|
|
Lumbar Selective Nerve Root Block |
|
|
|
1 Level |
64483 |
$271.00 |
|
2 Level |
64484 |
$373.00 |
|
Bilateral 1 Level |
64483 |
$384.00 |
|
CERVICAL FACET/THORACIC FACETS |
|
|
|
1 Level |
64490 |
$223.00 |
|
2 Level |
64491 |
$313.00 |
|
3 Level |
64492 |
$358.00 |
|
Bilateral 1 Level |
64490 |
$311.00 |
|
Bilateral 2 Level |
64491 |
$447.00 |
|
Bilateral 3 Level |
64492 |
$583.00 |
|
LUMBAR FACET |
|
|
|
1 Level |
64493 |
$208.00 |
|
2 Level |
64494 |
$292.00 |
|
3 Level |
64495 |
$375.00 |
|
Bilateral 1 Level |
64493 |
$289.00 |
|
Bilateral 2 Level |
64494 |
$415.00 |
|
Bilateral 3 Level |
64495 |
$540.00 |
|
CERVICAL/THORACIC FACETS W/RF |
|
|
|
1 Level |
64633 |
$434.00 |
|
2 Level |
64634 |
$607.00 |
|
3 Level |
64634 |
$694.00 |
|
Bilateral 1 Level |
64633 |
$628.00 |
|
Bilateral 2 Level |
64634 |
$888.00 |
|
Bilateral 3 Level |
64634 |
$1,149.00 |
|
LUMBAR FACET W/ RF |
|
|
|
1 Level |
64635 |
$430.00 |
|
2 Level |
64636 |
$588.00 |
|
3 Level |
64636 |
$746.00 |
|
Bilateral 1 Level |
64635 |
$622.00 |
|
Bilateral 2 Level |
64636 |
$859.00 |
|
Bilateral 3 Level |
64636 |
$1,097.00 |
|
New Patient 3 |
99203 |
$103.00 |
|
Established OV 3 |
99213 |
$83.00 |
|
Presumptive Urine Drug Screen |
80307 |
$60.00 |
