Master Prices

Before slash is insurance rate, after slash is self pay rate

Office Visits

NEW PATIENT FEE ESTABLISHED FEE

PLEASE SEE PRINT OUT/ until this can be updated

Injections

PLEASE SEE APRIL'S EMAIL SENT 06-25-WORKING ON GETTING THIS MOVED INTO OUR MANUAL

Name Code Fee These prices ONLY reflect for the actual medicine!

Hyalgan J7321
SynviscONE J7325
Kenalog per 10mg J3301 ***Ultrasound fee COULD be an added fee, call Billing for more information***
Euflexxa J7323
Zilretta J3304
Orthovisc J7324
Monovisc J7327
Gel-One J7326
Durolane J7318

Fracture Care

Code Fee
25565
25600
25605
26600
26605
27752
27786
28400
28470

Casts

Cast Code Fee
Above Elbow 29065 447/335
Below Elbow 29075 403/302
Hand/Forearm 29085 444/333
Finger 29086 371/278
Above Knee 23945 632/474
Above Knee Walk 29355 651/488
Below Knee 29405 337/253
Below Knee Walk 29425 363/272
PTB 29435 549/412
Extension Cast 29799 varies
Casting Supplies A4590 Arm: 75
(Syn, goretex wet/dry) Leg: 148

Splints

Splint Code Fee
Above Elbow 29105 408/306
Below Elbow; Static 29125 301/226
Above Knee 29505 395/296
Below Knee 29515 334/251
Hallux Strapping 29550 87/65

Xray

Description Views Code Fee
AC Joints 73050 164/123
Ankle 2 73600 136/102
Ankle 3 73610 144/108
Calcaneus 73650 125/94
Clavicle 73000 128/96
Elbow 2 73070 125/94
Elbow 3 73080 144/108
Femur 1 73551 126/95
Femur 2+ 73552 151/113
Finger 73140 147/110
Foot 2 73620 133/100
Foot 3 73630 134/101
Forearm 2 73090 118/89
Hand 2 73120 130/98
Hand 3 73130 146/110
Hip 1 73501 138/104
Hip 2-3 73502 190/143
Hip 4+ 73503 237/178
Hip w/ Pelvis 2 73521 172/129
Hip w/ Pelvis 3-4 73522 224/168
Humerous 2 73060 133/100
Knee 1-2 73560 143/107
Knee 3 73562 164/123
Knee 4 73564 181/134
Bilat Stand 73565 164/123
Pelvis 1-2 72170 146/110
Ribs 2 71100 152/114
Scoliosis 1 72081 177/133
Scoliosis 2-3 72082 285/214
Scoliosis 4-5 72083 306/230
Scoliosis 6+ 72083 366/275
Shoulder 1 73020 105/79
Shoulder 2 73030 134/101
Spine 1 72020 102/77
Spine - Cervical 2 72040 152/114
w/ obl 4+ 72050 207/155
w/obl & flex/ext 72052 256/192
Thoracic 2 72070 156/117
Thoracolumbar 2 72080 154/116
Lumbar 3 72100 160/120
w/ obl 4-5 72050 207/155
w/ bending 6-7 72114 282/212
Coccyx/Sacrum 72220 89/67
Tib/Fib 2 73590 142/107
Toes 2 73660 130/98
Wrist 2 73100 144/108
Wrist 3+ 73110 160/120
Hip to Ankle 77077 279/209

MRI

Description Code Fee-Allowable/Self pay rates Self Pay Rate Flat Rate No INS

Lower Ext 73721 1871/936 670
Upper Ext 73221 1871/936 670
Lower Ext - non joint 73718 1687/844 670
Upper Ext - non joint 73218 1871/936 670
C-Spine 72141 1916/958 670
T-Spine 72146 2047/1024 670
Spinal Canal 72147 2319/1160 670
L-Spine 72148 2047/1024 670
Brain w/wo cont 70553 3866/1933 670
Pelvis 72195 2430/1215 670
Low-Ext w/wo cont 73723 2259/1129.50 670
Up-Ext w/wo cont 73223 1899/950 670
Low (non jnt) w/wo cont 73720 1899/950 670
Up (non jnt) w/wo cont 73220 1899/950 670
C-Spine w/wo cont 72156 3599/1799 670
T-Spine w/wo cont 72157 3599/1799 670
L-Spine w/wo cont 72158 2699/1350 670

L-w/ cont materials 72149 1742/871 670

EMG and NCS codes and Fees

EMG Code Fee

95885 272/204
95886 421/316
95860 331/248
95870 437/328

NCS Code Fee

95907 450/338
95908 900/675
95909 1500/1125
95910 2100/1575
95911 2700/2025
95912 3300/2475
95913 3900/2925

Special Procedures

Special Procedures Code Fee

Hardware Rem. Superf. 20670 1318/989
Trigger Finger Release 26055 2434/1826
Tendon Sheath 20550 245/184
Finger/Toe 20600 222/167
Wrist/Elbow/Ankle 20605 233/175
Shoulder/Hip/Knee 20610 279/209
Tendon Origin/Insertion 20551 280/210
1 or 2 Muscle Groups 20552 254/191
3+ Muscle Goups 20553 293/220
Carpal Tunnel 20526 358/269
Periph Nerve Block 6450 369/277