Pricing Transparency Policy
As a recipient of Federal financial assistance, the facility affiliates shall not exclude, deny benefits to, or otherwise discriminate against any person on the basis of age, race, color, national origin, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation, or gender identity or expression, in admission to, participation in, or receipt of the services and benefits under any of its programs and activities, or in employment therein, whether carried out by the affiliate directly or through a contractor or any other entity with which the affiliate arranges to carry out its programs and activities.
This statement is in accordance with the provisions of Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, Regulations of the U.S. Department of Health and Human Services issued pursuant to the Acts, Title 45 Code of Federal Regulations Parts 80, 84, 91 and Section 1557 of the Patient Protection and Affordable Care Act of 2010, 42 U.S.C. § 18116.
| 45385 |
Colonscopy w/removal of tumor or polyp |
$5,076 |
| 43239 |
EGD w/biopsy |
$5,076 |
| 45380 |
Colonoscopy w/biopsy |
$5,076 |
| 45378 |
Colonoscopy |
$5,076 |
| 43248 |
EGD w/dilation |
$3,618 |
| 64635 |
Lumbar Radiofrequency Ablation 1st level |
$5,985 |
| 64636 |
Lumbar Radiofrequency Ablation addtl level |
$1,950 |
| 62321 |
Cervical Epidural Steroid injection |
$2,164 |
| 62323 |
Lumbar Epidural Steroid Injection |
$2,164 |
| 64479 |
Cervical Transforaminal Epidural Injection 1st level |
$2,711 |
| 64480 |
Cervical Transforaminal Epidural Injection addtl level |
$1,950 |
| 64483 |
Lumbar Transforaminal Epidural Injection 1st level |
$2,711 |
| 64484 |
Lumbar Transforaminal Epidural Injection addtl level |
$1,950 |
| 64490 |
Cervical Facet Joint injection 1st level |
$2,711 |
| 64491 |
Cervical Facet Joint Injection 2nd level |
$1,950 |
| 64491 |
Cervical Facet Joint Injection 2nd level |
$1,950 |
| 64491 |
Cervical Facet Joint Injection 2nd level |
$1,950 |
| 64492 |
Cervical Facet Joint Injection 3rd level |
$1,950 |
| 64493 |
Lumbar Facet Joint Injection 1st level |
$2,711 |
| 64494 |
Lumbar Facet Joint Injection 2nd level |
$1,950 |
| 64495 |
Lumbar Facet Joint Injection 3rd level |
$1,950 |
| 64520 |
Lumbar or Thoracic Paravertebral Sympathetic Nerve block |
$2,711 |
| 64624 |
Genicular Nerve Radiofrequency Ablation |
$5,985 |
| 64633 |
Cervical Radiofrequency Ablation 1st level |
$5,985 |
| 64634 |
Cervical Radiofrequency Ablation additional level |
$2,651 |
| G0260 |
SI Joint Injection |
$2,651 |
AMA/CPT Copyright Notice Copyright Notice CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply. Fee schedules, relative value units, conversion factors and/or related components aren't assigned by the AMA, aren't part of CPT, and the AMA isn't recommending their use. The AMA doesn't directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.