Bundled Services

Regional Bundled Total
Gastroenterology
GA1 - COLONOSCOPY w/ 2 biopsies, Pre Exam, Post Exam $4,815.15
$2,120.31
GA2 - Esophagogastroduodenoscopy (EGD) w/ 2 biopsies, Pre Exam, Post Exam $4,381.60 $1,950.56
GA3 - EGD and COLONOSCOPY w/ 5 biopsies, Pre/Post Exams $6,482.47 $3,048.43
GA5 - Diagnostic Colonoscopy w/Pre, Post $4,237.88 $1,861.75
GA6 - Endoscopic Ultrasound w/ FNA w/ biopsies (up to 3 biopsies) & Fluoroscopy $4,890.50 $2,226.17
GA7 - Endoscopic Ultrasound w/ ERCP w/ biopsies (up to 3 biopsies) & Fluoroscopy $13,418.30 $5,502.23
GA8 - COLONOSCOPY w/ lesion removal, Pre, Post $4,849.05 $2,150.94
GA5MN - Diagnostic Colonoscopy, Pre, Post $4,287.88 $1,920.75
GA8MN - Colonoscopy w/ lesion removal, Pre, Post $4,899.05 $2,209.94
GA9MN - Diagnostic Sigmoidoscopy, Pre, Post $2,617.76 $1,238.33
GA10MN - Colorectal Cancer Screening, Not High Risk Individual, Pre, Post $4,478.84 $2,031.67
GA11MN - Upper GI Endoscopy, Pre, Post $4,551.87 $2,061.88
GA12MN - Colorectal Cancer Screening, High Risk Individual, Pre, Post $4,434.82 $2,031.21
GA13MN - COLONOSCOPY w/ control bleeding w/ 2 biopsies, Pre Exam, Post Exam $6,349.98 $2,713.40
GA14MN - Upper GI Scope w/ Submucosal Injection $4,698.70 $2,045.53
GA15MN - EGD w/ Foreign Body Removal, Pre, Post $4,803.91 $2,088.09
GA16MN - COLONOSCOPY w/ 2 biopsies, Pre, Post $4,865.15 $2,186.63
GA17MN - ERCP w/ removal of duct calculi, Pre, Post $10,222.90 $4,351.79
GA18MN - Endoscopic Ultrasound Exam Esophagus, Pre, Post $6,101.86 $2,687.36
GA19MN - EGD Diagnostic Brush/wash $4,410.61 $1,914.43
GA20MN - ERCP Remove Foreign Body/ Stent Biliary/ Panc Duct $10,152.80 $4,322.56
GA21MN - EGD Ultrasound Exam Duodenum/Jejunum $6,122.27 $2,687.36
GA22MN - Endoscopic Ultrasound w/ FNA w/ biopsies (up to 3 biopsies) $4,723.22 $2,758.48
GA23MN - Colonoscopy w/ submucosal injection $4,937.14 $2,174.42
Dermatology
DE2 - Biopsy Skin Lesion (up to 3 biopsies) $1,761.95
$728.33
Ears, Nose and Throat (ENT)
EN2 - Tonsillectomy & Adenoidectomy $5,861.15
$2,479.17
EN3 - Bilateral Myringotomy w/ Tubes $5,827.57 $2,285.95
EN4 - Bone Anchored Hearing Aid Device (BAHA: Includes Device) $39,539.90 $14,956.80
EN5 - Cochlear Implant $41,096.00 $15,183.00
EN6 - Foreign Body Removal $3,930.79 $1,586.46
EN7 - Inner Ear - Stapedectomy $13,623.00 $5,263.98
EN8 - Mastoidectomy $42,762.90 $15,350.90
EN9 - Myringoplasty $8,287.85 $3,158.68
EN10 - Ossiculoplasty $15,203.00 $5,713.20
EN11 - Tymp-Mastoid $14,673.00 $5,451.26
EN12 - Tympanoplasty $16,245.50 $6,123.24
EN13 - Bilateral Submucosal Resection of Turbinates $7,000.77 $2,744.30
EN14 - Nasal Fracture Complex Open $7,023.56 $2,797.84
EN15 - Nasal Fracture Simple Closed $5,746.96 $2,245.71
EN16 - Septoplasty $7,777.06 $3,025.97
EN17 - Adenoidectomy $6,010.43 $2,391.03
EN18 - Adenoidectomy and BMT $14,416.00 $5,820.63
EN19 - Diagnostic Laryngoscopy with Biopsy $6,854.18 $2,706.11
EN20 - Esophagoscopy With or Without Dilatation/Biopsy $4,513.38 $1,839.64
EN21 - Frenulectomy $6,461.33 $2,553.80
EN22 - Thyroglossal Duct Cyst Excision $11,855.90 $4,510.91
EN23 - Tonsillectomy $11,292.60 $4,182.40
EN24 - Tonsillectomy / BMT $14,216.80 $5,890.39
EN25 - Tonsillectomy and Adenoidectomy and BMT $10,403.40 $4,201.93
EN26 - Uvulopalatopharyngoplasty (UPPP) $12,938.30 $4,910.52
Neurology
NE2 - Lower Back Disk Surgery $14,847.50
$6,262.48
OBGYN
OB2 - Dilation & Curettage (D&C), with biopsies (up to 3 biopsies each) $6,040.14
$2,436.53
OB4 - D&C/ Hysteroscopy, with biopsies (up to 3 biopsies each) $6,489.44 $2,853.83
OB6 - Anterior Vaginal Wall Repair $10,240.70 $4,618.37
OB8 - Posterior Vaginal Wall Repair $10,107.40 $4,624.59
OB10 - Endometrial Ablation $11,883.00 $5,026.38
OB12 - Bladder Sling $10,720.60 $4,624.40
OB14 - Diagnostic Laparoscopy $9,861.04 $4,348.60
OB16 - Laparoscopic Ovarian Cystectomy $11,599.80 $5,063.09
OB18 - Laparoscopic Endometriosis Resection $11,599.80 $5,063.09
OB19 - Laparoscopy, Abdomen, Peritoneum, and Omentum, Diagnostic $11,970.30 $4,315.52
OB20 - Rectocele Repair $12,677.80 $4,525.88
OB21 - Laparoscopic assisted vaginal hysterectomy $15,149.50 $5,164.43
OB22 - Hysterectomy (Includes Overnight Stay) $21,091.10 $7,361.04
OB23 - Hysteroscopy $7,759.87 $2,741.55
OB24 - Hysteroscopy / Ablation $17,165.20 $6,204.24
OB25 - Removal of Ovary(s) $13,133.30 $4,805.47
OB26 - Removal of Adhesions, Lesion, Cysts on Ovary(s) $13,293.30 $4,898.77
OB27 - Laparoscopic Hysterectomy w/ Anterior Repair (for urinary incontinence) $26,126.00 $10,979.90
Ophthalmology
OP1 - Blepharoplasty (droopy eyelids) $7,992.42
$2,809.48
OP2 - Eye Muscle Surgery, 1 Muscle $7,710.43 $2,780.08
OP3 - Eye Muscle Surgery, 2 Muscles $11,336.80 $3,952.73
OP4 - Eye Muscle Surgery, More than 2 Muscles $8,540.89 $3,097.90
OP5 - Chalazion $2,729.16 $1,086.12
OP6 - Nasolacrimal Duct Probe - Single $7,122.49 $2,476.72
Orthopedics
OR1 - Anterior Cervical Discectomy w/ Fusion, 1 level (Includes hardware) $40,684.10
$15,985.40
OR2 - Anterior Cervical Discectomy w/ Fusion, 2 levels (Includes hardware) $76,495.40 $29,324.60
OR61 - Microdiscectomy $16,487.30 $6,098.16
OR62 - Lumbar Laminectomy $16,972.00 $6,308.57
OR3 - Distal Clavicle Excision $14,789.20 $5,863.32
OR4 - Open Rotator Cuff Repair $14,467.30 $5,863.32
OR5 - Bankart Stabilization $17,129.50 $6,138.75
OR8 - Manipulation Shoulder / Anesthesia $4,701.13 $1,872.24
OR10 - Repair Pectoralis Muscle Rupture $9,837.66 $3,909.57
OR11 - Repair, Tendon or Muscle, Upper Arm or Elbow, Each Tendon or Muscle, Primary or Secondary (Excludes Rotator Cuff) $9,837.66 $3,909.57
OR43 - Shoulder Arthroscopy $16,370.40 $6,240.93
OR45 - Extensive Debridement, Shoulder $10,018.70 $3,708.20
OR46 - Distal Clavicle Excision (Arthroscopic) $10,158.90 $3,785.16
OR48 - Rotation Cuff Repair (Arthroscopic) $16,324.80 $6,233.89
OR6 - Simple Fracture Requiring Open Reduction, proximal humeral $2,947.89 $1,254.91
OR7 - Complex Fracture (Includes Rodding Humerus / Tibia / Femur) $19,708.50 $7,641.17
OR17 - Closed Reduction & Casting, Distal Radial Fracture $6,232.72 $2,426.79
OR22 - Percutaneous Pinning - Finger 1-2 Pins $6,760.79 $2,627.46
OR9 - Bursectomy (elbow) $6,022.09 $2,442.51
OR12 - Distal Biceps Reattachment (includes hardware) $9,953.06 $3,949.31
OR13 - Tennis elbow (lateral debridement) $8,729.10 $1,802.15
OR44 - Elbow Arthroscopy $6,889.12 $2,602.26
OR66 - Ulnar Nerve Transposition / Epicondylectomy $14,767.20 $5,741.53
OR14 - Dupuytren's Contracture $6,335.19 $1,802.15
OR15 - Ganglion Excision $6,271.38 $2,393.06
OR16 - Suspensionplasty, Arthroplasty, Interposition, Intercarpal or Carpometacarpal Joints $10,935.60 $10,942.00
OR18 - Trigger Finger $7,394.82 $2,789.96
OR19 - Fasciectomy, Partial Palmar w/ Release of Single Digit w/ Proximal Interphalangeal Joint $10,910.70 $4,044.28
OR20 - Synovectomy, Tendon Sheath, Radical, Flexor Tendon, Palm and/or Finger, Each Tendon $6,887.36 $2,691.71
OR21 - Excision of Lesion of Tendon Sheath/Joint Capsule $7,140.17 $2,813.34
OR49 - Wrist Arthroscopy $8,976.37 $3,445.42
OR65 - Carpal Tunnel Release $6,511.56 $2,510.25
OR24 - Medial Collateral Ligament $9,871.96 $3,791.71
OR25 - Posterior Cruciate Ligament Repair $10,975.00 $4,227.83
OR52 - Knee Arthroscopy $9,124.37 $3,542.96
OR53 - Knee Arthroscopy w/ Lateral Release or Microfracture $9,427.62 $3,563.20
OR55 - Complete Synovectomy $9,885.89 $3,768.28
OR56 - Chondroplasty $9,905.00 $3,712.66
OR57 - Med & Lateral Meniscectomy $9,646.38 $3,618.52
OR58 - Anterior Cruciate Ligament (ACL) Repair $20,699.90 $7,800.59
OR28 - Achilles Repair $10,262.20 $3,770.73
OR30 - Brostrom Ligament Reconstruction $9,637.48 $3,739.18
OR60 - Ankle Arthroscopy $9,964.36 $3,798.31
OR29 - Gastrocnemius Recession $9,171.86 $3,446.62
OR31 - Plantar Fasciotomy $6,865.18 $2,726.16
OR32 - Plantar Fasciotomy / Tarsal Tunnel $6,865.18 $2,726.16
OR33 - Neuroma Excision $6,924.93 $2,739.13
OR34 - Ostectomy Partial Excision $6,693.44 $2,641.18
OR35 - Hammertoe (1) $6,898.33 $2,752.81
OR36 - Hammertoe (2) $8,053.33 $3,207.11
OR37 - Hammertoe (3) $9,538.33 $3,791.21
OR39 - Bunionectomy $10,259.50 $4,003.86
OR40 - Osteotomy $10,136.20 $3,895.65
OR41 - Arthrodesis, Great Toe; Metatarsophalangeal Joint $16,053.50 $5,884.77
OR42 - Plantar Fasciitis Ultrasound Treatment (shockwave) $3,417.55 $1,419.98
OR50 - Hip Arthroscopy, Simple $9,821.06 $3,771.69
Pain Management
PA2 - Stellate Ganglion Block $2,901.37
$1,242.42
PA3 - Lumbar Epidural Steroid Injection (with sedation) $3,993.12 $1,493.13
PA4 - Lumbar Epidural Steroid Injection $3,443.12 $1,198.13
PA5 - Reblock for Acute Postop Pain $3,509.61 $1,208.29
PA6 - Lumbar Sympathetic $3,205.62 $1,110.65
PA7 - Cervical Epidural Steriod Injection $2,727.11 $1,198.13
Radiology
RA1 - MRI Upper Joint w/o contrast (Shoulder, Elbow & Wrist) $1,869.14
$757.08
RA2 - MRI Lower Joint w/o contrast (Hip, Knee, Ankle) $1,198.07 $496.50
RA3 - MRI Lower Extremity w/o contrast (Thigh, Leg, Foot) $1,664.88 $715.47
RA4 - MRI Upper Extremity w/o contrast (Arm, Hand, Finger) $1,664.88 $715.47
RA5 - MRI Pelvis/ Sacrum w/o contrast (Sacroiliac Joints) $1,746.32 $724.83
RA6 - MRI Abdomen w/o contrast $1,580.94 $655.96
RA7 - MRI Lumbar Spine w/o contrast $1,142.55 $473.38
RA8 - MRI Chest w/o contrast $1,901.80 $789.59
RA9 - MRI Brain w/o contrast $1,172.53 $485.87
RA10 - MRI on Lower Extremity w/ contrast (Hip, Knee, Ankle) $1,858.31 $903.75
RA11 - MRA w/ contrast (Neck) $2,169.69 $878.67
RA12 - MRA w/o contrast (Neck) $1,869.14 $757.08
RA13 - MRA w&w/o contrast (Neck) $2,713.66 $1,098.75
RA14 - MRA w&w/o contrast (Abdomen) $1,898.89 $769.11
RA15 - CT Abdomen & Pelvis w/o contrast $1,049.59 $434.66
RA16 - CT Abdomen w/o contrast $872.97 $354.05
RA17 - CT Chest w/o contrast $981.66 $406.37
RA18 - CT Lower Extremity w/o contrast $975.98 $404.14
RA19 - CT Upper Extremity w/o contrast $975.98 $404.14
RA20 - CT Head/ Brain w/o contrast $741.72 $300.95
RA21 - CT Lumbar Spine $998.24 $404.73
RA22 - X-Ray Ribs (Unilateral- 3 views) $594.12 $221.64
RA23 - X-Ray Chest (1 view- frontal) $370.97 $199.31
RA24 - X-Ray Ankle (3 views) $403.52 $213.51
RA25 - X-Ray Hip (Unilateral- 2 or 3 views) $623.27 $230.29
RA26 - X-Ray Knee (3 views) $454.80 $221.09
Urology
UR2 - Vasectomy $5,911.60
$2,449.29
UR4 - Inguinal Hernia $10,616.90 $3,739.07
UR5 - Transurethral Resection, Bladder Tumor $8,619.48 $2,974.94
UR6 - Cystoscopy for Stone/ Stent Placement $9,942.44 $3,383.47
UR7 - Cystoscopy with Pyelography $9,024.28 $3,063.41
UR8 - Transurethral Resection, Prostate $13,817.20 $4,697.66
UR9 - Laser Transurethral Resection of Prostate $18,718.80 $6,339.39
UR10 - Testicular Biopsy $5,306.42 $1,963.56
UR11 - Epididymectomy - Partial $8,932.48 $3,248.92
UR12 - Epididymectomy - Total $8,932.48 $3,248.92
UR13 - Hydrocelectomy $9,785.44 $3,454.31
UR14 - Vasovasotomy $9,728.21 $3,388.88
UR15 - Ultrasound-Guided Prostate Biopsy $6,635.17 $2,275.35
UR16 - Anterior Repair $12,703.00 $4,519.66
UR17 - Posterior Repair $12,718.80 $4,525.88
UR18 - Mini-Arc Urethral Suspension $12,922.00 $4,591.31