OFFICE VISITS
- New Patient Consult: $450.00
- Established Patient Visit: $165.00
- Urine Toxicology Screen: $200
- Telemedicine Self Pay $165.00
- IT Pump Refill: $250
PROCEDURES
- 77003 Fluoroscopy: $100
- 20552 Trigger Point Injection: $63
- 20553 Trigger Point Injection: $72
- 20600 Small Bursa Injection: $60
- 20605 Medium Bursa Injection: $62
- 20610 Large Bursa Injection: $73
- 27096 Sacroiliac Joint Injection: $190
- 61070 Pump Dye Study: $65
- 61790 Gasserian: $1,000
- 62273 Epidural Blood Patch: $196
- 62290 Lumbar Discogram: $426
- 62291 Cervical Discogram: $400
- 62321 Cervical Epidural Steroid Injection: $311
- 62323 Lumbar Epidural Steroid Injection: $310
- 62362 (pump) + 62350 (catheter) Intrathecal Pump Implant: $438 + $456 = $894
- 62362 Intrathecal Pump Revision: $337
- 62365 Intrathecal Pump Removal: $310
- 62355 Intrathecal Catheter Removal: $344
- 63650 Spinal Cord Stimulator Trial: $2,600
- 63650 (electrode) + 63685 (generator) Spinal Cord Stimulator Implant: $2,363.61 + $374.23 = $3,012
- 63663 Spinal Cord Stimulator Electrode Revision: $1,037
- 63688 Spinal Cord Stimulator Generator Revision: $423
- 64400 Trigeminal Nerve Block: $130
- 64405 Greater Occipital Nerve Block: $85
- 64420 Intercostal Nerve Block (single): $115
- 64413 Cervical Plexus Block: $167
- 64415 Brachial Plexus Block: $131
- 64418 Suprascapular Block: $102
- 64420 Intercostal Nerve Block: $115
- 64421 Intercostal Nerve Block (multiple): $115 + $39 = $154
- 64425 Illionguinal Nerve Block: $132
- 64430 Pudenal Nerve Block: $112
- 64445 Sciatic/Pyriformis Muscle: $148
- 64450 Peripheral Nerve Block/ Genicular Nerve Block: $90
- 64479 Cervical Transforaminal Epidural Steroid Injection: $307
- 64480 Cervical Transforaminal Epidural Additional Levels: $153
- 64483 Lumbar Transforaminal Epidural Steroid Injection: $286
- 64484 Lumbar Transforaminal Epidural Additional Levels: $128
- 64490 Cervical Medial Branch Block: $223
- 64491 Cervical Medical Branch Additional Levels: $113
- 64493 Lumbar Medial Branch Block: $205
- 64494 Lumbar Medial Branch Additional Levels: $105
- 64495 ^ third additional levels: $105
- 64505 Shenopalantine: $156
- 64510 Stellate Ganglion Block: $170
- 64517 Superior Hypogas: $223
- 64520 Paravertebral Sympathetic Nerve Block: $267
- 64530 Celiac Plexus Nerve Block: $268
- 64600 Trigeminal Nerve Block: $538
- 64615 Botox: $225 + $100 Flouro (if used)
- 64633 Cervical Radiofrequency: $488
- 64635 Lumbar Radiofrequency: $484
- 64636 Radiofrequency additional levels: $202
EMG
- 95885: $70
- 95886: $109
- 95907: $100
- 95908: $124
- 95909: $149
- 95910: $195
- 95911: $235
- 95912: $273
- 95913: $317
DME
- Back Brace: $200
- Knee Brace: $210
- Knee Control Condylar Pad: $108
- Knee Orthosis: $729
- Knee Sleeve: $45
- Necker Collar: $150
- Suspension Sleeve (lower ext): $126
- TENS Unit: $50
- TENS Pad Pack: $35
- TENS Pad Single: $10
- Theraband: $10
MPD Self Pay Fee Schedule
- Initial exam: $125
- Established exam: $85
- 1-2 region adjustment: $35
- 3-4 region adjustment: $45
- Electrical muscle stimulation: $10 per session
- Heat/ice: $5 per session
- Intervertebral decompression: $45 per session
- Low level Laser: $35 per session
- Therapeutic exercise: $35 per session
- Acupuncture $50.00 with an added $20.00 per additional region.
- Balance Test: $50
- VNG: $150
FCE: $400