Van Diest Medical Center

All Services Surgery
CPT 49650 Laparoscopy, surgical; repair initial inguinal hernia See All Rates
CPT 66984 Removal of cataract with insertion of lens See All Rates
CPT 45385 Removal of polyps or growths of large bowel using an endoscope See All Rates
CPT 43239 Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope See All Rates
CPT 28485 Open treatment of metatarsal fracture, includes internal fixation, when performed, each See All Rates
MSDRG 216 Cardiac Valve Replacement See All Rates
CPT 20610 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance $402.00 Standard Charge See All Rates
MSDRG 743 Uterine and adnexa procedures for non-malignancy See All Rates
MSDRG 470 Major joint replacement or reattachment of lower extremity See All Rates
CPT 41899 Oral Rehabilitation See All Rates
CPT 45378 Diagnostic examination of large bowel using an endoscope See All Rates
CPT 45380 Biopsy of large bowel using an endoscope See All Rates
CPT 27698 Repair, secondary, disrupted ligament, ankle, collateral (eg, Watson-Jones procedure) See All Rates
MSDRG 473 Cervical spinal fusion See All Rates
CPT 43235 Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope See All Rates
CPT 27096 Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or ct) including arthrography when performed See All Rates
CPT 27792 Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when performed See All Rates
CPT 64454 Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed See All Rates
CPT 64493 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level See All Rates
CPT 47562 Removal of gallbladder using an endoscope See All Rates
CPT 64483 Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance See All Rates
CPT 36415 Collection of venous blood by venipuncture $21.00 Standard Charge See All Rates
CPT 62321 Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (ie, fluoroscopy or CT) See All Rates
CPT 49505 Repair of groin hernia patient age 5 years or older See All Rates
CPT 28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy) See All Rates
CPT 62323 Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT) See All Rates
CPT 28825 Amputation, toe; interphalangeal joint See All Rates
CPT 66982 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; without endoscopic cyclophotocoagulation See All Rates
CPT 28820 Amputation, toe; metatarsophalangeal joint See All Rates
CPT 64635 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint See All Rates
CPT 27822 Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; without fixation of posterior lip See All Rates
CPT 20680 Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate) See All Rates
CPT 64624 Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed See All Rates
MSDRG 460 Spinal fusion except cervical See All Rates
CPT 62322 Injection of substance into spinal canal of lower back or sacrum using imaging guidance $531.00 Standard Charge See All Rates
CPT 54700 Incision and drainage of epididymis, testis and/or scrotal space (eg, abscess or hematoma) See All Rates
CPT 44970 Laparoscopy, surgical, appendectomy See All Rates

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All Services Surgery

Laparoscopy, surgical; repair initial inguinal hernia

Removal of cataract with insertion of lens

Removal of polyps or growths of large bowel using an endoscope

Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope

Open treatment of metatarsal fracture, includes internal fixation, when performed, each

Cardiac Valve Replacement

Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance

Uterine and adnexa procedures for non-malignancy

Major joint replacement or reattachment of lower extremity

Oral Rehabilitation

Diagnostic examination of large bowel using an endoscope

Biopsy of large bowel using an endoscope

Repair, secondary, disrupted ligament, ankle, collateral (eg, Watson-Jones procedure)

Cervical spinal fusion

Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope

Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or ct) including arthrography when performed

Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when performed

Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level

Removal of gallbladder using an endoscope

Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance

Collection of venous blood by venipuncture

Repair of groin hernia patient age 5 years or older

Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)

Amputation, toe; interphalangeal joint

Amputation, toe; metatarsophalangeal joint

Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint

Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; without fixation of posterior lip

Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)

Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed

Spinal fusion except cervical

Injection of substance into spinal canal of lower back or sacrum using imaging guidance

Incision and drainage of epididymis, testis and/or scrotal space (eg, abscess or hematoma)

Laparoscopy, surgical, appendectomy