We Accept Care Credit

Transcription

1 We Accept Care Credit Standard Fee Schedule Valid 1-Jan-18 to 1-July-18 **Prices Subject to Change, Call For Verification** Exam CPT PAYMENT IN FULL AT TIME OF SERVICE EKG TREADMILL PLAIN FILMS/ X-RAYS (X-RAYS ARE WALK-IN 8AM TO 4 PM) ABDOMEN AP VIEW ABDOMEN 2 VIEW ABDOMEN 3 VIEW ABDOMEN SERIES ANKLE UNILATERAL COMPLETE ANKLE UNILATERAL LIMITED BONE AGE STUDIES CALCANEUS (HEEL) CHEST PA CHEST 2 VIEW CHEST 3 VIEW CHEST 4 VIEW CLAVICAL C-SPINE SINGLE VIEW C-SPINE 3 VIEWS OR LESS C-SPINE 4-5 VIEWS C-SPINE 6+ VIEWS DEXA SCAN (BODY COMP/FAT) DEXA SCAN ELBOW 2 VIEW ELBOW UNILATERAL COMPLETE FACICAL BONES MIN 3 VIEWS FEMUR 1 VIEW FEMUR 2 VIEW FINGERS FOOT 2 VIEWS FOOT UNILATERAL FOREARM UNILATERAL AP/LAT HAND 2 VIEWS HAND UNILATERAL Page 1

2 HIP 1 VIEW W/PELVIS HIP 2-3 VIEWS W/PELVIS HIP 4 VIEWS W/PELVIS HIP BILAT W/PELVIS 2 VIEWS HIP BILAT W/PELVIS 3-4 VIEWS HIP BILAT W/PELVIS 5 VIEWS HUMERUS UNILATERAL 2 VIEWS KNEE UNILATERAL COMPLETE KNEE UNILATERAL LIMITED L-SPINE 2-VIEWS L-SPINE 4-VIEWS L-SPINE 5+ VIEWS MANDIBLE 4 VIEWS MANDIBLE 1-3 VIEWS MASTOIDS 3 VIEWS NASAL 3 VIEWS ORBITS 4 VIEWS PELVIS RIBS UNILATERAL 2-VIEW RIBS UNILATERAL 3-VIEW RIBS BILATERAL SACRUM & COCCYX SCOLIOSIS STANDING 2-3 VIEWS SCOLIOSIS STANDING 4-5 VIEWS SHOULDER UNILATERAL 1-VIEW SHOULDER UNI COMPLETE SIALOGRAM S.I. JOINTS SINUSES LESS THAN 3-VIEWS SINUSES PARANASAL SKELETAL SURVEY (LIMITED) SKELETAL SURVEY (COMPLETE) SKULL LESS THAN 4-VIEWS SKULL COMPLETE SOFT TISSUE NECK STERNUM 2 VIEW THORACIC & SWIM VIEW THORACOLUMBAR SPINE TIBIA/FIBULA TMJ BILATERAL TOES T-SPINE 2-VIEW Page 2

3 WRIST 2 VIEW WRIST UNILATERAL COMPLETE MAMMOGRAPHY EACH ADD L VIEW/SPOT/MAG (COULD BE MORE THAN ONE) GALACTOGRAM/DUCTAGRAM , 77053, 77065, Q9965 DIAGNOSTIC MAMMO UNILATERAL DIAGNOSTIC MAMMO BILATERAL DIAGNOSTIC MAMMO BILAT W/IMPLANTS D DIAGNOSTIC MAMMO UNILATERAL 77065, D DIAGNOSTIC MAMMO BILATERAL 77066, D DIAGNOSTIC MAMMO BILAT W/IMPLANTS 77066, SCREENING MAMMO SCREENING MAMMO W/IMPLANTS D SCREENING MAMMO 77067, D SCREENING MAMMO W/IMPLANTS 77067, BIOPSY / FINE NEEDLE ASPIRATION *All Biopsies and Aspirations will have additional charges from the lab* BREAST ASPIRATION 76942, STEREOTACTIC BREAST BIOPSY lab fees BREAST BIOPSY ULTRASOUND GUIDED lab fees CT KIDNEY BIOPSY 50200, lab fees CT LIVER BIOPSY 47000, lab fees CT LUNG BIOPSY 32405, lab fees CT GUIDED BONE MARROW 38221, lab fees CT NECK BIOPSY 21550, lab fees CT MUSCLE/ SOFT TISSUE BIOPSY 20206, lab fees PARACENTESIS THYROID ASPIRATION /FNA 76942, THORACENTESIS MRI BREAST BIOPSY lab fees ULTRASOUND ABDOMEN ABDOMEN AAA SCREENING ABI ONLY ABDOMINAL DOPPLER RENAL DOPPLER QUADRANT/LIMITED BILATERAL LOWER EXT. ARTERIAL BILATERIAL UPPER EXT. ARTERIAL DOPPLER BLADDER POST VOID Page 3

4 BREAST COMPLETE (UNILATERAL) BREAST LIMITED (UNILATERAL) UPPER EXTREMITY DOPPLER (UNILATERAL) ARTERIAL DOPPLER LOWER EXTREMITY (UNILATERAL) HIP (INFANT) CAROTID DOPPLER CRANIUM CHEST ECHO NON-VASCULAR EXTREMITY NON-VASCULAR EXT LIMITED (GROIN / AXILA) SIS 76831, OB MULTIPLE OB SINGLE FETUS >/= 14 WEEKS OB SINGLE FETUS <14 WEEKS OB TRANSVAG (EARLY OB) PARACENTESIS PELVIC / TRANSVAGINAL PELVIC LIMITED PELVIC TRANSABDOMINAL ALONE (ONLY IN SPECIAL CASES) TRANSVAGINAL ALONE (ONLY IN SPECIAL CASES) RETROPERITONEAL (RENAL, BLADDER) RENAL ULTRASOUND SPINAL CANAL TESTICULAR THORACENTESIS THYROID/NECK THYROID ASPIRATION 76942, THYROID BIOPSY 60100, VENOUS DOPPLER (BILATERAL) VENOUS DOPPLER (UNILATERAL) CAT SCAN CT ABD / PELVIS WITHOUT CONTRAST CT ABD/PELVIS WITH CONTRAST CT ABD/PELVIS W/WO CONTRAST CT ABDOMEN WITHOUT CONTRAST CT ABDOMEN WITH CONTRAST CT ABDOMEN W/WO CONTRAST CT ANGIOGRAM ABDOMEN W/WO CONTRAST Q CT ANGIOGRAM AORTA CHEST/ABD/PELVIS W/WO CONTRAST Q9967 Page 4

5 CT ANGIOGRAM BRAIN W/WO CONTRAST Q CT ANGIOGRAM CAROTIDS W/WO CONTRAST Q CT ANGIOGRAM CHEST W/WO CONTRAST Q CT ANGIOGRAM CORONARIES CT ANGIOGRAM CHEST/ABD Q CT ANGIOGRAM LOWER EXT Q CT ANGIOGRAM NECK Q CT ANGIOGRAM PELVIC Q CT ANGIOGRAM PULMONARY Q CT ANGIOGRAM RENAL W/WO CONTRAST Q CT ANGIOGRAM RUN-OFFS W/WO CONTRAST Q CT ANGIOGRAM UPPER EXTREMITIES Q CT BRAIN WITHOUT CONTRAST CT BRAIN WITH CONTRAST CT BRAIN W/WO CONTRAST CT CALCIUM SCORE CT CHEST WITHOUT CONTRAST CT CHEST WITH CONTRAST CT CHEST W/WO CONTRAST CT CERVICAL SPINE WITHOUT CONTRAST CT CERVICAL SPINE WITH CONTRAST CT CERVICAL SPINE W/WO CONTRAST CT LIMITED/ FOLLOW-UP CT LOWER EXTREMITY WITHOUT CONTRAST CT LOWER EXTREMITY WITH CONTRAST CT LOWER EXTREMITY W/WO CONTRAST CT LUMBAR SPINE WITHOUT CONTRAST CT LUMBAR SPINE WITH CONTRAST CT LUMBAR SPINE W/WO CONTRAST CT DENTAL SCAN (DENTISTS ONLY) CT MAXILLOFACIAL CT GUIDED BONE MARROW 77012, lab fees CT PELVIS WITHOUT CONTRAST CT PELVIS WITH CONTRAST CT PELVIS W/WO CONTRAST CT NECK WITHOUT CONTRAST CT NECK WITH CONTRAST CT NECK W/WO CONTRAST CT ORBITS/SELLA/IACS WITHOUT CONTRAST CT ORBITS/SELLA/IACS WITH CONTRAST CT ORBITS W/WO CONTRAST CT THORACIC SPINE WITHOUT CONTRAST Page 5

6 CT THORACIC SPINE WITH CONTRAST CT THORACIC SPINE W/WO CONTRAST CT UPPER EXTREMITY WITHOUT CONTRAST CT UPPER EXTREMITY WITH CONTRAST CT UPPER EXTREMITY W/WO CONTRAST CT NECK/CHST/ABD/PELVIS 70491, 71270, VIRTUAL COLONOSCOPY SCREENING VIRTUAL COLONOSCOPY DIAGNOSTIC ARTHROGRAM HIP / W MRI ARTHROGRAM KNEE ARTHROGRAM SHOULDER ARTHROGRAM WRIST FLUOROSCOPY 73722, 27093, 77002, A9579, Q , 77002, 27370, A9579, Q , 23350, 77002, A9579, Q , 25246, A9579, 77002, Q9967 BARIUM ENEMA W/AIR DYE STUDY ESOPHAGRAM/BARIUM SWALLOW HIP INJECTION 20610, HSG 58340, IVP LUMBAR PUNCTURE 62270, MYELOGRAM / C-SPINE 72126, 62284, Q MYELOGRAM / L-SPINE 72132, 62284, Q PORT PLACEMENT IN ARM 36571, 77001, Q PORT PLACEMENT IN CHEST 36561, 77001, Q PORT ACCESS CHECK (DYE STUDY) 76000, PORT REPLACEMENT IN SAME ACCESS DEVICE PICC LINE 36569, 77001, Q REMOVAL OF VENUS PORT SIALOGRAM 42550, 70390, SMALL BOWEL SERIES SNIFF TEST 76000, UGI W/KUB & AIR UGI W/SBF (74254) VOIDING CYSTOGRAM (VCUG) 51600, VENOGRAM 36005, MRI / MRA MRA ABDOMEN MRA CHEST/THORAX MRA HEAD / BRAIN WITHOUT CONTRAST MRA HEAD / BRAIN WITH CONTRAST Page

7 MRA HEAD / BRAIN W/WO CONTRAST MRA LOWER EXT MRA UPPER EXT MRA NECK / CAROTID WITHOUT CONTRAST MRA NECK / CAROTID WITH CONTRAST MRA NECK / CAROTID W/ WO CONTRAST MRA PELVIS MRA SPINE MRI/MRA BRAIN MRI / TMJ MRI ABDOMEN WITHOUT CONTRAST MRI ABDOMEN WITH CONTRAST MRI ABDOMEN W/WO CONTRAST MRI BRAIN WITHOUT CONTRAST MRI BRAIN WITH CONTRAST MRI BRAIN W/WO CONTRAST MRI BREAST (BILATERAL) MRI BREAST (UNILATERAL) MRI CHEST/THORAX WITHOUT CONTRAST MRI CHEST/THORAX WITH CONTRAST MRI CHEST/THORAX W/WO CONTRAST MRI CERVICAL SPINE WITHOUT CONTRAST MRI CERVICAL SPINE WITH CONTRAST MRI CERVICAL SPINE W/WO CONTRAST MRI HEAD/NECK/FACE WITHOUT MRI LOWER EXT WITHOUT CONTRAST MRI LOWER EXT WITH CONTRAST MRI LOWER EXT. W/WO CONTRAST MRI LOWER EXT. JOINT WITHOUT CONTRAST MRI LOWER EXT JOINT WITH CONTRAST MRI LOWER EXT. JOINT W/WO CONTRAST MRI L-SPINE WITHOUT CONTRAST MRI L-SPINE WITH CONTRAST MRI L-SPINE W/ WO CONTRAST MRI PELVIS WITHOUT CONTRAST MRI PELVIS WITH CONTRAST MRI PELVIS W/WO CONTRAST MRI T-SPINE WITHOUT CONTRAST MRI T-SPINE WITH CONTRAST MRI T-SPINE W/WO CONTRAST MRI TMJ MRI UPPER EXT. JOINT WITHOUT Page 7

8 MRI UPPER EXT. JOINT WITH CONTRAST MRI UPPER EXT JOINT W/WO CONTRAST MRI UPPER EXT. NON JOINT WITHOUT CONTR MRI UPPER EXT NON JOINT W/WO CONTR MRI-ORBIT/FACE/NECK WITHOUT CONTRAST MRI-ORBIT/FACE/NECK WITH CONTRAST MRI-OBIT/FACE/NECK W/WO CONTRAST NUCLEAR MEDICINE 3 PHASE BONE SCAN / MDP (A9503) 425 BONE SCAN, WHOLE BODY 78306, A GASTRIC EMPTY SCAN 78264, A GASTRIC EMPTY WITH SB TRANSIT 78265, A HIDA SCAN 78226(7), A9537, J /550 LEXISCAN 78452, 93015, A9500, J2785 LIMITED BONE SCAN / MDP (A9503) 250 LIVER/SPLEEN SCAN / Sulfur Colloid (A9520) MECKEL SCAN MIRALUMA SCAN 78800, A MUGA SCAN 78472, A9538, A CARDIOLITE STESS TEST 78452, 93015, A OCTREOSCAN 78803, 78804, A PARATHYROID SUBRACTION PET SCAN LIMITED PET SCAN 78812, A PET SCAN W/ CT CAP, NECK 78812, 70491, 74178, 71270, A9552, Q PROSTASCINT SCAN 78802, 78803, A RENAL SCAN 78707, A SPECT SCAN 78320,A THYROID ABLATION STUDY 79005, A THYROID UPTAKE SCAN 78014, A VQ SCAN 78580, 78582, A9539, A9540 WHITE BLOOD CELL COUNT LIMITED 78805, A WHITE BLOOD CELL COUNT WHOLE BDY 78806, A Page 8