We Accept Care Credit Standard Fee Schedule Valid 1-Jan-18 to 1-July-18 **Prices Subject to Change, Call 702-222-3544 For Verification** Exam CPT PAYMENT IN FULL AT TIME OF SERVICE EKG 93000 35 TREADMILL 93015 80 PLAIN FILMS/ X-RAYS (X-RAYS ARE WALK-IN 8AM TO 4 PM) ABDOMEN AP VIEW 74018 30 ABDOMEN 2 VIEW 74019 35 ABDOMEN 3 VIEW 74021 45 ABDOMEN SERIES 74022 50 ANKLE UNILATERAL COMPLETE 73610 40 ANKLE UNILATERAL LIMITED 73600 35 BONE AGE STUDIES 77072 30 CALCANEUS (HEEL) 73650 30 CHEST PA 71045 30 CHEST 2 VIEW 71046 35 CHEST 3 VIEW 71047 45 CHEST 4 VIEW 71048 50 CLAVICAL 73000 30 C-SPINE SINGLE VIEW 72020 30 C-SPINE 3 VIEWS OR LESS 72040 40 C-SPINE 4-5 VIEWS 72050 50 C-SPINE 6+ VIEWS 72052 65 DEXA SCAN (BODY COMP/FAT) 76499 75 DEXA SCAN 77080 50 ELBOW 2 VIEW 73070 30 ELBOW UNILATERAL COMPLETE 73080 35 FACICAL BONES MIN 3 VIEWS 70150 45 FEMUR 1 VIEW 73551 30 FEMUR 2 VIEW 73552 35 FINGERS 73140 35 FOOT 2 VIEWS 73620 30 FOOT UNILATERAL 73630 35 FOREARM UNILATERAL AP/LAT 73090 30 HAND 2 VIEWS 73120 30 HAND UNILATERAL 73130 35 Page 1
HIP 1 VIEW W/PELVIS 73501 35 HIP 2-3 VIEWS W/PELVIS 73502 45 HIP 4 VIEWS W/PELVIS 73503 55 HIP BILAT W/PELVIS 2 VIEWS 73521 45 HIP BILAT W/PELVIS 3-4 VIEWS 73522 55 HIP BILAT W/PELVIS 5 VIEWS 73523 65 HUMERUS UNILATERAL 2 VIEWS 73060 35 KNEE UNILATERAL COMPLETE 73564 45 KNEE UNILATERAL LIMITED 73560 35 L-SPINE 2-VIEWS 72100 40 L-SPINE 4-VIEWS 72110 55 L-SPINE 5+ VIEWS 72114 70 MANDIBLE 4 VIEWS 70110 40 MANDIBLE 1-3 VIEWS 70100 35 MASTOIDS 3 VIEWS 70130 60 NASAL 3 VIEWS 70160 35 ORBITS 4 VIEWS 70200 45 PELVIS 72170 40 RIBS UNILATERAL 2-VIEW 71100 40 RIBS UNILATERAL 3-VIEW 71101 45 RIBS BILATERAL 71110 45 SACRUM & COCCYX 72220 30 SCOLIOSIS STANDING 2-3 VIEWS 72082 70 SCOLIOSIS STANDING 4-5 VIEWS 72083 80 SHOULDER UNILATERAL 1-VIEW 73020 30 SHOULDER UNI COMPLETE 73030 35 SIALOGRAM 70390 100 S.I. JOINTS 72202 40 SINUSES LESS THAN 3-VIEWS 70210 35 SINUSES PARANASAL 70220 40 SKELETAL SURVEY (LIMITED) 77074 75 SKELETAL SURVEY (COMPLETE) 77075 95 SKULL LESS THAN 4-VIEWS 70250 40 SKULL COMPLETE 70260 50 SOFT TISSUE NECK 70360 30 STERNUM 2 VIEW 71120 35 THORACIC & SWIM VIEW 72072 40 THORACOLUMBAR SPINE 72080 35 TIBIA/FIBULA 73590 30 TMJ BILATERAL 70330 55 TOES 73660 30 T-SPINE 2-VIEW 72070 40 Page 2
WRIST 2 VIEW 73100 35 WRIST UNILATERAL COMPLETE 73110 40 MAMMOGRAPHY EACH ADD L VIEW/SPOT/MAG (COULD BE MORE THAN ONE) GALACTOGRAM/DUCTAGRAM 77065 95 19030, 77053, 77065, Q9965 DIAGNOSTIC MAMMO UNILATERAL 77065 140 DIAGNOSTIC MAMMO BILATERAL 77066 175 DIAGNOSTIC MAMMO BILAT W/IMPLANTS 77066 200 3D DIAGNOSTIC MAMMO UNILATERAL 77065, 77061 185 3D DIAGNOSTIC MAMMO BILATERAL 77066, 77062 220 3D DIAGNOSTIC MAMMO BILAT W/IMPLANTS 77066, 77062 250 SCREENING MAMMO 77067 95 SCREENING MAMMO W/IMPLANTS 77067 125 3D SCREENING MAMMO 77067, 77063 125 3D SCREENING MAMMO W/IMPLANTS 77067,77063 150 BIOPSY / FINE NEEDLE ASPIRATION *All Biopsies and Aspirations will have additional charges from the lab* BREAST ASPIRATION 76942, 10022 250 STEREOTACTIC BREAST BIOPSY 19081 905 + lab fees BREAST BIOPSY ULTRASOUND GUIDED 19083 875 + lab fees CT KIDNEY BIOPSY 50200, 77012 750 + lab fees CT LIVER BIOPSY 47000, 77012 500 + lab fees CT LUNG BIOPSY 32405, 77012 625 + lab fees CT GUIDED BONE MARROW 38221, 77012 400 +lab fees CT NECK BIOPSY 21550, 77012 425 + lab fees CT MUSCLE/ SOFT TISSUE BIOPSY 20206, 77012 400 + lab fees PARACENTESIS 49083 375 THYROID ASPIRATION /FNA 76942, 10022 250 THORACENTESIS 32555 375 MRI BREAST BIOPSY 19085 1100 +lab fees ULTRASOUND ABDOMEN 76700 140 ABDOMEN AAA SCREENING 76706 100 ABI ONLY 93922 95 ABDOMINAL DOPPLER 93975 300 RENAL DOPPLER 93976 200 QUADRANT/LIMITED 76705 100 BILATERAL LOWER EXT. ARTERIAL 93925 275 BILATERIAL UPPER EXT. ARTERIAL DOPPLER 93930 200 BLADDER POST VOID 51798 40 370 Page 3
BREAST COMPLETE (UNILATERAL) 76641 115 BREAST LIMITED (UNILATERAL) 76642 93 UPPER EXTREMITY DOPPLER (UNILATERAL) 93931 140 ARTERIAL DOPPLER LOWER EXTREMITY (UNILATERAL) 93926 150 HIP (INFANT) 76885 150 CAROTID DOPPLER 93880 200 CRANIUM 76506 125 CHEST 76604 95 ECHO 93306 225 NON-VASCULAR EXTREMITY 76881 110 NON-VASCULAR EXT LIMITED (GROIN / AXILA) 76882 70 SIS 76831, 58340 250 OB MULTIPLE 76810 200 OB SINGLE FETUS >/= 14 WEEKS 76805 155 OB SINGLE FETUS <14 WEEKS 76801 135 OB TRANSVAG (EARLY OB) 76817 135 PARACENTESIS 49083 375 PELVIC / TRANSVAGINAL 76856 76830 250 PELVIC LIMITED 76857 70 PELVIC TRANSABDOMINAL ALONE (ONLY IN SPECIAL CASES) 76856 125 TRANSVAGINAL ALONE (ONLY IN SPECIAL CASES) 76830 130 RETROPERITONEAL (RENAL, BLADDER) 76770 130 RENAL ULTRASOUND 76775 65 SPINAL CANAL 76800 155 TESTICULAR 76870 75 THORACENTESIS 32555 375 THYROID/NECK 76536 130 THYROID ASPIRATION 76942, 10022 210 THYROID BIOPSY 60100, 76942 190 VENOUS DOPPLER (BILATERAL) 93970 220 VENOUS DOPPLER (UNILATERAL) 93971 130 CAT SCAN CT ABD / PELVIS WITHOUT CONTRAST 74176 300 CT ABD/PELVIS WITH CONTRAST 74177 350 CT ABD/PELVIS W/WO CONTRAST 74178 400 CT ABDOMEN WITHOUT CONTRAST 74150 175 CT ABDOMEN WITH CONTRAST 74160 250 CT ABDOMEN W/WO CONTRAST 74170 300 CT ANGIOGRAM ABDOMEN W/WO CONTRAST 74175 Q9949 350 CT ANGIOGRAM AORTA CHEST/ABD/PELVIS 71275 74174 900 W/WO CONTRAST Q9967 Page 4
CT ANGIOGRAM BRAIN W/WO CONTRAST 70496 Q9967 350 CT ANGIOGRAM CAROTIDS W/WO CONTRAST 70498 Q9949 350 CT ANGIOGRAM CHEST W/WO CONTRAST 71275 Q9949 350 CT ANGIOGRAM CORONARIES 75574 400 CT ANGIOGRAM CHEST/ABD 71275 74175 Q9967 650 CT ANGIOGRAM LOWER EXT 73706 Q9949 400 CT ANGIOGRAM NECK 70498 Q9949 350 CT ANGIOGRAM PELVIC 72191 Q9949 350 CT ANGIOGRAM PULMONARY 75572 Q9967 300 CT ANGIOGRAM RENAL W/WO CONTRAST 74175 Q9967 350 CT ANGIOGRAM RUN-OFFS W/WO CONTRAST 75635 Q9967 450 CT ANGIOGRAM UPPER EXTREMITIES 73206 Q9967 345 CT BRAIN WITHOUT CONTRAST 70450 175 CT BRAIN WITH CONTRAST 70460 200 CT BRAIN W/WO CONTRAST 70470 250 CT CALCIUM SCORE 75571 150 CT CHEST WITHOUT CONTRAST 71250 175 CT CHEST WITH CONTRAST 71260 225 CT CHEST W/WO CONTRAST 71270 250 CT CERVICAL SPINE WITHOUT CONTRAST 72125 180 CT CERVICAL SPINE WITH CONTRAST 72126 250 CT CERVICAL SPINE W/WO CONTRAST 72127 300 CT LIMITED/ FOLLOW-UP 76380 150 CT LOWER EXTREMITY WITHOUT CONTRAST 73700 175 CT LOWER EXTREMITY WITH CONTRAST 73701 250 CT LOWER EXTREMITY W/WO CONTRAST 73702 300 CT LUMBAR SPINE WITHOUT CONTRAST 72131 175 CT LUMBAR SPINE WITH CONTRAST 72132 250 CT LUMBAR SPINE W/WO CONTRAST 72133 300 CT DENTAL SCAN (DENTISTS ONLY) 70486 150 CT MAXILLOFACIAL 70486 175 CT GUIDED BONE MARROW 77012, 38221 400 + lab fees CT PELVIS WITHOUT CONTRAST 72192 175 CT PELVIS WITH CONTRAST 72193 250 CT PELVIS W/WO CONTRAST 72194 300 CT NECK WITHOUT CONTRAST 70490 175 CT NECK WITH CONTRAST 70491 250 CT NECK W/WO CONTRAST 70492 275 CT ORBITS/SELLA/IACS WITHOUT CONTRAST 70480 200 CT ORBITS/SELLA/IACS WITH CONTRAST 70481 300 CT ORBITS W/WO CONTRAST 70482 350 CT THORACIC SPINE WITHOUT CONTRAST 72128 175 Page 5
CT THORACIC SPINE WITH CONTRAST 72129 250 CT THORACIC SPINE W/WO CONTRAST 72130 300 CT UPPER EXTREMITY WITHOUT CONTRAST 73200 175 CT UPPER EXTREMITY WITH CONTRAST 73201 250 CT UPPER EXTREMITY W/WO CONTRAST 73202 300 CT NECK/CHST/ABD/PELVIS 70491, 71270, 74178 850 VIRTUAL COLONOSCOPY SCREENING 74263 795 VIRTUAL COLONOSCOPY DIAGNOSTIC 74261 550 ARTHROGRAM HIP / W MRI ARTHROGRAM KNEE ARTHROGRAM SHOULDER ARTHROGRAM WRIST FLUOROSCOPY 73722, 27093, 77002, A9579, Q9967 73722, 77002, 27370, A9579, Q9967 73222, 23350, 77002, A9579, Q9967 73222, 25246, A9579, 77002, Q9967 BARIUM ENEMA W/AIR 74280 225 DYE STUDY 76000 50 ESOPHAGRAM/BARIUM SWALLOW 74220 100 HIP INJECTION 20610, 77002 175 HSG 58340, 74740 250 IVP 74415 145 LUMBAR PUNCTURE 62270, 77003 265 MYELOGRAM / C-SPINE 72126, 62284, Q9965 450 MYELOGRAM / L-SPINE 72132, 62284, Q9965 450 PORT PLACEMENT IN ARM 36571, 77001, Q9966 1725 PORT PLACEMENT IN CHEST 36561, 77001, Q9966 1600 PORT ACCESS CHECK (DYE STUDY) 76000, 71010 75 PORT REPLACEMENT IN SAME ACCESS DEVICE 36582 1055 PICC LINE 36569, 77001, Q9966 500 REMOVAL OF VENUS PORT 36590 275 SIALOGRAM 42550, 70390, 70150 285 SMALL BOWEL SERIES 74250 115 SNIFF TEST 76000, 71020 85 UGI W/KUB & AIR 74247 150 UGI W/SBF (74254) 74249 200 VOIDING CYSTOGRAM (VCUG) 51600, 74455 280 VENOGRAM 36005, 75820 465 MRI / MRA MRA ABDOMEN 74185 425 MRA CHEST/THORAX 71555 425 MRA HEAD / BRAIN WITHOUT CONTRAST 70544 450 MRA HEAD / BRAIN WITH CONTRAST 70545 500 Page 6 725 700 675 700
MRA HEAD / BRAIN W/WO CONTRAST 70546 650 MRA LOWER EXT. 73725 425 MRA UPPER EXT. 73225 450 MRA NECK / CAROTID WITHOUT CONTRAST 70547 450 MRA NECK / CAROTID WITH CONTRAST 70548 500 MRA NECK / CAROTID W/ WO CONTRAST 70549 650 MRA PELVIS 72198 425 MRA SPINE 72159 450 MRI/MRA BRAIN 70544 70553 850 MRI / TMJ 70336 350 MRI ABDOMEN WITHOUT CONTRAST 74181 375 MRI ABDOMEN WITH CONTRAST 74182 475 MRI ABDOMEN W/WO CONTRAST 74183 550 MRI BRAIN WITHOUT CONTRAST 70551 350 MRI BRAIN WITH CONTRAST 70552 400 MRI BRAIN W/WO CONTRAST 70553 475 MRI BREAST (BILATERAL) 77059 575 MRI BREAST (UNILATERAL) 77058 575 MRI CHEST/THORAX WITHOUT CONTRAST 71550 450 MRI CHEST/THORAX WITH CONTRAST 71551 500 MRI CHEST/THORAX W/WO CONTRAST 71552 625 MRI CERVICAL SPINE WITHOUT CONTRAST 72141 325 MRI CERVICAL SPINE WITH CONTRAST 72142 375 MRI CERVICAL SPINE W/WO CONTRAST 72156 475 MRI HEAD/NECK/FACE WITHOUT 70540 375 MRI LOWER EXT WITHOUT CONTRAST 73718 400 MRI LOWER EXT WITH CONTRAST 73719 450 MRI LOWER EXT. W/WO CONTRAST 73720 550 MRI LOWER EXT. JOINT WITHOUT CONTRAST 73721 325 MRI LOWER EXT JOINT WITH CONTRAST 73722 425 MRI LOWER EXT. JOINT W/WO CONTRAST 73723 525 MRI L-SPINE WITHOUT CONTRAST 72148 325 MRI L-SPINE WITH CONTRAST 72149 375 MRI L-SPINE W/ WO CONTRAST 72158 475 MRI PELVIS WITHOUT CONTRAST 72195 400 MRI PELVIS WITH CONTRAST 72196 450 MRI PELVIS W/WO CONTRAST 72197 550 MRI T-SPINE WITHOUT CONTRAST 72146 325 MRI T-SPINE WITH CONTRAST 72147 375 MRI T-SPINE W/WO CONTRAST 72157 475 MRI TMJ 70336 350 MRI UPPER EXT. JOINT WITHOUT 73221 325 Page 7
MRI UPPER EXT. JOINT WITH CONTRAST 73222 425 MRI UPPER EXT JOINT W/WO CONTRAST 73223 525 MRI UPPER EXT. NON JOINT WITHOUT CONTR 73218 350 MRI UPPER EXT NON JOINT W/WO CONTR 73220 550 MRI-ORBIT/FACE/NECK WITHOUT CONTRAST 70540 350 MRI-ORBIT/FACE/NECK WITH CONTRAST 70542 425 MRI-OBIT/FACE/NECK W/WO CONTRAST 70543 500 NUCLEAR MEDICINE 3 PHASE BONE SCAN 78315 / MDP (A9503) 425 BONE SCAN, WHOLE BODY 78306, A9503 350 GASTRIC EMPTY SCAN 78264, A9541 400 GASTRIC EMPTY WITH SB TRANSIT 78265, A9541 450 HIDA SCAN 78226(7), A9537, J2805 450/550 LEXISCAN 78452, 93015, A9500, J2785 LIMITED BONE SCAN 78300 / MDP (A9503) 250 LIVER/SPLEEN SCAN 78215 / Sulfur Colloid (A9520) MECKEL SCAN 78261 400 MIRALUMA SCAN 78800, A9500 300 MUGA SCAN 78472, A9538, A9512 300 CARDIOLITE STESS TEST 78452, 93015, A9500 700 OCTREOSCAN 78803, 78804, A4642 4225 PARATHYROID SUBRACTION 78070 400 PET SCAN LIMITED 78811 1500 PET SCAN 78812, A9552 1700 PET SCAN W/ CT CAP, NECK 78812, 70491, 74178, 71270, A9552, Q9967 950 275 2100 PROSTASCINT SCAN 78802, 78803, A9507 3500 RENAL SCAN 78707, A9562 600 SPECT SCAN 78320,A9503 300 THYROID ABLATION STUDY 79005, A9517 250 THYROID UPTAKE SCAN 78014, A9516 350 VQ SCAN 78580, 78582, A9539, A9540 WHITE BLOOD CELL COUNT LIMITED 78805, A9521 1400 WHITE BLOOD CELL COUNT WHOLE BDY 78806, A9521 1550 450 Page 8