EXAM   NAME

COST

CPT/HCPCS

CODE

Abdomen and pelvis with intravenous contrast ¹ $1,170.00 74177
Abdomen and pelvis without intravenous contrast $725.00 74176
Abdomen without intravenous contrast, followed by imaging with intravenous contrast ¹ $841.00 74170
Abdomen with intravenous contrast ¹ $747.00 74160
Abdomen without intravenous contrast $379.00 74150
Abdomen and pelvis without intravenous contrast, followed by imaging with intravenous contrast ¹ $1,170.00 74178
Angiogram: Abdomen ¹ $876.00 74175
Angiogram: Abdomen and pelvis ¹ $1,170.00 74174
Angiogram: Abominal aorta runoff ¹ $876.00 75635
Angiogram: Chest ¹ $876.00 71275
Angiogram: Head ¹ $876.00 70496
Angiogram: Lower extremity ¹ $876.00 73706
Angiogram: Neck ¹ $876.00 70498
Angiogram: Pelvis ¹ $876.00 72191
Angiogram: Upper extremity ¹ $876.00 73206
Bone mineral density study $270.00 77078
Cervical spine with intrathecal contrast ¹² $747.00 72126
Cervical spine without intrathecal contrast $379.00 72125
Cervical spine without intrathecal contrast, followed by imaging with intrathecal contrast ¹² $841.00 72127
Chest with intravenous contrast ¹ $747.00 71260
Chest without intravenous contrast $379.00 71250
Chest without intravenous contrast, followed by imaging with intravenous contrast ¹ $841.00 71270
Head with intravenous contrast ¹ $747.00 70460
Head without intravenous contrast $379.00 70450
Head without intravenous contrast, followed by imaging with intravenous contrast ¹ $841.00 70470
Lower extremity (hip, femur, knee, tibia/fibula, ankle, or foot) with intravenous contrast ¹ $747.00 73701
Lower extremity (hip, femur, knee, tibia/fibula, ankle, or foot) without intravenous contrast $379.00 73700
Lower extremity (hip, femur, knee, tibia/fibula, ankle, or foot) without intravenous contrast, followed by imaging with intravenous contrast ¹ $841.00 73702
Lumbar spine with intrathecal contrast ¹² $747.00 72132
Lumbar spine without intrathecal contrast $379.00 72131
Lumbar spine without intrathecal contrast, followed by imaging with intrathecal contrast ¹² $841.00 72133
Facial bones with intravenous contrast ¹ $747.00 70487
Facial bones without intravenous contrast $379.00 70486
Facial bones without intravenous contrast, followed by imaging with intravenous contrast ¹ $841.00 70488
Neck, soft tissue, with intravenous contrast ¹ $747.00 70491
Neck, soft tissue, without intravenous contrast $379.00 70490
Neck, soft tissue, without intravenous contrast, followed by imaging with intravenous contrast ¹ $841.00 70492
Orbits, sella, posterior fossa, outer ear, middle ear, or inner ear with intravenous contrast ¹ $747.00 70481
Orbits, sella, posterior fossa, outer ear, middle ear, or inner ear without intravenous contrast $379.00 70480
Orbits, sella, posterior fossa, outer ear, middle ear, or inner ear without intravenous contrast, followed by imaging with intravenous contrast ¹ $841.00 70482
Pelvis with intravenous contrast ¹ $747.00 72193
Pelvis without intravenous contrast $379.00 72192
Pelvis without intravenous contrast, followed by imaging with intravenous contrast ¹ $841.00 72194
Thoracic spine with intrathecal contrast ¹² $747.00 72129
Thoracic spine without intrathecal contrast $379.00 72128
Thoracic spine without intrathecal contrast, followed by imaging with intrathecal contrast ¹² $841.00 72130
Upper extremity (shoulder, humerus, elbow, forearm, wrist, or hand) with intravenous contrast ¹ $747.00 73201
Upper extremity (shoulder, humerus, elbow, forearm, wrist, or hand) without intravenous contrast $379.00 73200
Upper extremity (shoulder, humerus, elbow, forearm, wrist, or hand) without intravenous contrast, followed by imaging with intravenous contrast ¹² $841.00 73202

 

¹ Additional charges for contrast/medications may apply
² Examination may require additional services provided by other departments in the hospital. Price is for radiology procedure only.