EXAM NAME

COST

CPT/HCPCS CODE

Arthrogram, hip ¹ $1,625.00 27093, 73525
Arthrogram, knee² $1,625.00 27370, 73580
Arthrogram, shoulder ¹ $1,625.00 23350, 73040
Arthrogram, wrist ¹ $1,625.00 25246, 73115
Aspiration, (shoulder, knee, or hip) ¹² $1,407.00 20610, 77002
Barium enema, single contrast study ¹ $454.00 74270
Barium enema, with air and barium ¹ $454.00 74280
Cholangiogram via existing catheter ¹² $1,055.00 47531
Cholangiogram via new access ¹² $6,531.00 47532
Cystogram ¹ $1,380.00 51600, 74430
Esophagus imaging ¹ $306.00 74220
Fistulogram/sinogram including catheterization and injection ¹² $1,561.00 20501, 76080
Lumbar puncture ¹² $1,862.00 62270, 77003
IVU (intravenous urogram) ¹ $773.00 74400
Myelogram, 2 or more regions (CT of specified regions not included) ¹² $1,792.00 62305
Myelogram, cervical, with lumbar injection (CT of cervical spine cost not included) ¹² $1,792.00 62302
Myelogram, lumbar, with lumbar injection (CT of lumbar spine cost not included) ¹² $1,792.00 62304
Myelogram, thoracic, with lumbar injection (CT of thoracic spine not included) ¹² $1,792.00 62303
Small bowel series ¹ $306.00 74250
Swallowing function examination with cineradiography ¹²³ $306.00 74230
Upper GI with KUB, with air ¹ $454.00 74247
Upper GI with KUB, without air ¹ $454.00 74241
Upper GI without KUB, with air ¹ $454.00 74246
Upper GI without KUB, without air ¹ $454.00 74240
Upper GI with small bowel follow-through, with air ¹ $454.00 74249
Upper GI with small bowel follow-through, without air ¹ $454.00 74245

 

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.

³ Price does not include speech therapist’s evaluation fee