CPT Code Description of Service Medical Care Ballad Health

74177 CT ABDOMEN & PELVIS W CONTRAST 500.00$ 5,370.00$

74178 CT ABDOMEN & PELVIS W/WO CONTRAST 550.00$ 6,265.00$

74176 CT ABDOMEN & PELVIS WO CONTRAST 450.00$ 4,612.00$

74160 CT ABDOMEN W CONTRAST 450.00$ 3,637.00$

74170 CT ABDOMEN W/WO CONTRAST 450.00$ 4,361.00$

74150 CT ABDOMEN WO CONTRAST 350.00$ 3,162.00$

70496 CT ANGIO HEAD W/WO CONTRAST 500.00$ 4,152.00$

70498 CT ANGIO NECK W/WO CONTRAST 500.00$ 4,457.00$

71260 CT CHEST W CONTRAST 450.00$ 3,059.00$

71270 CT CHEST W/WO CONTRAST 500.00$ 4,266.00$

71250 CT CHEST/THORAX WO CONTRAST 400.00$ 2,744.00$

72127 CT C-SPINE W/WO CONTRAST 400.00$ 3,453.00$

72125 CT C-SPINE WO CONTRAST 350.00$ 2,888.00$

70450 CT HEAD 400.00$ 2,448.00$

70460 CT HEAD W CONTRAST 450.00$ 3,036.00$

70470 CT HEAD W/WO CONTRAST 500.00$ 3,070.00$

72132 CT L- SPINE W CONTRAST 350.00$ 3,275.00$

73700 CT LOWER EXTREMITY 400.00$ 2,926.00$

73701 CT LOWER EXTREMITY W CONTRAST 450.00$ 3,634.00$

72133 CT L-SPINE W/WO CONTRAST 400.00$ 3,379.00$

72131 CT L-SPINE WO CONTRAST 350.00$ 3,124.00$

70487 CT MAXILLOFACIAL W CONTRAST 450.00$ 3,011.00$

70488 CT MAXILLOFACIAL W/WO CONTRAST 500.00$ 2,502.00$

70491 CT NECK W CONTRAST 450.00$ 3,458.00$

70492 CT NECK W/WO CONTRAST 500.00$ 4,152.00$

70490 CT NECK WO CONTRAST 350.00$ 3,036.00$

70480 CT ORBIT SELLA EAR WO CONTRAST 350.00$ 2,502.00$

70481 CT ORBIT W CONTRAST 450.00$ 2,850.00$

70482 CT ORBIT W/ WO CONTRAST 500.00$ 2,502.00$

72193 CT PELVIS W CONTRAST 500.00$ 3,059.00$

72194 CT PELVIS W/WO CONTRAST 550.00$ 3,453.00$

72192 CT PELVIS WO CONTRAST 450.00$ 2,566.00$

70486 CT SINUSES MAXILLOFACIAL 350.00$ 2,502.00$

72128 CT T-SPINE W/O CONTRAST 350.00$ 2,805.00$

72130 CT T-SPINE W/WO CONTRAST 400.00$ 3,321.00$

73201 CT UPPER EXTREMITY W CONTRAST 450.00$ 3,583.00$

73202 CT UPPER EXTREMITY W/WO CONTRAST 500.00$ 4,402.00$

73200 CT UPPER EXTREMITY WO CONTRAST 400.00$ 3,583.00$

74174 CTA ABDOMEN & PELVIS W CONTRAST 850.00$ 5,414.00$

77080 DEXA FULL/LARGE BONE 100.00$ 786.00$

77085 DEXA VFA VERTEBRAL ASSESSENT 125.00$ 966.00$

93306TC ECHO SPECTRAL & COLOR DOPPLER 350.00$ 748.00$

77066 MAMMO DIAGNOSTIC BILATERAL/CAD 175.00$ 612.00$

77065 MAMMO DIAGNOSTIC UNILATERAL/CAD 150.00$ 591.00$

77067 MAMMO SCREENING BILATERAL/CAD 150.00$ 530.00$

70544 MRA HEAD WO CONTRAST 800.00$ 5,498.00$

HOW TO USE THE GUIDE:Search by CPT Code or by Description of Service. To locate your desired scan, simply hit Ctrl+F on your keyboard, then use the “Find” search box to locate and compare prices on the services of your choice. All services are listed in alphabetical order by type.

IMPORTANT NOTES:- Medical Care’s MRI & MRA services are available only to Medical Care’s patients and are NOT AVAILABLE by outside referral.- Ballad Health’s additional reading fees are not listed on this document. - Ballad’s charge amounts are valid as of June 10, 2019 and are available to download. Copy and paste this link into your browser to download the complete spreadsheet from Ballad Health’s website:https://www.balladhealth.org/sites/balladhealth/files/documents/Sycamore-Shoals-Hospital-chargemaster-2018.xlsx

70547 MRA NECK WO CONTRAST 850.00$ 5,489.00$

74183 MRI ABDOMEN W/WO CONTRAST 850.00$ 5,490.00$

74181 MRI ABDOMEN WO CONTRAST 800.00$ 5,225.00$

74185 MRI ANGIO ABDOMEN W/WO CONTRAST 850.00$ 5,834.00$

73722 MRI ARTHRO LOWER EXTREMITY JOINT W CONTRAST 650.00$ 6,393.00$

73222 MRI ARTHRO UPPER EXTREMITY JOINT W CONTRAST 600.00$ 5,407.00$

70552 MRI BRAIN W CONTRAST 850.00$ 4,400.00$

70553 MRI BRAIN W/WO CONTRAST 850.00$ 5,833.00$

70551 MRI -BRAIN WO CONTRAST 800.00$ 4,067.00$

72141 MRI C-SPINE W/O CONTRAST 800.00$ 4,573.00$

72142 MRI C-SPINE WITH CONTRAST 850.00$ 5,492.00$

72156 MRI C-SPINE WO/WITH SEQUENCES 850.00$ 6,630.00$

73723 MRI JOINT LOWER EXTREM W/W0 CONTRAST 650.00$ 7,392.00$

73721 MRI LOWER EXTRE JOINT WO CONTRAST 600.00$ 7,000.00$

73718 MRI LOWER EXTRE NOT JOINT WO CONTRAST 600.00$ 5,591.00$

73720 MRI LOWER EXTREMITY W/WO CONTRAST 700.00$ 5,903.00$

72149 MRI L-SPINE W CONTRAST 850.00$ 4,574.00$

72148 MRI L-SPINE WO CONTRAST 800.00$ 3,791.00$

72158 MRI L-SPINE W/WO CONTRAST 850.00$ 6,404.00$

70543 MRI ORBIT FACE NECK W/WO CONTRAST 850.00$ 5,988.00$

72195 MRI PELVIS WO CONTRAST 800.00$ 4,575.00$

72197 MRI PELVIS W/WO CONTRAST 850.00$ 5,314.00$

72157 MRI SPINAL CANAL W/WO CONTRAST 850.00$ 5,232.00$

72146 MRI T-SPINE WO CONTRAST 800.00$ 4,637.00$

73221 MRI UPPER EXTREMITY JOINT WO CONTRAST 600.00$ 4,274.00$

73218 MRI UPPER EXTREMITY NON JOINT WO CONTRAST 600.00$ 5,407.00$

73220 MRI UPPER EXTREMITY W/WO CONTRAST 700.00$ 4,674.00$

76706 ULTRASOUND AA ANEURYSM SCREENING 125.00$ 643.00$

76705 ULTRASOUND ABDOMEN LIMITED 140.00$ 982.00$

76700 ULTRASOUND ABDOMINAL 200.00$ 1,234.00$

93922 ULTRASOUND ANKLE BRACHIAL INDEX 125.00$ 916.00$

93925 ULTRASOUND ARTERIAL DOPPLER LOWER BILATERAL 225.00$ 1,421.00$

51798 ULTRASOUND BLADDER 75.00$ 643.00$

76641 ULTRASOUND BREAST 150.00$ 892.00$

76642 ULTRASOUND BREAST LIMITED 125.00$ 743.00$

76856 ULTRASOUND PELVIC COMPLETE 150.00$ 1,007.00$

76857 ULTRASOUND PELVIC LIMITED 120.00$ 880.00$

76770 ULTRASOUND RENAL 165.00$ 1,027.00$

76870 ULTRASOUND SCROTUM/TESTICULAR 135.00$ 895.00$

76536 ULTRASOUND THYROID HEAD NECK 150.00$ 859.00$

76830 ULTRASOUND TRANSVAGINAL 150.00$ 846.00$

93970 ULTRASOUND VENOUS DOPPLER BILATERAL 225.00$ 2,088.00$

93971 ULTRASOUND VENOUS DOPPLER-UNILATERAL 175.00$ 1,240.00$

74019 XRAY ABDOMEN 2 VIEWS W/INTERP 55.00$ 636.00$

74021 XRAY ABDOMEN 3 OR MORE VIEWS W/INTERP 60.00$ 808.00$

73050 XRAY AC JOINTS BILATERAL 55.00$ 675.00$

73610 XRAY ANKLE W/INTERP 50.00$ 548.00$

CPT Code Description of Service Medical Care Ballad Health

77072 XRAY BONE AGE STUDIES 82.00$ 454.00$

73650 XRAY CALCANEUS W/INTERP 45.00$ 420.00$

72040 XRAY CERVICAL SPINE 2-3 VIEWS 65.00$ 566.00$

72050 XRAY CERVICAL SPINE 4-5 VIEWS 75.00$ 762.00$

71045 XRAY CHEST 1 VIEW 40.00$ 325.00$

71046 XRAY CHEST 2 VIEWS W/INTERP 50.00$ 476.00$

71047 XRAY CHEST 3 VIEWS 75.00$ 588.00$

71101 XRAY CHEST AND RIBS 65.00$ 715.00$

73000 XRAY CLAVICAL W/INTERP 50.00$ 407.00$

73070 XRAY ELBOW 2 VIEWS 45.00$ 466.00$

73080 XRAY ELBOW 3 OR MORE VIEWS 55.00$ 498.00$

70150 XRAY FACIAL COMPLETE W/INTERP 50.00$ 671.00$

73551 XRAY FEMUR 1 VIEW 45.00$ 443.00$

73552 XRAY FEMUR 2 OR MORE VIEWS 45.00$ 443.00$

73140 XRAY FINGER W/INTERP 35.00$ 402.00$

73630 XRAY FOOT W/INTERP 50.00$ 528.00$

73090 XRAY FOREARM W/INTERP 45.00$ 436.00$

73130 XRAY HAND W/INTERP 50.00$ 607.00$

73501 XRAY HIP UNILATERNAL 1 VIEW 45.00$ 441.00$

73502 XRAY HIP UNILATERNAL 2-3 VIEWS 50.00$ 441.00$

73503 XRAY HIP UNILATERNAL 4 OR MORE VIEWS 55.00$ 577.00$

73521 XRAY HIPS BILATERAL 2 VIEWS 65.00$ 822.00$

73522 XRAY HIPS BILATERAL 3-4 VIEWS 75.00$ 822.00$

73523 XRAY HIPS BILATERAL MORE THAN 4 VIEWS 80.00$ 1,565.00$

73060 XRAY HUMERUS W/INTERP 45.00$ 467.00$

73560 XRAY KNEE 1-2 VIEWS W/INTERP 45.00$ 405.00$

73562 XRAY KNEE 3 VIEWS 60.00$ 537.00$

73564 XRAY KNEE MORE THAN 4 VIEWS W/INTERP 75.00$ 537.00$

73565 XRAY KNEES BILATERAL 55.00$ 592.00$

74018 XRAY KUB 1 VIEW W/INTERP 45.00$ 423.00$

72100 XRAY LUMBAR SPINE 2-3V W/INTRP 55.00$ 577.00$

72110 XRAY LUMBAR SPINE 4VW W/INTERP 75.00$ 808.00$

70110 XRAY MANDIBLE 4 VIEWS W/INTERP 45.00$ 580.00$

70120 XRAY MASTOIDS 3 VIEWS ONE SIDE 50.00$ 655.00$

70160 XRAY NASAL BONES W/INTERP 35.00$ 551.00$

70360 XRAY NECK SOFT TISSUE 35.00$ 859.00$

70200 XRAY ORBITALS W/INTERP 55.00$ 612.00$

77074 XRAY OSSEOUS SURVEY LIMITED 215.00$ 1,276.00$

72170 XRAY PELVIS W/INTERP 45.00$ 452.00$

71100 XRAY RIB 2 VIEWS W/INTERP 55.00$ 680.00$

72200 XRAY S. I. JOINTS W/INTERP 45.00$ 388.00$

72220 XRAY SACRUM COCCYX 45.00$ 462.00$

73010 XRAY SCAPULA COMPLETE 45.00$ 596.00$

73030 XRAY SHOULDER W/INTERP 55.00$ 564.00$

70210 XRAY SINUS SERIES W/INTERP 40.00$ 823.00$

70250 XRAY SKULL 4 VIEWS W/INTERP 45.00$ 921.00$

72020 XRAY SPINE 1 VIEW 45.00$ 365.00$

CPT Code Description of Service Medical Care Ballad Health

71120 XRAY STERNUM W/INTERP 40.00$ 456.00$

72072 XRAY THORACIC SPINE 3 VIEWS 75.00$ 627.00$

73590 XRAY TIBIA/FIBULA 2 VIEWS W/INTERP 45.00$ 418.00$

70330 XRAY TMJ BILATERAL 65.00$ 552.00$

73660 XRAY TOE W/INTERP 45.00$ 366.00$

73100 XRAY WRIST 2 VIEWS 45.00$ 387.00$

73110 XRAY WRIST 3 VIEWS W/INTERP 55.00$ 488.00$

CPT Code Description of Service Medical Care Ballad Health