radiology book 2019

RADIOLOGY & IMAGING

MEDICALCARE, PLLC

REFERRAL GUIDE&Radiology

Imaging

(423) 431-0315 | medicalcarepllc.com

Medical Care Radiology | Request Form

Provider NPI#: _______________________ Practice Name: _____________________________________________

Address: _______________________________________________________________ SSN: _______________________

Precert # / ICD-10 Code: _______________________________________________________________________________

Knee - Standing [JC Office]

Max: 450lbs

Max: 350lbs

Max: 450lbs

Max: E 300lbs JC 350lbs

1Request Form

Precertification Checklist

_________

_________

_________

_________

_________

_________

__________________Please note:

- Medical Care is not in network with all BlueCross BlueShield Medicare Advantage plans. We can provide services as an out-of-network provider, but patients will be responsible for out-of-network co-insurance.

- Medical Care is not in network with Amerigroup Medicare Advantage Plans. - For all BlueCare, Amerigroup, and United Healthcare TennCare patients, one of Medical Care’s providers must be the PCP before radiology studies can be performed.

2

Medical Care Radiology Locations 3

Medical Care Elizabethton1500 W Elk Ave

Elizabethton, TN 37643

Directions:From Johnson City

Take Exit 24 off of I-26 onto US 321 toward

Elizabethton. Follow US 321 for 5.8 miles. Medical

Care office will be on RIGHT, across from Sycamore

Shoals Hospital.

From Hampton

Follow 19-E toward Elizabethton. Turn LEFT onto US

321. Continue for approximately 3 miles. Medical Care

office will be on LEFT, across from Sycamore Shoals

Hospital.

Medical Care Johnson City401 E Main St

Johnson City, TN 37601

DirectionsFrom Elizabethton

Follow US 321 toward Johnson City. Turn RIGHT onto

I-26. Continue for 0.5 miles and take Exit 23. Medical

Care office will be directly in front of off-ramp.

From Kingsport

Follow I-26 from Kingsport into Johnson City. Take Exit

23. Cross Market Street and Medical Care office will be

on LEFT.

For more information: (423) 431-0315 | medicalcarepllc.com RADIOLOGY & IMAGINGRADIOLOGY & IMAGING

MEDICALCARE, PLLC

Front Entrance

Left Side Radiology Entrance

Front Entrance

Rear/Downstairs Radiology Entrance

CT Scan 4

For more information: (423) 431-0315 | medicalcarepllc.com RADIOLOGY & IMAGING

Available at: Medical Care Elizabethton, Medical Care Johnson City

Scans Available:Abdomen, Chest, CTA Chest, CTA Head, CTA Neck, Extremities, Head, Maxillofacial, Soft Tissue Neck, Pelvis, Sinus, Smoker Screening, Spine, Stone Protocol, Urogram

Max Weight: 450 lbs

CT Scan Prep:

Estimated Test Duration: 15 minutes - 1 hour

Patient Instructions:

• If you are being administered a contrasting agent, please do not eat or drink anything other than water or black coffee for 4 hours prior to exam. You may take medications as you normally do.

• If you are not being administered a contrasting agent, no prep is required.

• Patients who are diabetic or have a history of renal abnormalities will need to have their creatinine levels checked within the last 30 days prior to receiving an IV contrasting agent.

Instructions for Oral Contrast [if applicable]

• 90 minutes prior to exam: Drink first bottle of contrast.

• 30 minutes prior to exam: Drink 1/2 of second bottle of contrast.

• Bring remainder of second bottle to appointment.

• You will be instructed when to drink the remaining contrast before your exam.

Notes:

RADIOLOGY & IMAGING

MEDICALCARE, PLLC

DEXA Scan 5



Scans Available:Bone Densitometry Scan, Body Fat Analysis, Verterbral Fracture Assessment

Max Weight: E 350 lbs JC 300 lbs

DEXA Scan Prep

Estimated Test Duration: 15 minutes


• For your convenience please wear loose, comfortable clothing with no metal snaps, buckles, or buttons. Hospital gowns will be available for patients if needed.

Notes:

RADIOLOGY & IMAGING

MEDICALCARE, PLLC


Digital Mammogram 6


Scans Available:Screening Mammogram, Diagnostic Mammogram

Mammogram Prep

Estimated Test Duration: 15 - 30 minutes

Patient Instructions:• DO NOT wear deodorants or perfumes

Notes:

RADIOLOGY & IMAGING

MEDICALCARE, PLLC

Ultrasound 7



Scans Available:Abdomen, ABI, Aorta, Arterial Doppler, Bladder, Breast, Cartoid, Doppler, Extremity Non-Vascular, Echocardiogram, Gallbladder, Liver, Pelvic, Renal, Testicular, Thyroid, Transvaginal, Soft Tissue, Venous Doppler

Max Weight: 450 lbs

Age Restrictions:

• General Ultrasound: Age 16 or older• Vascular Ultrasound: Age 16 or older• Echocardiogram: Age 18 or older

Ultrasound Prep

Estimated Test Duration: 30 Minutes - 1 hour


• Gallbladder, Liver, Abdominal and Aorta Ultrasound: - Do not eat or drink anything for 8 hours prior to exam, or exam will be rescheduled.

• Pelvis and Bladder Ultrasound: - For pelvis, drink 42oz of clear liquids 1 hour prior to examination. Do not void. - For bladder, drink 12oz of clear liquids 1 hour prior to examination. Do not void.

• Other Ultrasounds: - No additional preparation required.

*Patient will be charged a separate fee for echocardiogram reads from CVA*

Notes:

RADIOLOGY & IMAGING

MEDICALCARE, PLLC

Diagnostic X-Ray 8


Scans Available:Abdomen, A-C Joint, Ankle, Bone Age, Calcaneus Heel, Chest, Clavicle, Elbow, Facial Bones, Femur, Fingers, Foot, Forearm, Hand, Hip, Humerus, Knee, Mandible, Nasal Bone, Orbits, Pelvis, Ribs, Sacrum / Coccyx, Scap-ula, Shoulder, SI Joints, Sinus, Skull, Soft Tissue Neck, Spine, Sternum, Tibia / Fibula, Toes, Wrist

Max Weight: 350 lbs

Diagnostic X-Ray Prep

Estimated Test Duration: 15 - 45 minutes


• For your convenience please do not wear clothing with metal snaps, buckles, or buttons near affected area. Hospital gowns will be available for patients if needed.

*Standing views available at Medical Care Johnson City only*

Notes:

For more information: (423) 431-0315 | medicalcarepllc.com RADIOLOGY & IMAGINGRADIOLOGY & IMAGING

MEDICALCARE, PLLC

Radiology Price Comparisons by Modality 9

CT SCAN74177 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 WO CONTRAST $ 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 DEXA SCAN77080 DEXA FULL/LARGE BONE $ 100.00 $ 786.00 77085 DEXA VFA VERTEBRAL ASSESSENT $ 125.00 $ 966.00 MAMMOGRAM77066 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 MRI / MRA70544 MRA HEAD WO CONTRAST $ 800.00 $ 5,498.00 70547 MRA NECK WO CONTRAST $ 50.00 $ 5,489.00 74183 MRI ABDOMEN W/WO CONTRAST $ 850.00 $ 5,490.00

CPT Description of Service Medical Care Ballad Health 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.

- These prices are based on

Ballad’s charge amounts at

Sycamore Shoals Hospital

and Johnson City Medical

Center as of June 10, 2019

and are available online 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/fil

es/documents/Sycamore-

Shoals-Hospital-chargema

ster-2018.xlsx

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 EXT. JOINT W CONTRAST $ 650.00 $ 6,393.00 73222 MRI ARTHRO UPPER EXT. 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 EXT. W/WO CONTRAST $ 650.00 $ 7,392.00 73721 MRI LOWER EXT. JOINT WO CONTRAST $ 600.00 $ 7,000.00 73718 MRI LOWER EXT. 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 EXT. JOINT WO CONTRAST $ 600.00 $ 4,274.00 73218 MRI UPPER EXT. NON JOINT WO CONTRAST $ 600.00 $ 5,407.00 73220 MRI UPPER EXTREMITY W/WO CONTRAST $ 700.00 $ 4,674.00 ULTRASOUND93306TC ECHO SPECTRAL & COLOR DOPPLER $ 350.00 $ 748.00 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 BIL. $ 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 X-RAY74019 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 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 CLAVICLE 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 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


Important Notes- Medical Care’s MRI & MRA







on this document.











Health’s website:





ster-2018.xlsx



CPT Description of Service Medical Care Ballad Health72050 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 CLAVICLE 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 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









on this document.











Health’s website:





ster-2018.xlsx



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 CLAVICLE 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 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 Description of Service Medical Care Ballad Health








on this document.











Health’s website:





ster-2018.xlsx

Radiology Price Comparisons by CPT Code 12


51798 ULTRASOUND BLADDER $ 75.00 $ 643.00 70110 XRAY MANDIBLE 4 VIEWS W/INTERP $ 45.00 $ 580.00 70120 XRAY MASTOIDS 3 VIEWS ONE SIDE $ 50.00 $ 655.00 70150 XRAY FACIAL COMPLETE W/INTERP $ 50.00 $ 671.00 70160 XRAY NASAL BONES W/INTERP $ 35.00 $ 551.00 70200 XRAY ORBITALS W/INTERP $ 55.00 $ 612.00 70210 XRAY SINUS SERIES W/INTERP $ 40.00 $ 823.00 70250 XRAY SKULL 4 VIEWS W/INTERP $ 45.00 $ 921.00 70330 XRAY TMJ BILATERAL $ 65.00 $ 552.00 70360 XRAY NECK SOFT TISSUE $ 35.00 $ 859.00 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 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 70486 CT SINUSES MAXILLOFACIAL $ 350.00 $ 2,502.00 70487 CT MAXILLOFACIAL W CONTRAST $ 450.00 $ 3,011.00 70488 CT MAXILLOFACIAL W/WO CONTRAST $ 500.00 $ 2,502.00 70490 CT NECK WO CONTRAST $ 350.00 $ 3,036.00 70491 CT NECK W CONTRAST $ 450.00 $ 3,458.00 70492 CT NECK W/WO CONTRAST $ 500.00 $ 4,152.00 70496 CT ANGIO HEAD W/WO CONTRAST $ 500.00 $ 4,152.00 70498 CT ANGIO NECK W/WO CONTRAST $ 500.00 $ 4,457.00 70543 MRI ORBIT FACE NECK W/WO CONTRAST $ 850.00 $ 5,988.00 70544 MRA HEAD WO CONTRAST $ 800.00 $ 5,498.00 70547 MRA NECK WO CONTRAST $ 850.00 $ 5,489.00 70551 MRI -BRAIN WO CONTRAST $ 800.00 $ 4,067.00 70552 MRI BRAIN W CONTRAST $ 850.00 $ 4,400.00 70553 MRI BRAIN W/WO CONTRAST $ 850.00 $ 5,833.00 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 71100 XRAY RIB 2 VIEWS W/INTERP $ 55.00 $ 680.00 71101 XRAY CHEST AND RIBS $ 65.00 $ 715.00 71120 XRAY STERNUM W/INTERP $ 40.00 $ 456.00 71250 CT CHEST/THORAX WO CONTRAST $ 400.00 $ 2,744.00 71260 CT CHEST W CONTRAST $ 450.00 $ 3,059.00 71270 CT CHEST W/WO CONTRAST $ 500.00 $ 4,266.00 72020 XRAY SPINE 1 VIEW $ 45.00 $ 365.00 72040 XRAY CERVICAL SPINE 2-3 VIEWS $ 65.00 $ 566.00 72050 XRAY CERVICAL SPINE 4-5 VIEWS $ 75.00 $ 762.00 72072 XRAY THORACIC SPINE 3 VIEWS $ 75.00 $ 627.00 72100 XRAY LUMBAR SPINE 2-3V W/INTRP $ 55.00 $ 577.00 72110 XRAY LUMBAR SPINE 4VW W/INTERP $ 75.00 $ 808.00 72125 CT C-SPINE WO CONTRAST $ 350.00 $ 2,888.00 72127 CT C-SPINE W/WO CONTRAST $ 400.00 $ 3,453.00 72128 CT T-SPINE W/O CONTRAST $ 350.00 $ 2,805.00 72130 CT T-SPINE W/WO CONTRAST $ 400.00 $ 3,321.00 72131 CT L-SPINE WO CONTRAST $ 350.00 $ 3,124.00 72132 CT L-SPINE W CONTRAST $ 350.00 $ 3,275.00








on this document.











Health’s website:





ster-2018.xlsx



72133 CT L-SPINE W/WO CONTRAST $ 400.00 $ 3,379.00 72141 MRI C-SPINE W/O CONTRAST $ 800.00 $ 4,573.00 72142 MRI C-SPINE WITH CONTRAST $ 850.00 $ 5,492.00 72146 MRI T-SPINE WO CONTRAST $ 800.00 $ 4,637.00 72148 MRI L-SPINE WO CONTRAST $ 800.00 $ 3,791.00 72149 MRI L-SPINE W CONTRAST $ 850.00 $ 4,574.00 72156 MRI C-SPINE WO/WITH SEQUENCES $ 850.00 $ 6,630.00 72157 MRI SPINAL CANAL W/WO CONTRAST $ 850.00 $ 5,232.00 72158 MRI L-SPINE W/WO CONTRAST $ 850.00 $ 6,404.00 72170 XRAY PELVIS W/INTERP $ 45.00 $ 452.00 72192 CT PELVIS WO CONTRAST $ 450.00 $ 2,566.00 72193 CT PELVIS W CONTRAST $ 500.00 $ 3,059.00 72194 CT PELVIS W/WO CONTRAST $ 550.00 $ 3,453.00 72195 MRI PELVIS WO CONTRAST $ 800.00 $ 4,575.00 72197 MRI PELVIS W/WO CONTRAST $ 850.00 $ 5,314.00 72200 XRAY S. I. JOINTS W/INTERP $ 45.00 $ 388.00 72220 XRAY SACRUM COCCYX $ 45.00 $ 462.00 73000 XRAY CLAVICLE W/INTERP $ 50.00 $ 407.00 73010 XRAY SCAPULA COMPLETE $ 45.00 $ 596.00 73030 XRAY SHOULDER W/INTERP $ 55.00 $ 564.00 73050 XRAY AC JOINTS BILATERAL $ 55.00 $ 675.00 73060 XRAY HUMERUS W/INTERP $ 45.00 $ 467.00 73070 XRAY ELBOW 2 VIEWS $ 45.00 $ 466.00 73080 XRAY ELBOW 3 OR MORE VIEWS $ 55.00 $ 498.00 73090 XRAY FOREARM W/INTERP $ 45.00 $ 436.00 73100 XRAY WRIST 2 VIEWS $ 45.00 $ 387.00 73110 XRAY WRIST 3 VIEWS W/INTERP $ 55.00 $ 488.00 73130 XRAY HAND W/INTERP $ 50.00 $ 607.00 73140 XRAY FINGER W/INTERP $ 35.00 $ 402.00 73200 CT UPPER EXTREMITY WO CONTRAST $ 400.00 $ 3,583.00 73201 CT UPPER EXTREMITY W CONTRAST $ 450.00 $ 3,583.00 73202 CT UPPER EXTREMITY W/WO CONTRAST $ 500.00 $ 4,402.00 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 73221 MRI UPPER EXTREMITY JOINT WO CONTRAST $ 600.00 $ 4,274.00 73222 MRI ARTHRO UPPER EXTREMITY JOINT W CONTRAST $ 600.00 $ 5,407.00 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 73551 XRAY FEMUR 1 VIEW $ 45.00 $ 443.00 73552 XRAY FEMUR 2 OR MORE VIEWS $ 45.00 $ 443.00 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 73590 XRAY TIBIA/FIBULA 2 VIEWS W/INTERP $ 45.00 $ 418.00 73610 XRAY ANKLE W/INTERP $ 50.00 $ 548.00 73630 XRAY FOOT W/INTERP $ 50.00 $ 528.00








on this document.











Health’s website:





ster-2018.xlsx



73650 XRAY CALCANEUS W/INTERP $ 45.00 $ 420.00 73660 XRAY TOE W/INTERP $ 45.00 $ 366.00 73700 CT LOWER EXTREMITY $ 400.00 $ 2,926.00 73701 CT LOWER EXTREMITY W CONTRAST $ 450.00 $ 3,634.00 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 73721 MRI LOWER EXTRE JOINT WO CONTRAST $ 600.00 $ 7,000.00 73722 MRI ARTHRO LOWER EXTREMITY JOINT W CONTRAST $ 650.00 $ 6,393.00 73723 MRI JOINT LOWER EXTREM W/W0 CONTRAST $ 650.00 $ 7,392.00 74018 XRAY KUB 1 VIEW W/INTERP $ 45.00 $ 423.00 74019 XRAY ABDOMEN 2 VIEWS W/INTERP $ 55.00 $ 636.00 74021 XRAY ABDOMEN 3 OR MORE VIEWS W/INTERP $ 60.00 $ 808.00 74150 CT ABDOMEN WO CONTRAST $ 350.00 $ 3,162.00 74160 CT ABDOMEN W CONTRAST $ 450.00 $ 3,637.00 74170 CT ABDOMEN W/WO CONTRAST $ 450.00 $ 4,361.00 74174 CTA ABDOMEN & PELVIS W CONTRAST $ 850.00 $ 5,414.00 74176 CT ABDOMEN & PELVIS WO CONTRAST $ 450.00 $ 4,612.00 74177 CT ABDOMEN & PELVIS W CONTRAST $ 500.00 $ 5,370.00 74178 CT ABDOMEN & PELVIS W/WO CONTRAST $ 550.00 $ 6,265.00 74181 MRI ABDOMEN WO CONTRAST $ 800.00 $ 5,225.00 74183 MRI ABDOMEN W/WO CONTRAST $ 850.00 $ 5,490.00 74185 MRI ANGIO ABDOMEN W/WO CONTRAST $ 850.00 $ 5,834.00 76536 ULTRASOUND THYROID HEAD NECK $ 150.00 $ 859.00 76641 ULTRASOUND BREAST $ 150.00 $ 892.00 76642 ULTRASOUND BREAST LIMITED $ 125.00 $ 743.00 76700 ULTRASOUND ABDOMINAL $ 200.00 $ 1,234.00 76705 ULTRASOUND ABDOMEN LIMITED $ 140.00 $ 982.00 76706 ULTRASOUND AA ANEURYSM SCREENING $ 125.00 $ 643.00 76770 ULTRASOUND RENAL $ 165.00 $ 1,027.00 76830 ULTRASOUND TRANSVAGINAL $ 150.00 $ 846.00 76856 ULTRASOUND PELVIC COMPLETE $ 150.00 $ 1,007.00 76857 ULTRASOUND PELVIC LIMITED $ 120.00 $ 880.00 76870 ULTRASOUND SCROTUM/TESTICULAR $ 135.00 $ 895.00 77065 MAMMO DIAGNOSTIC UNILATERAL/CAD $ 150.00 $ 591.00 77066 MAMMO DIAGNOSTIC BILATERAL/CAD $ 175.00 $ 612.00 77067 MAMMO SCREENING BILATERAL/CAD $ 150.00 $ 530.00 77072 XRAY BONE AGE STUDIES $ 82.00 $ 454.00 77074 XRAY OSSEOUS SURVEY LIMITED $ 215.00 $ 1,276.00 77080 DEXA FULL/LARGE BONE $ 100.00 $ 786.00 77085 DEXA VFA VERTEBRAL ASSESSENT $ 125.00 $ 966.00 93922 ULTRASOUND ANKLE BRACHIAL INDEX $ 125.00 $ 916.00 93925 ULTRASOUND ARTERIAL DOPPLER LOWER BIL. $ 225.00 $ 1,421.00 93970 ULTRASOUND VENOUS DOPPLER BILATERAL $ 225.00 $ 2,088.00 93971 ULTRASOUND VENOUS DOPPLER-UNILATERAL $ 175.00 $ 1,240.00 93306TC ECHO SPECTRAL & COLOR DOPPLER $ 350.00 $ 748.00

RADIOLOGY & IMAGING

MEDICALCARE, PLLC

(423) 431-0315 | medicalcarepllc.com

radiology book 2019

Documents