Advanced imaging CT Scan (computer tomography)

Service Billing (CPT)

Code** The Everett Clinic Self-

Pay Fee Prompt Pay

Incentive 15%

*Abdomen & Pelvis with contrast 74177 $1,022.75 $869.34

Abdomen & Pelvis without contrast 74176 $581.50 $494.28

Abdomen with and without contrast 74170 $795.00 $760.75

*Abdomen with contrast 74160 $792.75 $673.84

*Adrenal protocol (Abdomenwith/without contrast)

74170 $895.75 $761.18

Ankle without contrast (Right or Left) 73700 & 76376 $667.00 $566.95

Chest, without contrast (High Resolution)

71250 $541.75 $460.49

*Chest (PE, Pulmonary Angiogram) 71260 $753.50 $640.48

*Chest with contrast 71260 $753.50 $640.48

Chest without contrast 71250 $541.75 $460.49

Clavicle without contrast (Right or Left) 73200 & 76376 $665.25 $565.46

Colonography 74261 & 76377 $1,538.00 $1,307.30

Elbow without contrast (Right or Left) 73200 & 76376 $665.25 $565.46

Finger without contrast (Right or Left) 73200 & 76376 $665.25 $565.46

Foot without contrast (Right or Left) 73700 & 76376 $667.00 $566.95

Hand without contrast (Right or Left) 73200 & 76376 $665.25 $565.46

Head without contrast 70450 $412.25 $350.41

*IVP (Hematuria protocol) 74178 $1,137.75 $967.09

Knee without contrast (Right or Left) 73700 & 76376 $667.00 $566.95

*Liver protocol (Abdomen with/withoutcontrast)

74170 $895.75 $761.39

Lumbar Spine without contrast 72131 & 76376 $668.50 $568.23

*Neck with contrast 70491 $768.75 $653.44

*Pancreas protocol (Abdomenwith/without contrast)

74170 $895.75 $761.39

*Pelvis with contrast 72193 $778.50 $661.73

*Renal mass protocol (Abdomenwith/without contrast)

74170 $895.75 $761.39

Shoulder without contrast (Right or Left)

73200 & 76376 $665.25 $565.46

Sinus (Image Guided) 70486 $547.75 $465.59

Sinus without contrast 70486 $547.75 $465.59

Stone protocol (Urography, KUB) 74176 $581.50 $494.28

Temporal Bones without contrast 70480 $688.25 $585.01

Tibia/Fibula without contrast (Right or Left)

73700 & 76376

$667.00 $566.95

Toe without contrast (Right or Left) 73700 & 76376 $667.00 $566.95

Wrist without contrast (Right or Left) 73200 & 76376 $665.25 $565.46

*Includes CT "contrast" estimated cost of $100, code Q9967.

DEXA Scan

Service Billing (CPT) Code** The Everett Clinic Self-Pay Fee Prompt Pay Incentive 15%

Dexascan 77080 $123.00 $104.55

Mammography*

Service Billing (CPT)

Code** The Everett

ClinicSelf-Pay Fee Prompt Pay

Incentive 15%

Screening Mammogram 2D with or without implants

77067 $386.50 $328.53

Screening Mammogram 3D tomosynthesis with or without implants

77063 & 77067

$538.25 $457.51

Diagnostic mammograms are performed at the Comprehensive Breast Center. Please contact them for an estimate. *Not all insurance companies will pay the additional fee for a 3D mammogram. Out of pocketexpense for 3D is $151.75 for 2022.

MRI (Magnetic Resonance Imaging)

Service Billing (CPT)

Code** The Everett Clinic

Self-Pay Fee Prompt Pay

Incentive 15%

Abdomen With and without contrast (Adrenals, Liver, Kidney, Pancreas)

74183 $1,424.25 $1,210.61

Ankle without contrast (Right or Left) 73721 $689.25 $585.86

Brain IAC with and without contrast 70553 $1,387.25 $1,179.16

Brain MRA without contrast 70544 $1,125.75 $956.89

Brain with and without contrast 70553 $1, 387.25 $1,179.16

Brain without contrast 70551 $1 ,062.50 $903.13

Cervical Spine with and without contrast 72156 $1,363.00 $1,158.55

Cervical Spine without contrast 72141 $929.75 $790.29

Elbow without contrast (Right or Left) 73221 $691.75 $587.99

Enterography (Small Bowel) 72196 &

74182 $2,417.75 $2,055 .09

Fingers without contrast (Right or Left) 73221 $691.75 $587.99

Foot without contrast (Right or Left) 73721 $689.25 $585.86

Hand without contrast (Right or Left) 73221 $691.75 $587.99

Hips without contrast (Right or Left) 72195 $1,048.25 $891.01

Knee without contrast (Right or Left) 73721 $689.25 $585.86

Lumbar Spine with and without contrast 72158 $1,356.50 $1,153.03

Lumbar Spine without contrast 72148 $930.50 $790.93

MRCP (Pancreas and Gallbladder ducts) 74181 $933.25 $793.26

Shoulder without contrast (Right or Left) 73221 $691.75 $587.99

Thoracic Spine without contrast 72146 $931.25 $791.56

Toes without contrast (Right or Left) 73721 $689.25 $585.86

Wrist without contrast (Right or Left) 73221 $691.75 $587.99

Nuclear Medicine

Service Billing (CPT) Code** The Everett Clinic

Self-Pay Fee Prompt Pay

Incentive 15%

Bone Scan (3-Phase) 78315 & A9503 $1,036.00 $880.60

Bone Scan (Whole Body) 78306 & A9503 $905.25 $769.46

Bone Scan (with Spect) 78320 & A9503 $654.75 $556.54

Gastric Emptying 78264 & SS494 $1,111.75 $944.99

Gastroespohageal Reflux Scan 78262 & SS494 $839.25 $713.36

HIDA Scan 78226 & A9537 $1,086.50 $923.53

HIDA Scan with CCK 78227, J7050, SS707,

AA279, A9537 $1,625.00 $1,381.25

Lymphoscintigraphy (Breast or Melanoma)

78195 & AA456 $1,171.00 $995.35

MUGA Scan 78472 & A9560 $879.50 $747.58

Renal Scan with Lasix 78708 & A9562 $2,358.25 $2,004.51

VQ Lung Scan (Ventilation and Perfusion)

78582, SA098, A9540, A9567

$1,358.00 $1,154.30

Ultrasound

Service Billing (CPT)

Code** The Everett Clinic Self-

Pay Fee Prompt Pay

Incentive 15%

Abdomen 76700 $354.75 $301.53

Abdomen and Pelvis with Transvaginal

76700, 76856, 76830

$1,015.50 $863.18

Abdominal Wall 76705 $272.00 $231.20

Aorta 76770 $332.50 $282.63

Bladder/PVR 76857 $230.25 $195.72

Groin 76856 $313.00 $266.05

Head/Neck 76536 $328.75 $279.44

Infant Hips 76885 $384.00 $326.40

Obstetric (2nd or 3rd Trimester) 76805 $394.25 $335.11

Obstetric (Focused) 76815 $235.00 $199.75

Obstetric with Transvaginal (1st Trimester)

76817 & 76801 $609.75 $518.29

Pelvis with Transvaginal 76830 & 76856 $660.75 $561.64

Renal 76770 $332.50 $282.63

Testicle/Scrotum 76870 $311.25 $264.57

Thyroid 76536 $328.75 $279.44

Wrist/Hand 76881 $305.00 $259.25

X-Ray (Radiology)

Service Billing (CPT) Code**

The Everett Clinic Self-Pay Fee

Prompt Pay Incentive 15%

Abdomen KUB (Kidney, Ureter, Bladder)

74018 $82.00 $69.70

Ankle - Right or Left (3 Views) 73610 $98.50 $83.73

Cervical Spine (2 or 3 Views) 72040 $107.00 $90.95

Chest (2 Views) 71046 $91.50 $77.78

Finger - Right or Left (1 or 2 Views)

73140 $101.00 $85.85

Foot - Right or Left (1 or 2 Views) 73630 $92.25 $78.41

Forearm - Right or Left (2 Views) 73090 $81.00 $68.85

Hand - Right or Left (3+ Views) 73130 $98.50 $83.73

Hip - Right or Left (2+ Views) 73502 $127.50 $108.38

Knee - Bilateral Standing 73565 $109.75 $93.29

Knee - Right or Left (1 or 2 Views)

73560 $94.50 $80.33

Lumbar Spine (2 or 3 Views) 72100 $107.00 $90.95

Ribs - Right or Left (2 Views) 71100 $99.75 $84.79

Shoulder - Right or Left (2+ Views)

73030 $93.25 $79.26

Spine - Cervical (2 or 3 Views) 72040 $107.00 $90.95

Spine - Lumbar (2 or 3 Views) 72100 $107.00 $90.95

Toes - Right or Left 73660 $79.25 $67.36

Wrist - Right or Left (3+ Views) 73110 $109.75 $93.29

Disclaimer: While The Everett Clinic strives to give you accurate information regarding prices and estimated costs, several factors may affect pricing, including, but not limited to: (1) Time of selection: Prices are subject to change at any time. (2) Additional expenses: Beyond what's defined, some laboratory and professional fees, such as a physician, radiologist, anesthesiologist and pathologist, may not be included in this estimate. (3) Additional services: Your health condition may require additional time with the same practitioner, specialist or a different condition than scheduled.