* Cash pricing is ONLY valid for patients choosing to pay in-full at the time of service.
No insurance will be billed.
Please note: this is a full service (Global) fee which includes procedure & interpretation | ||||
As of 1/30/2019 subject to change without notice |
CT: Note: Additional Contrast Charge May apply*** | ||||
CPT | Description | |||
75635 | CTA ABDOMINAL AORTA W RUNOFF W CONTRAST | $ 665 | ** | |
71275 | CTA CHEST W/O & W CONTRAST | $ 453 | ** | |
70498 | CTA CAROTIDS (NECK) | $ 441 | ** | |
70496 | CTA HEAD | $ 442 | ** | |
74176 | CT ABDOMEN & PELVIS WO CONTRAST | $ 303 | ||
74177 | CT ABDOMEN & PELVIS W CONTRAST | $ 470 | *** | |
74178 | CT ABDOMEN & PELVIS WO & W CONTRAST | $ 533 | *** | |
74150 | CT ABDOMEN WO CONTRAST | $ 226 | ||
74160 | CT ABDOMEN W CONTRAST | $ 348 | *** | |
74170 | CT ABDOMEN WO & W CONTRAST | $ 396 | *** | |
71250 | CT CHEST WO CONTRAST | $ 246 | ||
71260 | CT CHEST W CONTRAST | $ 296 | *** | |
71270 | CT CHEST WO & W CONTRAST | $ 355 | *** | |
70487 | CT FACIAL BONES / SINUS W CONTRAST | $ 253 | *** | |
70486 | CT FACIAL BONES / SINUS WO CONTRAST | $ 210 | ||
70488 | CT FACIAL BONES / SINUS WO & W CONTRAST | $ 308 | *** | |
70470 | CT HEAD WO & W CONTRAST | $ 289 | *** | |
70450 | CT HEAD WO CONTRAST | $ 175 | ||
70460 | CT HEAD W CONTRAST | $ 246 | *** | |
73700 | CT LOWER EXTREMITY WO CONTRAST | $ 271 | ||
73701 | CT LOWER EXTREMITY W CONTRAST | $ 341 | *** | |
73702 | CT LOWER EXTREMITY WO & W CONTRAST | $ 412 | *** | |
70491 | CT NECK W/CONTRAST | $ 307 | *** | |
70490 | CT NECK WO CONTRAST | $ 254 | ||
70492 | CT NECK WO & W CONTRAST | $ 369 | *** | |
70480 | CT ORBITS WO CONTRAST | $ 351 | ||
70481 | CT ORBITS W CONTRAST | $ 416 | *** | |
70482 | CT ORBITS W & W/O CONTRAST | $ 453 | *** | |
72192 | CT PELVIS WO CONTRAST | $ 220 | ||
72193 | CT PELVIS W CONTRAST | $ 341 | *** | |
72194 | CT PELVIS WO & W CONTRAST | $ 392 | *** | |
72125 | CT SPINE CERVICAL WO CONTRAST | $ 278 | ||
72126 | CT SPINE CERVICAL W CONTRAST | $ 344 | *** | |
72127 | CT SPINE CERVICAL WO & W CONTRAST | $ 407 | *** | |
72131 | CT SPINE LUMBAR WO CONTRAST | $ 271 | ||
72132 | CT SPINE LUMBAR WCONTRAST | $ 344 | *** | |
72133 | CT SPINE LUMBAR WO & W CONTRAST | $ 406 | *** | |
72128 | CT SPINE THORACIC WO CONTRAST | $ 272 | ||
72129 | CT SPINE THORACIC W CONTRAST | $ 345 | *** | |
72130 | CT SPINE THORACIC WO & W CONTRAST | $ 410 | *** | |
76377 | CT 3D RENDERING | $ 107 | ||
CT CONTRAST | ||||
Description | ||||
** | CTA CONTRAST CHARGE | $ 100 | ||
*** | CT CONTRAST CHARGE | $ 75 | ||
Mammography: | ||||
CPT | Description | |||
77067 | MAMMOGRAPHY: SCREENING BILAT DIGITAL | $ 208 | ||
77065 | MAMMOGRAPHY: DIAGNOSTIC UNILAT DIGITAL | $ 204 | ||
77066 | MAMMOGRAPHY: DIAGNOSTIC BILAT DIGITAL | $ 258 | ||
Bone Density | ||||
CPT | Description | |||
77080 | DXA BONE DENSITY AXIAL SKELTON | $ 63 | ||
BODY COMPOSITION ANALYSIS | $ 50 | |||
Ultrasound | ||||
CPT | Description | |||
76700 | US ABDOMINAL COMPLETE | $ 186 | ||
76705 | US ABDOMINAL LTIMITED | $ 139 | ||
76706 | US AORTA SCREENING AAA | $ 143 | ||
76641 | US BREAST, UNI COMPLETE | $ 163 | ||
76642 | US BREAST, UNI LIMITED | $ 134 | ||
76604 | US CHEST (CHEST WALL/UPPER BACK) | $ 135 | ||
76882 | US EXTRMITY NONVASCULAR (ie Bakers Cyst) | $ 87 | ||
76770 | US KIDNEY & BLADDER | $ 172 | ||
76775 | US KIDNEY LIMITED | $ 88 | ||
76856 | US PELVIS NON OB | $ 167 | ||
76830 | US TRANSVAGINAL | $ 186 | ||
76857 | US PELVIS LIMITED | $ 74 | ||
76870 | US TESTICULAR | $ 103 | ||
76536 | US THYROID | $ 177 | ||
76801 | OB US <14 WEEKS TRANSABDOMINAL | $ 188 | ||
76817 | OB US TRANSVAGINAL | $ 148 | ||
76802 | OB EACH ADDITIIONAL GESTATION 1st TRIMESTER | $ 99 | ||
76805 | OB US > 14 WEEKS TRANSABDOMINAL | $ 216 | ||
76810 | OB EACH ADDITIONAL GESTATION >14 WEEKS | $ 142 | ||
76815 | OB US LIMITED | $ 128 | ||
76816 | OB US FOLLOW-UP FROM PREVIOUS SCAN | $ 176 | ||
Doppler | ||||
93922 | ANKEL/BRACHIAL INDEX 1-2 LEVEL BILATERAL | $ 134 | ||
93978 | DOPPLER: AORTA DUPLEX COMPLETE | $ 292 | ||
93880 | DOPPLER:CAROTID ARTERY BILATERAL | $ 310 | ||
93926 | DOPPLER LOWER EXTREMITY ARTERY UNI | $ 232 | ||
93925 | DOPPLER LOWER EXTREMITY ARTERY BILATERAL | $ 397 | ||
93930 | DOPPLER; UPPER EXTREMITY ARTERIAL BILATERAL | $ 318 | ||
93931 | DOPPLER; UPPER EXTREMITY ARTERIAL UNI | $ 198 | ||
93970 | DOPPLER VENOUS EXTREMITY BILATERAL | $ 299 | ||
93971 | DOPPLER VENOUS EXTREMITY UNI | $ 183 | ||
X-Ray | ||||
Definitions: Uni or Unilateral means 1 or one side. Bilateral means 2 or both sides | ||||
CPT | Description | |||
74018 | ABDOMEN: 1 VIEW | $ 41 | ||
74019 | ABDOMEN: 2 VIEWS | $ 50 | ||
74021 | ABDOMEN: 3 OR MORE VIEWS | $ 59 | ||
73050 | ACROMIOCLAVICULAR JOINTS | $ 54 | ||
74022 | ACUTE ABDOMEN SERIES W/CHEST 3 VIEWS | $ 67 | ||
73600 | ANKLE 2 VIEWS | $ 45 | ||
73610 | ANKLE COMPLETE | $ 47 | ||
77072 | BONE AGE STUDIES | $ 35 | ||
77073 | BONE LENGTH STUDIES | $ 54 | ||
73650 | CALCANEOUS MIN 2 VIEWS | $ 41 | ||
71045 | CHEST SINGLE FRONTAL VIEW | $ 30 | ||
71046 | CHEST 2 VIEWS | $ 46 | ||
71047 | CHEST 3V | $ 59 | ||
71048 | CHEST 4 VIEWS or more | $ 63 | ||
73000 | CLAVICLE | $ 42 | ||
73070 | ELBOW 2 VIEWS | $ 41 | ||
73080 | ELBOW COMPLETE, MIN 3 VIEWS | $ 47 | ||
70150 | FACIAL BONES 3 VIEWS | $ 62 | ||
73551 | FEMUR 1 VIEW | $ 42 | ||
73552 | FEMUR 2 VIEWS | $ 50 | ||
73140 | FINGERS MIN 2 VIEWS | $ 49 | ||
73620 | FOOT 2 VIEWS | $ 39 | ||
73630 | FOOT COMPLETE | $ 44 | ||
73090 | FOREARM, 2 VIEWS | $ 39 | ||
73120 | HAND 2 VIEWS | $ 43 | ||
73130 | HAND COMPLETE | $ 48 | ||
73521 | HIP, BILATERAL,W PELVIS, 2 VIEWS | $ 57 | ||
73522 | HIP, BILATERAL, W PELVIS 3-4 VIEWS | $ 74 | ||
73523 | HIP,BILATERAL, W PELVIS MIN 5 VIEWS | $ 85 | ||
73501 | HIP, UNI, W PELVIS, 1 VIEW | $ 45 | ||
73502 | HIP, UNI,W PELVIS, 2-3 VIEWS | $ 62 | ||
73503 | HIP, UNI, MIN of 4 VIEWS | $ 78 | ||
73060 | HUMERUS MIN 2 VIEWS | $ 44 | ||
73560 | KNEE, 1-2 VIEWS | $ 47 | ||
73562 | KNEE, 3 VIEWS | $ 54 | ||
73564 | KNEE, COMP 4 OR MORE VIEWS | $ 60 | ||
73565 | KNEES, STANDING COMPARISON | $ 54 | ||
73592 | LOWER EXTREMITY INFANT 2 VIEW (<1 YR) | $ 41 | ||
70100 | MANDIBLE <4 VIEWS | $ 50 | ||
70110 | MANDIBLE COMPLETE 4 OR MORE VIEWS | $ 57 | ||
70120 | MASTOIDS < 3 VWS | $ 50 | ||
70130 | MASTOID COMPLETE, MIN 3 VIEWS PER SIDE | $ 82 | ||
70160 | NASAL BONES | $ 50 | ||
70360 | NECK SOFT TISSUE | $ 43 | ||
76010 | NOSE/RECTUM FOR CHILD FOREIGN BODY 1 VIEW | $ 39 | ||
70200 | ORBITS COMPLETE | $ 64 | ||
77074 | OSSEOUS SURVEY: LIMITED FOR METS | $ 97 | ||
77075 | OSSEOUS SURVEY: COMPLETE AXIAL & APPENDICULAR | $ 132 | ||
77076 | OSSEOUS SURVEY: INFANT ( <1 YR) | $ 144 | ||
72170 | PELVIS 1 OR 2 VIEWS | $ 48 | ||
72190 | PELVIS MIN 3 VIEWS | $ 57 | ||
71110 | RIBS: BILATERAL 3 VIEWS | $ 60 | ||
71111 | RIBS: BILATERAL W/CHEST, MIN 4 VIEWS | $ 71 | ||
71100 | RIBS: UNILATERAL 2 VIEWS | $ 50 | ||
71101 | RIBS: UNILATERAL W/CHEST MIN 3 VIEWS | $ 58 | ||
72200 | SACROILIAC JOINTS 1 OR 2 VWS | $ 43 | ||
72202 | SACROILIAC JOINTS 3 OR MORE | $ 50 | ||
72220 | SACRUM AND COCCYX MIN 2 VIEWS | $ 43 | ||
73010 | SCAPULA | $ 46 | ||
70240 | SELLA TURCIA | $ 46 | ||
73020 | SHOULDER, 1 VIEW | $ 35 | ||
73030 | SHOULDER COMPLETE MIN 2 VIEWS | $ 44 | ||
70210 | SINUS 1 VIEW | $ 45 | ||
70220 | SINUS COMPLETE MN 3 VIEWS | $ 57 | ||
70250 | SKULL < 4 VIEWS | $ 55 | ||
70260 | SKULL COMPLETE MIN 4 VIEWS | $ 69 | ||
72020 | SPINE: SINGLE VIEW, SPECIFY LEVEL | $ 34 | ||
72040 | SPINE CERVICAL 2 OR 3 VWS | $ 50 | ||
72050 | SPINE CERVICAL 4 or 5 VIEWS | $ 68 | ||
72052 | SPINE CERVICAL 6 OR MORE VIEWS | $ 84 | ||
72100 | SPINE LUMBAR 2 OR 3 VIEWS | $ 53 | ||
72110 | SPINE LUMBAR MIN 4 VIEWS | $ 74 | ||
72120 | SPINE LUMBAR BENDING 2 OR 3 VIEWS | $ 61 | ||
72114 | SPINE LUMBAR COMP MIN 6 VIEWS | $ 93 | ||
72070 | SPINE THORACIC 2 VIEWS | $ 51 | ||
72072 | SPINE THORACIC 3 VIEWS | $ 52 | ||
72074 | SPINE THORACIC MIN 4 VIEWS | $ 59 | ||
72081 | SPINE SCOLIOSIS 1 VIEW | $ 58 | ||
72082 | SPINE SCOLIOSIS 2-3 VIEWS | $ 94 | ||
72083 | SPINE SCOLIOSIS 4-5 VIEWS | $ 113 | ||
72084 | SPINE SCOLIOSIS MIN 6 VIEWS | $ 132 | ||
71130 | STERNOCLAVICULAR JOINT(S) MIN 3 VIEWS | $ 54 | ||
71120 | STERNUM MIN 2 VIEWS | $ 45 | ||
73590 | TIBIA & FIBULA, 2 VIEWS | $ 43 | ||
70328 | TMJ UNI | $ 46 | ||
70330 | TMJ BILATERAL | $ 71 | ||
73660 | TOES MIN 2 VIEWS | $ 43 | ||
73092 | UPPER EXTREMITY INFANT (<1 YR) 2 VIEW | $ 41 | ||
73100 | WRIST, 2 VIEWS | $ 47 | ||
73110 | WRIST, COMPLETE MIN 3 VIEW | $ 53 | ||
FLUOROSCOPY: | ||||
CPT | Description | |||
74270 | BARIUM ENEMA-COLON | $ 226 | ||
74220 | ESOPHAGRAM | $ 133 | ||
74250 | SMALL BOWEL W/SERIAL FILM | $ 156 | ||
74241 | UPPER GI WITH KUB | $ 176 | ||
74245 | UGI W/SMALL BOWEL | $ 257 |