Advanced Imaging

CT Scan (Computer Tomography)

ServiceCPT
Code
HIMG
Charge
Cash
Price
Abdomen & Pelvis with contrast, tech only74177-TC$406.00 $243.60
Abdomen & Pelvis with contrast material74177$905.00 $543.00
Abdomen & Pelvis without contrast, tech only74176-TC$208.00 $124.80
Abdomen & Pelvis without contrast material74176$612.00 $367.20
Abdomen with and without contrast74175-TC$796.00 $477.60
Abdomen with contrast74160$728.00 $436.80
Abdomen with contrast74160-TC$550.00 $330.00
Ankle without contrast73700$909.00 $244.80
Axial Thorax without contrast71250$549.00 $160.16
Axial Thorax without contrast71250-TC$408.00 $244.80
Axial Thorax with contrast71260$687.00 $412.20
Axial Thorax with contrast71260-TC$513.00 $307.80
Clavicle without contrast73200$547.00 $243.60
Elbow without contrast73200$547.00 $243.60
Finger without contrast73200$547.00 $243.60
Foot without contrast73700$909.00 $244.80
Hand without contrast73200$547.00 $243.60
Head without contrast70450$433.00 $259.80
Head without contrast70450-TC$315.00 $189.00
Knee without contrast73700$909.00 $244.80
Liver protocol (Abdomen with/without contrast)74170-TC$641.00 $384.60
Lumbar Spine without contrast72131$548.00 $328.80
Lumbar Spine without contrast72131-TC$409.00 $245.40
Neck with contrast70491$703.00 $421.80
Neck with contrast70491-TC$510.00 $306.00
Pancreas protocol (Abdomen with/without contrast)74170-TC$641.00 $384.60
Pelvis with contrast72193$714.00 $428.40
Pelvis with contrast72193-TC$550.00 $330.00
Renal mass protocol (Abdomen with/without contrast)74170-TC$641.00 $384.60
Shoulder without contrast73200$547.00 $243.60
Sinus without contrast70486$590.00 $354.00
Sinus without contrast70486-TC$431.00 $258.60
Stone protocol (Urography, KUB)74176$612.00 $367.20
Stone protocol (Urography, KUB)74176-TC$208.00 $124.80
Temporal Bones without contrast70480$611.00 $366.60
Temporal Bones without contrast70480-TC$431.00 $258.60
Tibia/Fibula without contrast73700$909.00 $244.80
Toe without contrast73700$909.00 $244.80
Wrist without contrast73200$547.00 $244.80

Dexa Scan

ServiceCPT
Code
HIMG
Charge
Cash
Price
Dexascan77080$201.00 $120.73

Mammography

ServiceCPT
Code
HIMG
Charge
Cash
Price
Screening MammogramG0202$300.00 $163.80

Nuclear Medicine

ServiceCPT
Code
HIMG
Charge
Cash
Price
Bone Scan (3-Phase)78315-TC$601.00 $360.60
Bone Scan (Whole Body)78306-TC$424.00 $254.40
Bone Scan (Whole Body)78306$516.00 $309.60
Bone Scan (Ltd. Area)78300-TC$293.00 $175.80
Bone Scan (Ltd. Area)78300-TC$293.00 $216.00
Gastric Emptying Study78264-TC$575.00 $345.00
Gastric Emptying Study78264$654.00 $358.65
Hepatobiliary System Imaging inc. Gallbladder78226$632.00 $379.20
Hepatobiliary System Imaging inc. Gallbladder, tech78226-TC$570.00 $342.00
Hepatobiliary System Imaging inc. Gallbladder, pharm78227$879.00 $489.88
Hepatobiliary System Imaging inc. Gall/pharm, tech78227-TC$783.00 $470.07

Ultrasound

ServiceCPT
Code
HIMG
Charge
Cash
Price
Abdomen76700$286.00 $171.60
Abdomen76700-TC$193.00 $115.80
Pelvis 76856$257.00 $154.20
Pelvis76856-TC$183.00 $109.80
Abdominal Wall (Retroperitoneal B-Scan)76705$220.00 $132.00
Abdominal Wall (Retroperitoneal B-Scan)76706-TC$125.00 $94.20
Aorta76770$273.00 $163.80
Aorta76770-TC$193.00 $115.80
Head/Neck76536$236.00 $141.60
Head/Neck76536-TC$179.00 $107.45
Pelvis with Transvaginal76830$258.00 $154.80
Pelvis with Transvaginal76830-TC$184.00 $110.40
Renal76770$273.00 $171.60
Renal76700-TC$193.00 $115.80
Testicle/Scrotum76870$256.00 $153.60
Testicle/Scrotum76870-TC$186.00 $111.60
Thyroid76536$236.00 $141.60
Thyroid76536-TC$179.00 $107.45
Wrist/Hand (Extremity)76881$348.00 $208.80
Wrist/Hand (Extremity)76881-TC$156.00 $93.60