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 without contrast, tech only74176-TC$208.00$124.80
Abdomen with and without contrast, tech only74175-TC$796.00$477.60
Abdome with contrast, tech only74160-TC$550.00$330.00
Ankle without contrast, tech only73700-TC$408.00$244.80
Axial thorax without contrast, tech only71250-TC$408.00$244.80
Axial Thorax with contrast, tech only71260-TC$513.00$307.80
Clavicle without contrast, tech only73200-TC$406.00$243.60
Elbow without contrast, tech only73200-TC$406.00$243.60
Finger without contrast, tech only73200-TC$406.00$243.60
Hand without contrast, tech only73200-TC$406.00$243.60
Foot without contrast, tech only73700-TC$408.00$244.80
Head without contrast, tech only70450-TC$315.00$189.00
Liver protocol (Abdomen w/wo contrast), tech only74170-TC$641.00$384.60
Lumbar Spine without contrast, tech only72131-TC$409.00$245.40
Neck with contrast, tech only70491-TC$510.00$306.00
Pelvis with contrast, tech only72193-TC$550.00$330.00
Sinus without contrast, tech only70486-TC$431.00$258.60
Stone protocol (Urography, KUB), tech only74176-TC$208.00$124.80
Temporal Bones without contrast, tech only70480-TC$431.00$258.60

Dexa Scan

ServiceCPT
Code
HIMG
Charge
Cash
Price
Dexascan77080 $201.00 $120.60

Mammography

ServiceCPT
Code
HIMG
Charge
Cash
Price
Screening Mammogram, tech only77067-TC $200.00 $120.00

Nuclear Medicine

ServiceCPT
Code
HIMG
Charge
Cash
Price
Bone Scan (3-Phase), tech only78315-TC$601.00$360.60
Bone Scan (whole body), tech only78306-TC$522.00$313.20
Bone Scan (Ltd. Area), tech only78300-TC$400.00$240.00
Gastric Emptying Study, tech only78264-TC$575.00$345.00
Hepatobiliary System Imaging, incl Gallbladder, tech only78226-TC$570.00$342.00
Hepatorbiliary System Imaging incl Gall/pharm, tech only78227-TC$783.00$469.80
Abdomen, tech only76700-TC$193.00$115.80
Pelvis, tech only76856-TC$183.00$109.80
Abdominal Wall (Retroperitoneal B-Scan), tech only76705-TC$157.00$94.20
Abdominal Aorta, tech only76706-TC$165.00$99.00
Aorta, tech only76770-TC$273.00$163.80
Thyroid, tech only76536-TC$179.00$107.40
Pelvis with Transvaginal, tech only76830-TC$184.00$110.40
Testicle/Scrotum, tech only76870-TC$186.00$111.60
Thyroid, tech only76536-TC$179.00$107.40
Wrist/Hand, tech only76881-TC$156.00$93.60

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$165.00 $99.00
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