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All Services Radiology Services

CPT 72170

X-ray Pelvis, 1-2 Views

$5,100.00 Standard Charge

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CPT 76817

Ultrasound, pregnancy, transvaginal

$2,298.80 Standard Charge

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CPT 74018

X-ray abdomen, 1 view

$5,100.00 Standard Charge

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CPT 74178

CT scan of abdomen & pelvis with and without contrast material

$9,500.00 Standard Charge

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CPT 76856

Ultrasound, pelvic, complete

$6,700.00 Standard Charge

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CPT 72070

X-ray thoracic spine, 2 views

$5,100.00 Standard Charge

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CPT 70553

MRI scan of brain before and after contrast

$13,500.00 Standard Charge

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CPT 78452

Image of the heart to assess perfusion

$6,315.40 Standard Charge

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CPT 76705

Ultrasound of abdomen, limited

$6,700.00 Standard Charge

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CPT 77065

Diagnostic mammography, unilateral

$4,500.00 Standard Charge

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CPT 70491

CT scan, soft tissue neck; with contrast material(s)

$9,500.00 Standard Charge

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CPT 72128

CT scan of thoracic spine without contrast

$9,500.00 Standard Charge

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CPT 70498

CTA scan of neck

$9,500.00 Standard Charge

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CPT 76819

Fetal biophysical profile without non-stress test

$572.00 Standard Charge

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CPT 76882

Ultrasound, shoulder joint/soft tissue

$534.78 Standard Charge

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CPT 76815

Ultrasound, pregnancy

$600.00 Standard Charge

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CPT 74176

CT scan of abdomen & pelvis without contrast material

$9,500.00 Standard Charge

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CPT 76818

Fetal biophysical profile with non- stress test

$1,724.80 Standard Charge

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CPT 76816

Ultrasound, pregnancy, transabdominal (pelvis)

$1,278.20 Standard Charge

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CPT 71045

X-ray of chest; Single View

$5,100.00 Standard Charge

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CPT 71260

CT Scan of thorax, with contrast material

$9,500.00 Standard Charge

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CPT 73000

X-ray clavicle, 1 view

$327.00 Standard Charge

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CPT 71275

CT Angiogram Chest with and without Contrast

$9,500.00 Standard Charge

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CPT 73090

X-ray Upper Arm, 2 Views

$181.95 Standard Charge

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CPT 71250

CT Scan of thorax, without contrast material

$9,500.00 Standard Charge

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CPT 71111

X-ray of Both Sides of Ribs, Including Chest, Minimum of 4 Views

$5,100.00 Standard Charge

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CPT 73700

CT scan of hip, knee, ankle, or foot without contrast

$9,500.00 Standard Charge

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CPT 72125

CT scan of cervical spine without contrast

$9,500.00 Standard Charge

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CPT 72100

X-ray Lower Sacral Spine, 2 or 3 views

$5,100.00 Standard Charge

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CPT 72114

X-ray complete lumbar spine (with bending), 6 or more views

$5,100.00 Standard Charge

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CPT 72148

MRI lumbar spine without contrast material

$13,500.00 Standard Charge

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CPT 77067

Mammogram Screening

$4,500.00 Standard Charge

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CPT 72220

X-ray sacrum and coccyx, 2 or more views

$747.00 Standard Charge

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CPT 77066

Mammography of both breasts

$4,500.00 Standard Charge

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CPT 76830

Ultrasound, transvaginal

$2,298.80 Standard Charge

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CPT 77080

Scan to measure bone mineral density (BMD) at the spine and hip

$5,100.00 Standard Charge

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CPT 70486

CT scan, maxillofacial area; without contrast material

$9,500.00 Standard Charge

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CPT 72197

MRI scan of pelvis with and without contrast

$13,500.00 Standard Charge

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CPT 73562

X-ray exam of knee, 3 views

$5,100.00 Standard Charge

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CPT 74175

CT angiography scan of abdomen

$9,500.00 Standard Charge

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CPT 74177

CT scan of abdomen & pelvis with contrast material

$9,500.00 Standard Charge

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CPT 71101

X-ray ribs, unilateral, 3 or more views

$6,601.19 Standard Charge

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CPT 71046

X-ray of chest; 2 Views

$5,100.00 Standard Charge

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CPT 70496

CTA scan of head

$9,500.00 Standard Charge

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CPT 76811

Ultrasound of single fetus

$2,455.60 Standard Charge

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CPT 72110

X-ray, lower back, minimum four views

$5,100.00 Standard Charge

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CPT 73221

MRI of upper extremity joint; without contrast material

$13,500.00 Standard Charge

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CPT 76805

Abdominal ultrasound of pregnant uterus, first trimester

$1,408.00 Standard Charge

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CPT 76700

Ultrasound of abdomen, complete

$2,499.00 Standard Charge

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CPT 76770

Ultrasound exam of abdomenal back wall, complete

$6,700.00 Standard Charge

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CPT 76881

Ultrasound Veins of Both Arms or Legs

$1,170.20 Standard Charge

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CPT 73721

MRI scan of leg joint

$13,500.00 Standard Charge

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CPT 73070

X-ray elbow, 2 views

$244.00 Standard Charge

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CPT 72131

CT scan of lumbar spine without contrast

$9,500.00 Standard Charge

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CPT 74183

MRI of abdomen without & with contrast material

$13,500.00 Standard Charge

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CPT 72193

CT scan, pelvis, with contrast

$9,500.00 Standard Charge

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CPT 76813

Evaluation through measurement of fetal nuchal translucency

$518.00 Standard Charge

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CPT 72052

X-ray Lower Sacral Spine, 4 or More Views

$5,100.00 Standard Charge

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CPT 70551

MRI scan of brain (including brain stem); without contrast material

$13,500.00 Standard Charge

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CPT 72040

X-ray Lower Sacral Spine, 2-3 Views

$5,100.00 Standard Charge

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CPT 72082

X-ray entire spine (scoliosis evaluation), 2 views

$5,100.00 Standard Charge

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CPT 70450

CT scan, head or brain, without contrast

$9,500.00 Standard Charge

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CPT 73521

X-ray hip and pelvis, 2 views

$593.26 Standard Charge

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CPT 76536

Ultrasound exam of head and neck

$6,700.00 Standard Charge

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CPT 76857

Ultrasound of pelvis

$6,700.00 Standard Charge

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CPT 73140

X-ray Fingers, 2 Views

$412.00 Standard Charge

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