Application CPT Code Cash Price EYE FOREIGN BODY BIL $43.47* EYE FOREIGN BODY RT $43.47* EYE FOREIGN BODY LT $43.
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- Shanon Turner
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1 Diagnostic X-Ray Head & Neck EYE FOREIGN BODY BIL $43.47* EYE FOREIGN BODY RT $43.47* EYE FOREIGN BODY LT $43.47* MANDIBLE < 4V $47.37* MANDIBLE MIN 4V $59.73* MASTOIDS < 3V $51.27* MASTOIDS MIN 3V $82.68* INTERNAL AUDITORY MEATUS $70.94* FACIAL BONES < 3V $45.18* ZYGOMATIC ARCH $45.18* FACIAL BONES MIN 3V $64.19* NASAL BONES < 3 V $49.01* NASAL BONES MIN 3V $49.01* OPTIC FORAMINA $53.55* ORBITS MIN 4V $66.45* NASAL BONES < 3 VIEW $49.01* SINUSES < 3 V $45.69* SINUSES MIN 3V $58.62* SELLA TURCICA $45.18* SKULL < 4V $54.72* SKULL MIN 4V $71.03* TMJ UNI/LT $46.26* TMJ BIL $70.83* TMJ UNI/RT $46.26* NECK SOFT TISSUE $41.79*
2 Diagnostic X-Ray Chest & Abdomen CHEST 1V $36.83* CHEST 2V $41.76* CHEST 2V W/AP LORDOTIC $50.0* CHEST SPECIAL VIEW $52.94* RIBS UNI 2V LT $49.68* RIBS UNI 2V RT $49.68* 1V CXR & RIBS UNI LT $59.79* 1V CXR & RIBS UNI RT $59.79* RIBS BIL 3V $61.44* CXR & RIBS BIL MIN 4V $78.20* STERNUM MIN 2V $49.08* STERNOCLAV JTS < 3 VIEW $56.90* STERNOCLAV JTS MIN 3V $56.90* ABDOMEN AP KUB $39.06* ABDOMEN AP/OBL/CONE $56.91* ABD COMP W/DEC &/OR ERECT $60.87* ABD ACUTE W/CHEST $73.22* NOSE-RECTUM FB IV CHLD $42.93* Diagnostic X-Ray Spine SPINE ENTIRE AP & LAT $107.25* SPINE 1V $36.78* CERVICAL SPINE 2/3V $57.36* CERVICAL SPINE MIN 4V $79.20* CERVICAL SPINE W/OBLIQ & FLEX $99.29* THORACIC SPINE 2V $51.33* THORACIC SPINE 3 V $57.47* THORACIC SPINE MIN 4 V $66.90* THORACIC LUMBAR SPINE 2V $54.59* SCOLIOSIS STUDY $73.50*
3 Diagnostic X-Ray Spine (continued) LUMBAR SPINE 2/3 V $60.15* LUMBAR SPINE MIN 4V $82.53* LUMBAR SPINE COMP W/ BEND $109.20* PELVIS MIN 3V $61.22* SI JTS < 3V $44.58* SI JTS MIN 3V $52.40* SACRUM/COCCYX MIN 2V $44.58* Diagnostic X-Ray Upper Extremities AC JTS BIL WW0 WGT $56.22* CLAVICLE COMP RT $43.92* CLAVICLE COMP LT $43.92* CLAVICLE COMP BIL $43.92* SCAPULA COMP RT $45.06* SCAPULA COMP LT $45.06* SCAPULA COMP BIL $45.06* SHOULDER 1V LT $36.23* SHOULDER 1V RT $36.23* SHOULDER 1V BIL $36.23* SHOULDER MIN 2V LT $46.19* SHOULDER MIN 2V RT $46.19* SHOULDER MIN 2V BIL $46.19* HUMERUS MIN 2V LT $45.06* HUMERUS MIN 2V RT $45.06* HUMERUS MIN 2V BIL $45.06* HUMERUS 1V LT $45.06* HUMERUS 1V BIL $45.06* HUMERUS MIN 1V RT $45.06* ELBOW 2V LT $41.78* ELBOW 2V RT $41.78*
4 Diagnostic X-Ray Upper Extremities (continued) ELBOW 2V BIL $41.78* ELBOW 1V LT $41.78* ELBOW 1V BIL $41.78* ELBOW 1V RT $41.78* ELBOW MIN 3V LT $52.35* ELBOW MIN 3V RT $52.35* ELBOW MIN 3V BIL $52.35* FOREARM 2V LT $41.79* FOREARM 2V RT $41.79* FOREARM 1V RT $41.79* FOREARM 1V BIL $41.79* WRIST 2V LT $45.57* WRIST 2V RT $45.57* WRIST 2V BIL $45.57* WRIST 1V LT $45.57* WRIST 1V RT $45.57* WRIST 1V BIL $45.57* WRIST MIN 3V LT $52.92* WRIST MIN 3V RT $52.92* WRIST MIN 3V BIL $52.92* WRIST NAVICULAR LT $52.92* WRIST NAVICULAR RT $52.92* HAND 2V LT $41.24* HAND 2V RT $41.24* HAND 2V BIL $41.24* HAND 1V LT $41.24* HAND 1V RT $41.24* HAND 1V BIL $41.24* HAND MIN 3V LT $47.93* HAND MIN 3V RT $47.93* HAND MIN 3V BIL $47.93*
5 Diagnostic X-Ray Upper Extremities (continued) FINGERS MIN 2V LT $45.62* FINGERS MIN 2V RT $45.62* FINGERS MIN 2V BIL $45.62* UP EXT INFANT MIN 2V LT $43.44* UP EXT INFANT MIN 2V RT $43.44* UP EXT INFANT MIN 2V BIL $43.44* Diagnostic X-Ray Lower Extremities PELVIS 1/2 V $41.16* PELVIS MIN 3V $61.22* PELVIS/HIPS CHLD MIN2V $59.00* HIP 1V BIL $40.05* HIP UNI MIN 2V LT $56.79* HIP UNI MIN 2V RT $56.79* HIPS >1 V INCL AP/PELV $60.80* HIPS MIN 2V BIL W/O PELV $60.80* FEMUR 2V LT $43.94* FEMUR 2V RT $43.94* FEMUR 2V BIL $43.94* FEMUR 1V LT $43.94* FEMUR 1V RT $43.94* FEMUR 1V BIL $43.94* KNEE 1/2V LT $45.06* KNEE 1/2V RT $45.06* KNEE 1/2V BIL $45.06* KNEE 3V LT $53.39* KNEE 3V RT $53.39* KNEE 3V BIL $53.39* KNEE MIN 4V LT $61.79* KNEE MIN 4V RT $61.79*
6 Diagnostic X-Ray Lower Extremities (continued) KNEE AP STAND BIL $48.95* KNEE MIN 4V BIL $61.79* TIBIA/FIBULA 2V LT $41.79* TIBIA/FIBULA 2V RT $41.79* TIBIA/FIBULA 2V BIL $41.79* TIBIA/FIBULA 1V LT $41.79* TIBIA/FIBULA 1V RT $41.79* TIBIA/FIBULA 1V BIL $41.79* LW EXT INFANT MIN 2V LT $44.01* LW EXT INFANT MIN 2V RT $44.01* LW EXT INFANT MIN 2V BIL $44.01* ANKLE 2V LT $41.79* ANKLE 2V RT $41.79* ANKLE 2V BIL $41.79* ANKLE 1V LT $41.79* ANKLE MIN 3V LT $47.93* ANKLE MIN 3V RT $47.93* ANKLE MIN 3V BIL $47.93* FOOT 2V LT $40.68* FOOT 2V RT $40.68* FOOT 2V BIL $40.68* FOOT 1V LT $40.68* FOOT 1V RT $40.68* FOOT 1V BIL $40.68* FOOT MIN 3V LT $47.37* FOOT MIN 3V RT $47.37* FOOT MIN 3V BIL $47.37* CALCANEUS MIN 2V LT $41.24* CALCANEUS MIN 2V RT $41.24* CALCANEUS MIN 2V BIL $41.24*
7 Diagnostic X-Ray Lower Extremities (continued) TOE(S) 1V/RT $42.83* TOE(S) 1V/LT $42.83* TOES MIN 2V LT $42.83* TOES MIN 2V RT $42.83* TOES MIN 2V BIL $42.83* Bone Studies DEXA BONE AGE STUDIES $36.30* BONE SURVEY COMP $151.29* BONE SURVEY INFANT $145.97* DEXA BONE DENSITY AXIAL (L-SPINE/HIPS) $128.36* DEXA BONE DENSITY PERIPH $59.60* PET/CT PET TUMOR LTD AREA W/CONTRAST $1,573.23* PET TUMOR SKULLUMBAR THIGH W/CONTRAST $1,589.29* PET TUMOR WB W/CONTRAST $1,593.08* CT Head & Neck CT BRAIN/HEAD W/O CONTRAST $250.91* CT BRAIN/HEAD W/CONTRAST $326.25* CT BRAIN/HEAD W & W/O CONTRAST $392.66* CT ORB/PFOS/EAR W/O CONTRAST $337.63* CT ORB/PFOS/EAR W/CONTRAST $453.40* CT ORB/PFOS/EAR W & W/O CONTRAST $515.53* CT SELLA TURICA W/O CONTRAST $337.63* CT SELLA TURICA W/CONTRAST $453.40*
8 CT Head & Neck (continued) CT TEMPORAL BONE W/O CONTRAST $337.63* CT TEMPORAL BONE W/CONTRAST $453.40* CT TEMPORAL BONE W & W/O CONTRAST $515.53* CT MAXI-FACIAL W/O CONTRAST $327.75* CT MAXI-FACIAL W/CONTRAST $396.35* CT MAXI-FACIAL W & W/O CONTRAST $480.30* CT MANDIBLE W/O CONTRAST $327.75* CT MANDIBLE W/CONTRAST $396.35* CT MANDIBLE W & W/O CONTRAST $480.30* CT SINUSES W/O CONTRAST $327.75* CT SINUSES W/CONTRAST $396.35* CT SINUSES W & W/O CONTRAST $480.30* CT DENTASCAN $327.75* CT NECK W/O CONTRAST $325.14* CT NECK W/CONTRAST $390.01* CT NECK W & W/O CONTRAST $470.64* CT Chest, Abdomen and Pelvis CT CHEST W/O CONTRAST $328.16* CT CHEST W/CONTRAST $393.09* CT CHEST/HIGH RES W/O CONTRAST $328.16* CT CHEST/HIGH RES W/CONTRAST $393.09* CT CHEST/HIGH RES W & W/O CONTRAST $483.48* CT CHEST/HIGH RES W/O CONTRAST $328.16* CT CHEST/HIGH RES W/CONTRAST $393.09* CT CHEST/HIGH RES W & W/O CONTRAST $483.48* CT CHEST/PE W/CONTRAST $393.09* CT ABDOMEN W/O CONTRAST $315.28* CT ABDOMEN/STONE W/O CONTRAST $315.28* CT ABDOMEN W/CONTRAST $419.50*
9 CT Chest, Abdomen and Pelvis (continued) CT ABDOMEN W & W/O CONTRAST $523.75* CT PELVIS W/O CONTRAST $310.94* CT PELVIS/STONE W/O CONTRAST $310.94* CT PELVIS W/CONTRAST $372.14* CT PELVIS W & W/O CONTRAST $474.01* CT SI JOINTS W/O CONTRAST $310.94* CT SI JOINTS W/CONTRAST $372.14* CT SI JOINTS W & W/O CONTRAST $474.01* CT ABDOMEN/PELVIS W/CONTRAST $791.64* CT ABDOMEN/PELVIS W/O CONTRAST $626.22* CT ABDOMEN/PELVIS W & W/O CONTRAST $997.76* CT Spine CT CERVICAL SPINE W/O CONTRAST $329.09* CT CERVICAL SPINE W/CONTRAST $392.98* CT CERVICAL SPINE W & W/O CONTRAST $475.43* CT THORACIC SPINE W/O CONTRAST $328.64* CT THORACIC SPINE W/CONTRAST $392.98* CT THORACIC SPINE W & W/O CONTRAST $476.43* CT LUMBAR SPINE W/O CONTRAST $328.16* CT LUMBAR SPINE W/CONTRAST $392.51* CT LUMBAR SPINE W & W/O CONTRAST $476.35* CT CERVICAL SPINE W/O CONTRAST $329.09* CT CERVICAL SPINE W/CONTRAST $392.98* CT CERVICAL SPINE W & W/O CONTRAST $475.43* CT THORACIC SPINE W/O CONTRAST $328.64* CT THORACIC SPINE W/CONTRAST $392.98* CT THORACIC SPINE W & W/O CONTRAST $476.43* CT LUMBAR SPINE W/O CONTRAST $328.16* CT LUMBAR SPINE W/CONTRAST $392.51*
10 CT Upper Extremities CT LUMBAR SPINE W & W/O CONTRAST $476.35* CT UP EXT W/O CONTRAST LT $314.18* CT UP EXT W/O CONTRAST BIL $314.18* CT UP EXT W/CONTRAST RT $375.84* CT UP EXT W/CONTRAST LT $375.84* CT UP EXT W & W/O CONTRAST RT $479.13* CT UP EXT W & W/O CONTRAST LT $479.13* CT UP EXT W & W/O CONTRAST BIL $479.13* CT Lower Extremities CT LW EXT W/O CONTRAST RT $314.63* CT LW EXT W/O CONTRAST LT $314.63* CT LW EXT W/O CONTRAST BIL $314.63* CT LW EXT W/CONTRAST RT $378.15* CT LW EXT W/CONTRAST LT $378.15* CT LW EXT W/CONTRAST BIL $378.15* CT LW EXT W & W/O CONTRAST RT $480.04* CT LW EXT W & W/O CONTRAST LT $480.04* CT LW EXT W & W/O CONTRAST BIL $480.04* CTA / Angio Exams CTA HEAD W & W/O CONTRAST $557.53* CTA NECK W & W/O CONTRAST $557.11* CTA CHEST W & W/O CONTRAST $568.83* CTA ABDOMEN W & W/O CONTRAST $568.25* CTA ABDOMINAL AORTA W/RUNOFF $603.26* CTA PELVIS W & W/O CONTRAST $563.40* CTA UP EXT W & W/O CONTRAST RT $560.93* CTA UP EXT W & W/O CONTRAST LT $560.93*
11 CTA / Angio Exams (continued) CTA UP EXT W & W/O CONTRAST BIL $560.93* CTA LW EXT W & W/O CONTRAST RT $568.33* CTA LW EXT W & W/O CONTRAST LT $568.33* CTA LW EXT W & W/O CONTRAST BIL $568.33* Cardiac CT FHMMC Only $161.36* FHMMC Only $576.32* FHMMC Only $818.52* FHMMC Only $842.31* MR Head & Neck MRI TMJ $528.19* MRI ORBITS W/O CONTRAST $519.17* MRI ORBITS W & W/O CONTRAST $800.46* MRI FACE W/O CONTRAST $519.17* MRI FACE W & W/O CONTRAST $800.46* MRI NECK W/O CONTRAST $519.17* MRI NECK W & W/O CONTRAST $800.46* MRI NECK W & W/O CONTRAST LTD $800.46* MRA/MRV HEAD W/O CONTRAST $509.23* MRA NECK W/O CONTRAST $509.23* MRA NECK W & W/O CONTRAST $776.95* MRI BRAIN W/O CONTRAST $527.38* MRI BRAIN W/CONTRAST $639.20* MRI BRAIN W & W/O CONTRAST $814.13* MRI PITUITARY W & W/O CONTRAST $814.13* MRI IAC W & W/O CONTRAST BIL $814.13*
12 MR Chest, Abdomen & Pelvis MRI CHEST W/O CONTRAST $526.82* MRI CHEST W & W/O CONTRAST $807.74* MRI ABDOMEN W/O CONTRAST $526.02* MRI ABDOMEN W & W/O CONTRAST $807.74* MRI PELVIS W/O CONTRAST $526.82* MRI PELVIS W & W/O CONTRAST $807.74* MCP (CHOLANGIOGRAM) $526.02* MR Spine MRI CERVICAL SPINE W/O CONTRAST $513.96* MRI CERVICAL SPINE W & W/O CONTRAST $794.01* MRI THORACIC SPINE W/O CONTRAST $514.38* MRI THORACIC SPINE W & W/O CONTRAST $794.01* MRI LUMBAR SPINE W/O CONTRAST $506.18* MRI LUMBAR SPINE W & W/O CONTRAST $781.34* MRI Upper Extremities MRI UP EXT W/O CONTRAST LT $518.72* MRI UP EXT W/O CONTRAST RT $518.72* MRI UP EXT W & W/O CONTRAST LT $800.89* MRI UP EXT W & W/O CONTRAST RT $800.89* MRI SHOULDER W/O CONTRAST LT $519.98* MRI SHOULDER W/O CONTRAST RT $519.98* MRI SHOULDER W & W/O CONTRAST LT $800.46* MRI SHOULDER W & W/O CONTRAST RT $800.46* MRI ELBOW W/O CONTRAST LT $519.98* MRI ELBOW W/O CONTRAST RT $519.98* MRI ELBOW W & W/O CONTRAST LT $800.46* MRI ELBOW W & W/O CONTRAST RT $800.46*
13 MR Upper Extremities (continued) MRI WRIST W/O CONTRAST LT $519.98* MRI WRIST W/O CONTRAST RT $519.98* MRI WRIST W & W/O CONTRAST LT $800.46* MRI WRIST W & W/O CONTRAST RT $800.46* MRA/MRV UP EXT W & W/O CONTRAST LT $519.98* MRA/MRV UP EXT W & W/O CONTRAST RT $519.98* MR Lower Extremities MRI LW EXT W/O CONTRAST LT $498.32* MRI LW EXT W/O CONTRAST RT $498.32* MRI LW EXT W & W/O CONTRAST LT $767.52* MRI LW EXT W & W/O CONTRAST RT $767.52* MRI HIP W/O CONTRAST LT $498.32* MRI HIP W/O CONTRAST RT $498.32* MRI HIP W & W/O CONTRAST LT $767.52* MRI HIP W & W/O CONTRAST RT $767.52* MRI HIP W & W/O CONTRAST BIL $767.52* MRI KNEE W/O CONTRAST LT $498.32* MRI KNEE W/O CONTRAST RT $498.32* MRI KNEE W & W/O CONTRAST LT $767.52* MRI KNEE W & W/O CONTRAST RT $767.52* MRI ANKLE W/O CONTRAST LT $498.32* MRI ANKLE W/O CONTRAST RT $498.32* MRI ANKLE W & W/O CONTRAST RT $767.52* MRA/MRV LW EXT W & W/O CONTRAST LT $691.39* MRA/MRV LW EXT W & W/O CONTRAST RT $691.39* MRA/MRV LW EXT W & W/O CONTRAST BIL $691.39*
14 MR Breast MRI BREAST W/O CONTRAST UNI LT $872.86* MRI BREAST W/O CONTRAST UNI RT $872.86* MRI BREAST W/O CONTRAST BIL $919.70* MRI BREAST W & W/O CONTRAST UNI RT $872.86* MRI BREAST W & W/O CONTRAST UNI LT $872.86* MRI BREAST W & W/O CONTRAST BIL $919.70* MR Angiography MRA CHEST W & W/O CONTRAST $692.73* MRA ABDOMEN W & W/O CONTRAST $687.95* MRA PELVIS W & W/O CONTRAST $690.08* Ultrasound Head & Neck DUPL EXTRCRNIAL BIL $240.85* DUPL EXTRCRNIAL UN/LTD RT $206.65* DUPL EXTRCRNIAL UN/LTD LT $206.65* US SOFT TISS HEAD/NECK $141.84* US THYROID $141.84* Ultrasound Chest, Abdomen & Pelvis US CHEST W/MEDIASTINUM $108.98* US BREAST BIL $117.68* US BREAST UNI LT $117.68* US BREAST UNI RT $117.68* US ABDOMEN COMP $173.19* DUPL ABD/PELV LTD $269.41* US PELVIS W/ APPENDIX $107.30*
15 Ultrasound Chest, Abdomen & Pelvis (continued) US ABDOMEN LTD OR F/U $131.25* US GB LIVER PANCREAS $131.25* US PYLORIC STENOSIS $131.25* US SPLEEN $131.25* US LIVER $131.25* US PANCREAS $131.25* US ADRENAL $131.25* US APPENDIX $131.25* US GALLBLADDER $131.25* US BILE DUCTS $131.25* US RETROPERITIONEAL COMP $164.74* US RETROPERITIONEAL LTD $139.95* US AORTA $139.95* US RENAL TRANSPLANT W/DOC $184.68* US TRANSVAGINAL NONOBSTE $152.25* US PELVIS NON OB COMP $153.55* US SCROTUM AND CONTENTS $151.61* US SOFT TISSUE MASS $0.00* US INFANT HIPS STATIC LTD $121.20* US STUDY FOLLOW UP $109.04* Ultrasound Obstetrics US 1ST TRI NU TRAN EA ADD $103.69* US 1ST TRI NUCHAL TRANSLU $160.84* US PREG AFTER 1ST TRIMES $183.74* US PREG UTERUS LTD $113.38* US PREG REPEAT PER FETUS $136.31* US FETAL BIO PROF W/ NST $152.84* US FETAL BIO PROF W/O NST $116.75*
16 Ultrasound Obstetrics (continued) US PREG 1ST TRIMESTER $163.76* US PREG UTERUS TRANSVAGIN $128.74* US PREG W/DETAIL ANAT SNG $247.13* US PREG W/DETAIL ANAT ADD $197.88* DUPL UP EXT ARTERIAL UNI/LTD LT $147.36* DUPL UP EXT ARTERIAL UNI/LTD RT $147.36* DOP UP EXT ARTERIAL BIL $153.99* DUPL UP EXT VENOUS UN/LTD LT $157.71* DUPL UP EXT VENOUS UN/LTD RT $157.71* DUPL UP EXT VENOUS BIL $246.85* Ultrasound Lower Extremity DUPL LW EXT ART BIL $238.98* DUPL LWEXT ART UNI/LTD RT $153.43* DUPL LWEXT ART UNI/LTD LT $153.43* US KNEE POPLITEAL LT $162.71* US KNEE POPLITEAL RT $162.71* US KNEE POPLITEAL BIL $162.71* US EXT NON VASCULAR LT $162.71* US EXT NON VASCULAR RT $162.71* US EXT NON VASCULAR BIL $162.71* US LW EXT VENOUS UNI/LTD LT $157.71* US LW EXT VENOUS UNI/LTD RT $157.71* US EXT VENOUS BIL $246.85* US EXT ARTERIAL SGL LVL BIL $150.65* US EXT ARTERIAL MLY LVL BIL $232.29*
17 Mammography MAMMOGRAM DX DIGITAL LT $195.62* MAMMOGRAM DX DIGITAL RT $195.62* MAMMOGRAM DX DIGITAL BIL $249.30* MAMMOGRAM SCRN DIGITAL LT $185.63* MAMMOGRAM SCRN DIGITAL RT $185.63* MAMMOGRAM SCRN DIGITAL BIL $185.63* MAMMO SCRN DIGIT PROMO $185.63*
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