|
CT Scan
|
1
|
CT without contrast (any part)
|
700.00
|
|
|
2
|
CT with contrast (any part)
|
900.00
|
|
|
3
|
CT Angiography
|
1500.00
|
|
MRI
|
1
|
MRI without contrast (any part)
|
1100.00
|
|
|
2
|
MRI with contrast (any part)
|
1300.00
|
|
Ultrasound (Sonography)
|
1
|
Ultrasound abdomen, KUB, or one organ
|
300.00
|
|
|
2
|
Doppler (any part except extremity)
|
400.00
|
|
|
3
|
Doppler extremity (one side)
|
450.00
|
|
|
4
|
Doppler extremity (both sides)
|
750.00
|
|
|
5
|
Obstetric Ultrasound
|
400.00
|
|
|
6
|
NT/Morphology/OB Doppler Scan
|
300.00
|
|
|
7
|
NT Scan with double marker / Anomaly scan with triple marker
|
500.00
|
|
|
8
|
3D Baby Ultrasound
|
800.00
|
|
|
9
|
4D Baby Ultrasound
|
850.00
|
|
|
10
|
Ultrasound Breast
|
300.00
|
|
|
11
|
Ultrasound Breast and Mammogram
|
600.00
|
|
Plain X-ray
|
1
|
One/Two Views
|
150.00
|
|
|
2
|
Additional View
|
100.00
|
|
|
3
|
IVU-IVP (Intravenous Urography)
|
700.00
|
|
|
4
|
Mammogram Bilateral
|
500.00
|
|
|
5
|
Mammogram Unilateral
|
400.00
|
|
Dental Exams
|
1
|
OPG 2D (Panoramic View)
|
200.00
|
|
|
2
|
Cephalometry View
|
200.00
|
|
|
3
|
CBCT (Cone Beam CT) 3D (Each Arch)
|
500.00
|
|
Bone Density
|
1
|
CT Bone Mineral Density Study (Axial Skeleton: hips, pelvis, spine)
|
800.00
|
|
|
2
|
CT Bone Mineral Density Study (Appendicular Skeleton: radius, wrist, heel)
|
600.00
|
|
|
3
|
DXA Bone Density Study (1 or more sites)
|
900.00
|
|
|
4
|
DXA Bone Density Study (Appendicular Skeleton: radius, wrist, heel)
|
900.00
|
|
|
5
|
DXA Bone Density Study (1 or more sites)
|
1300.00
|
