3T MRI 64 Slice CT ❑ 74181 Abdomen (wo) $240 ❑ 74261 Virtual Colonoscopy $235 ❑ 74183 Abdomen (w/wo) $470 ❑ 74178/76377 Enterography $430 ❑ A9581 w/ Eovist (Liver Contrast) $100 ❑ 74176 Abdomen/Pelvis (wo) $200 ❑ 70551 Brain (wo) $225 ❑ 74177 Abdomen/Pelvis (w) only $430 Trauma w/ DTI & SWI $175 ❑ 74178 Abdomen/Pelvis (w/wo) $415 ❑ 70552 Brain (w) only $385 ❑ 74150 Abdomen (wo) $150 ❑ 70553 Brain (w/wo) $440 ❑ 74170 Abdomen (w/wo) $325 ❑ 77048 Breast Uni (w/wo) $465 ❑ 70450 Brain (wo) $115 ❑ 77049 Breast Bilat (w/wo) $475 ❑ 70470 Brain (w/wo) $250 ❑ 73218 Brachial Plexus (wo) $290 ❑ 72125 Cervical (wo) $165 ❑ 72141 Cervical (wo) $220 ❑ 72127 Cervical (w/wo) $320 ❑ Axis Views - Alar/Transverse $75 ❑ 71260 Chest (w) $255 ❑ 72156 Cervical (w/wo) $445 ❑ G0297 Low Dose CT Chest (Screening for Lung Cancer) $235 ❑ 77012/73222/73201 Arthrogram Upper Ext (w)* ❑ 71250 Chest/Thorax (wo) $160 ❑ 23350 Shoulder 25246 Wrist 20610 Steroid* ❑ 71270 Chest/Thorax (w/wo) $290 ❑ 77012/73722/73701 Arthrogram Lower Ext (w)* ❑ 70486 Facial (wo) $140 ❑ 27093 Hip 27370 Knee 20610 Steroid* ❑ 70488 Facial (w/wo) $265 ❑ 70551 IACs (wo) $225 ❑ 72131 Lumbar (wo) $160 ❑ 70552 IACs (w) only $385 ❑ 72133 Lumbar (w/wo) $320 ❑ 70553 IACs (w/wo) $440 ❑ 72192 Pelvis (wo) $145 ❑ 72148 Lumbar (wo) $220 ❑ 72194 Pelvis (w/wo) $315 ❑ 72158 Lumbar (w/wo) $445 ❑ 74176 Renal Stone (wo) $200 ❑ 74181 MRCP (wo) $240 ❑ 70486 Sinus (wo) $140 ❑ 70540 Orbit, Face, Neck (wo) $265 ❑ 70490 Soft Tissue Neck (wo) $165 ❑ 70543 Orbit, Face, Neck (w/wo)$465 ❑ 70491 Soft Tissue Neck (w) $260 ❑ 72195 Pelvis (wo) $270 ❑ 70492 Soft Tissue Neck (w/wo) $305 ❑ 72197 Pelvis (w/wo) $470 ❑ 70480 Temporal Bone (IAC) (wo) $235 ❑ 70553 Pituitary (w/wo) $440 ❑ 70482 Temporal Bone (IAC) (w/wo) $330 ❑ 70336 T.M.J. (wo) $300 ❑ 72128 Thoracic (wo) $160 ❑ 72146 Thoracic (wo) $220 ❑ 72130 Thoracic (w/wo) $320 ❑ 72157 Thoracic (w/wo) $445 ❑ 76377 3D Reconstruction $75 ❑ 73221 Upper Ext. Joint L / R (wo) $230 ❑ 74177/76377 Urogram (w) $450 ❑ shoulder elbow wrist ❑ 74178/76377 Urogram (w/wo) $430 ❑ 73218 Upper Ext. Non-Joint L / R $290 ❑ humerus forearm hand CTA w/ Contrast ❑ 73223 Upper Ext. Joint (w/wo) $530 ❑ 70498 Carotid (w) $345 ❑ shoulder elbow wrist 71275 Chest (w) $350 ❑ 73220 Up Ext. Non-Joint (w/wo) $555 ❑ 70496 Head (w/wo) $345 ❑ humerus forearm hand ❑ 74175 Abdomen (w) $350 ❑ 73721 Lower Ext. Joint L / R (wo) $230 ❑ 74174 Abdomen/Pelvis (w/wo) $450 ❑ hip knee ankle ❑ 72191 Pelvis (w) $345 ❑ 73718 Lower Ext. Non-Joint (wo) $260 ❑ 75635 Extremity Run-off _upper _lower $375 ❑ femur tibia fibula foot ❑ 73723 Lower Ext. Joint (w/wo) $530 PET/CT - $1600 ❑ 78815 PET/CT Skull Base to Mid-Thigh $1600 ❑ hip knee ankle ❑ 78816 PET/CT Whole Body (Melanoma only) $1600 ❑ 73720 Lower Ext. Non-Joint (w/wo) $470 ❑ 78608 FDG PET Brain Imaging $1600 ❑ femur tibia fibula foot ❑ MRA 78814 PET/CT Brain-Amyvid (Alzheimer’s) $5000 ❑ 70544 Brain (COW) (wo) $275 ❑ A9580 NaF Bone Scan $1600 ❑ 70547 Neck/Carotids (wo) $275 ❑ 78816 PET/CT NaF Bone Scan Whole Body $1600 ❑ 70549 Neck/Carotids (w/wo) $495 ❑ 72198 Pelvis (w/wo) $465 ❑ 74185 Abdomen (w/wo) $465 ❑ 74185/72198/73725x2 Abd w/ Runoff $545 Updated 1/5/19

*Arthrograms approximately $995. Exact price given on a case by case basis. Rx is needed for pricing accuracy based upon order. Nuclear Medicine DXA SCAN - $45 ❑ 78305 Bone Scan Limited (multi areas) $280 ❑ 77080 DXA-Bone Density Scan $40 ❑ 78306 Bone Scan Whole Body $305 ❑ 78300 Bone Scan Limited (single area) $230 Complete Breast Imaging ❑ 78315 3 Phase Bone Scan $350 Mammography ❑ 78320 Spect Bone $230 * + Bone study ❑ 77067 Screening Mammo w/ CAD - Female $135 ❑ 78264 Gastric Emptying $335 ❑ 77066 Bilateral Diagnostic w/ CAD $170 ❑ 78227 HIDA-Hepatobiliary w/EF $445 ❑ 77065 Unilateral Diagnostic w/ CAD $135 ❑ 78226 HIDA-Hepatobiliary (wo) EF $470

❑ 78215 Liver/Spleen $195 Ultrasound ❑ 78205 Liver SPECT - Hemangioma Scan $215 ❑ 76641 Breast Left Right Bilateral $110 ❑ 78290 Meckels Scan $330

❑ 78472 MUGA Scan $230 ❑ 78070 Parathyroid Scan $300 3T MRI ❑ 78707 Renal Scan $235 ❑ 77048 Breast MRI Uni (w/wo) $390 ❑ 78708 Renal Scan _ Captopril _ Lasix $180 ❑ 77049 Breast MRI Bilat (w/wo) $400 ❑ 78014 Thyroid Uptake & Scan $245 Ultrasound Digital X-Ray ❑ 93978 Abdomen Aorta $190 ❑ 74019 Abdomen Flat/Upright (2v) $35 ❑ 76706 Abdominal Aorta AAA Screening $190 ❑ 74018 Abdomen (KUB) $30 ❑ 76700 Abdominal Complete $120 ❑ 74021 Acute Abd Series (2v) + PA Chest $40 ❑ 76705 Abdominal Limited $90 ❑ 73610 Ankle Complete (3v) $35 ❑ 93880 Carotid $200 ❑ 77075 Bone/Skeletal Survey Study $95 ❑ 93306 Echocardiogram $205 ❑ 73650 Calcaneus (2v) $30 ❑ 76882 Extremity Nonvascular Lmt $60 ❑ 72050 Cervical (4v) $50 ❑ 76801 Fetal OB < 1st Tri $125 ❑ 71046 Chest PA & LAT (2v) $35 ❑ 76805 Fetal OB > 2nd Tri $140 ❑ 73000 Clavicle (2v) $30 ❑ 76775 Kidneys (only) $60 ❑ 72052 Davis Series (6v+1) $60 ❑ 93925/93922 Lwr Ext.Artl Bil w/ABI $310 ❑ 73080 Elbow (3v) $30 ❑ 93926/93922 Lwr Ext.Art Uni w/ABI $220 ❑ 73552 Femur (2v) $35 ❑ 93930 Upper Ext. Artl Bilat $205 ❑ 73140 Finger (3v) $35 ❑ 93931 Upper Ext. Arterial Uni/Lmt $130 ❑ 73630 Foot (3v) $35 ❑ 93976 Liver/Portal Vein Doppler $150 ❑ 73090 Forearm (2v) $30 ❑ 93975 Renal Arterial $275 ❑ 73130 Hand (3v) $35 ❑ 76770 Retroperitoneal Complete (KUB) $115 ❑ 73502 Hip (2v) $45 ❑ 76536 Thyroid $115 ❑ 73522 Hip B/L (2v) w/ AP Pelvis $50 ❑ 93970 Venous Insufficiency/Varicose Vein $195 ❑ 73060 Humerus (2v) $30 ❑ 93971 Venous Ext Uni. _L _R _Upper _Lower $120 ❑ 73560 Knee (2v)$35 ❑ 76857 Pelvic Limited. – Male Only $50 ❑ 73562 Knee (3v)$40 ❑ 76870/93976 Testicular w/Doppler $255 ❑ 74000 KUB? ❑ 76856 Pelvic Complete - Female Only $110 ❑ 72100 Lumbar (2v) $40 ❑ 76830 Transvaginal $120 ❑ 72110 Lumbar (4v) $55

❑ 72170 Pelvis (1-2v) $35

❑ 71100 Rib - Uni min (2v) $35

❑ 71101 Rib - Uni w/ PA Chest min (min 3v) $40

❑ 71110 Ribs - Bilat Ribs $45

❑ 71111 Bilat Ribs w/ a PA Chest $50

❑ 72220 Sacrum/Coccyx (3v) $35

❑ 73030 Shoulder Complete (2v) $30

❑ 72202 S.I. Joints Bilat (3v) $35

❑ 70220 Sinus (3v) $40

❑ 72074 Thoracic (4v) $40

❑ 73590 Tibia/Fibula (2v) $30 Updated 1/5/19 ❑ 73110 Wrist (3v) $40