Grosse Pointe Physicians X-ray Center, P.C. Cash

* Cash pricing is ONLY valid for patients choosing to pay in-full at the time of service.
No insurance will be billed.

Please note: this is a full service (Global) fee which includes procedure & interpretation
As of 1/30/2019 subject to change without notice
  CT:         Note: Additional   Contrast Charge May apply***  
CPT Description      
75635 CTA ABDOMINAL AORTA W RUNOFF W CONTRAST   $   665 **
71275 CTA CHEST W/O & W CONTRAST   $   453 **
70498 CTA CAROTIDS (NECK)   $   441 **
70496 CTA HEAD   $   442 **
         
74176 CT ABDOMEN & PELVIS WO CONTRAST   $   303  
74177 CT ABDOMEN & PELVIS W CONTRAST   $   470 ***
74178 CT ABDOMEN & PELVIS WO & W CONTRAST   $   533 ***
74150 CT ABDOMEN WO CONTRAST   $   226  
74160 CT ABDOMEN W CONTRAST   $   348 ***
74170 CT ABDOMEN WO & W CONTRAST   $   396 ***
         
71250 CT CHEST WO CONTRAST   $   246  
71260 CT CHEST W CONTRAST   $   296 ***
71270 CT CHEST WO & W CONTRAST   $   355 ***
70487 CT FACIAL BONES / SINUS W CONTRAST   $   253 ***
70486 CT FACIAL BONES / SINUS WO CONTRAST   $   210  
70488 CT FACIAL BONES / SINUS WO & W CONTRAST   $   308 ***
70470 CT HEAD WO & W CONTRAST   $   289 ***
70450 CT HEAD WO CONTRAST   $   175  
70460 CT HEAD W CONTRAST   $   246 ***
73700 CT LOWER EXTREMITY WO CONTRAST   $   271  
73701 CT LOWER EXTREMITY W CONTRAST   $   341 ***
73702 CT LOWER EXTREMITY WO & W CONTRAST   $   412 ***
70491 CT NECK W/CONTRAST   $   307 ***
70490 CT NECK WO CONTRAST   $   254  
70492 CT NECK WO & W CONTRAST   $   369 ***
70480 CT ORBITS WO CONTRAST   $   351  
70481 CT ORBITS W CONTRAST   $   416 ***
70482 CT ORBITS W & W/O CONTRAST   $   453 ***
72192 CT PELVIS WO CONTRAST   $   220  
72193 CT PELVIS W CONTRAST   $   341 ***
72194 CT PELVIS WO & W CONTRAST   $   392 ***
72125 CT SPINE CERVICAL WO   CONTRAST   $   278  
72126 CT SPINE CERVICAL W CONTRAST   $   344 ***
72127 CT SPINE CERVICAL WO & W CONTRAST   $   407 ***
72131 CT SPINE LUMBAR WO CONTRAST   $   271  
72132 CT SPINE LUMBAR WCONTRAST   $   344 ***
72133 CT SPINE LUMBAR WO & W CONTRAST   $   406 ***
72128 CT SPINE THORACIC WO CONTRAST   $   272  
72129 CT SPINE THORACIC W CONTRAST   $   345 ***
72130 CT SPINE THORACIC WO & W CONTRAST   $   410 ***
76377 CT 3D RENDERING   $   107  
  CT CONTRAST      
  Description      
** CTA CONTRAST CHARGE   $   100  
*** CT CONTRAST CHARGE   $     75  
         
  Mammography:      
CPT Description      
77067 MAMMOGRAPHY: SCREENING BILAT DIGITAL   $   208  
77065 MAMMOGRAPHY: DIAGNOSTIC UNILAT DIGITAL   $   204  
77066 MAMMOGRAPHY: DIAGNOSTIC BILAT DIGITAL   $   258  
         
  Bone Density      
CPT Description      
77080 DXA BONE DENSITY AXIAL SKELTON   $     63  
  BODY COMPOSITION ANALYSIS   $     50  
         
  Ultrasound      
CPT Description      
76700 US ABDOMINAL COMPLETE   $   186  
76705 US ABDOMINAL LTIMITED   $   139  
76706 US AORTA SCREENING AAA   $   143  
76641 US BREAST, UNI COMPLETE   $   163  
76642 US BREAST, UNI LIMITED   $   134  
76604 US CHEST (CHEST WALL/UPPER BACK)   $   135  
76882 US EXTRMITY NONVASCULAR (ie Bakers Cyst)   $     87  
76770 US KIDNEY & BLADDER   $   172  
76775 US KIDNEY LIMITED   $     88  
76856 US PELVIS NON OB   $   167  
76830 US TRANSVAGINAL   $   186  
76857 US PELVIS LIMITED   $     74  
76870 US TESTICULAR   $   103  
76536 US THYROID   $   177  
76801 OB US <14 WEEKS TRANSABDOMINAL   $   188  
76817 OB US TRANSVAGINAL   $   148  
76802 OB EACH ADDITIIONAL GESTATION 1st TRIMESTER   $     99  
76805 OB US > 14 WEEKS TRANSABDOMINAL   $   216  
76810 OB EACH ADDITIONAL GESTATION >14 WEEKS   $   142  
76815 OB US LIMITED   $   128  
76816 OB US FOLLOW-UP FROM PREVIOUS SCAN   $   176  
         
  Doppler      
93922 ANKEL/BRACHIAL INDEX 1-2 LEVEL BILATERAL   $   134  
93978 DOPPLER: AORTA DUPLEX COMPLETE   $   292  
93880 DOPPLER:CAROTID ARTERY BILATERAL   $   310  
93926 DOPPLER LOWER EXTREMITY ARTERY UNI   $   232  
93925 DOPPLER LOWER EXTREMITY ARTERY BILATERAL   $   397  
93930 DOPPLER; UPPER EXTREMITY ARTERIAL BILATERAL   $   318  
93931 DOPPLER; UPPER EXTREMITY ARTERIAL UNI   $   198  
93970 DOPPLER VENOUS   EXTREMITY BILATERAL   $   299  
93971 DOPPLER VENOUS   EXTREMITY UNI   $   183  
         
  X-Ray      
  Definitions: Uni or Unilateral means 1 or one side. Bilateral means 2 or both sides  
CPT Description      
74018 ABDOMEN: 1 VIEW   $    41  
74019 ABDOMEN: 2 VIEWS   $    50  
74021 ABDOMEN: 3 OR MORE VIEWS   $    59  
73050 ACROMIOCLAVICULAR JOINTS   $    54  
74022 ACUTE ABDOMEN SERIES   W/CHEST 3 VIEWS   $    67  
73600 ANKLE 2 VIEWS   $    45  
73610 ANKLE COMPLETE   $    47  
77072 BONE AGE STUDIES   $    35  
77073 BONE LENGTH STUDIES   $    54  
73650 CALCANEOUS MIN 2 VIEWS   $    41  
71045 CHEST SINGLE FRONTAL VIEW   $    30  
71046 CHEST 2 VIEWS   $    46  
71047 CHEST 3V   $    59  
71048 CHEST 4 VIEWS or more   $    63  
73000 CLAVICLE   $    42  
73070 ELBOW 2 VIEWS   $    41  
73080 ELBOW COMPLETE, MIN 3 VIEWS   $    47  
70150 FACIAL BONES 3 VIEWS   $     62  
73551 FEMUR 1 VIEW   $     42  
73552 FEMUR 2 VIEWS   $     50  
73140 FINGERS MIN 2 VIEWS   $     49  
73620 FOOT 2 VIEWS   $     39  
73630 FOOT COMPLETE   $     44  
73090 FOREARM, 2 VIEWS   $     39  
73120 HAND 2 VIEWS   $     43  
73130 HAND COMPLETE   $     48  
73521 HIP, BILATERAL,W PELVIS, 2 VIEWS   $     57  
73522 HIP, BILATERAL, W PELVIS 3-4 VIEWS   $     74  
73523 HIP,BILATERAL, W PELVIS   MIN 5 VIEWS   $     85  
73501 HIP, UNI, W PELVIS, 1 VIEW   $     45  
73502 HIP, UNI,W PELVIS, 2-3 VIEWS   $     62  
73503 HIP, UNI, MIN of 4 VIEWS   $     78  
73060 HUMERUS MIN 2 VIEWS   $     44  
73560 KNEE, 1-2 VIEWS   $     47  
73562 KNEE, 3 VIEWS   $     54  
73564 KNEE, COMP 4 OR MORE VIEWS   $     60  
73565 KNEES, STANDING COMPARISON   $     54  
73592 LOWER EXTREMITY INFANT 2 VIEW (<1 YR)   $     41  
70100 MANDIBLE <4 VIEWS   $     50  
70110 MANDIBLE COMPLETE 4 OR MORE VIEWS   $     57  
70120 MASTOIDS < 3 VWS   $     50  
70130 MASTOID COMPLETE, MIN 3 VIEWS PER SIDE   $     82  
70160 NASAL BONES   $     50  
70360 NECK SOFT TISSUE   $     43  
76010 NOSE/RECTUM FOR CHILD FOREIGN BODY 1 VIEW   $     39  
70200 ORBITS COMPLETE   $     64  
77074 OSSEOUS SURVEY: LIMITED FOR METS   $     97  
77075 OSSEOUS SURVEY: COMPLETE AXIAL & APPENDICULAR $   132  
77076 OSSEOUS SURVEY: INFANT ( <1 YR)   $   144  
72170 PELVIS 1 OR 2 VIEWS   $     48  
72190 PELVIS MIN 3 VIEWS   $     57  
71110 RIBS: BILATERAL 3 VIEWS   $     60  
71111 RIBS: BILATERAL W/CHEST, MIN 4 VIEWS   $     71  
71100 RIBS: UNILATERAL 2 VIEWS   $     50  
71101 RIBS: UNILATERAL W/CHEST MIN 3 VIEWS   $     58  
72200 SACROILIAC JOINTS 1 OR 2 VWS   $     43  
72202 SACROILIAC JOINTS 3 OR MORE   $     50  
72220 SACRUM AND COCCYX MIN 2 VIEWS   $     43  
73010 SCAPULA   $     46  
70240 SELLA TURCIA   $     46  
73020 SHOULDER, 1 VIEW   $     35  
73030 SHOULDER COMPLETE MIN 2 VIEWS   $     44  
70210 SINUS 1 VIEW   $     45  
70220 SINUS COMPLETE MN 3 VIEWS   $     57  
70250 SKULL < 4 VIEWS   $     55  
70260 SKULL COMPLETE MIN 4 VIEWS   $     69  
72020 SPINE: SINGLE VIEW, SPECIFY LEVEL   $     34  
72040 SPINE CERVICAL 2 OR 3 VWS   $     50  
72050 SPINE CERVICAL 4 or 5 VIEWS   $     68  
72052 SPINE CERVICAL 6 OR MORE VIEWS   $     84  
72100 SPINE LUMBAR 2 OR 3 VIEWS   $     53  
72110 SPINE LUMBAR MIN 4 VIEWS   $     74  
72120 SPINE LUMBAR BENDING 2 OR 3 VIEWS   $     61  
72114 SPINE LUMBAR COMP MIN 6 VIEWS   $     93  
72070 SPINE THORACIC 2 VIEWS   $     51  
72072 SPINE THORACIC 3 VIEWS   $     52  
72074 SPINE THORACIC MIN 4 VIEWS   $     59  
72081 SPINE SCOLIOSIS 1 VIEW   $     58  
72082 SPINE SCOLIOSIS 2-3 VIEWS   $     94  
72083 SPINE SCOLIOSIS 4-5 VIEWS   $   113  
72084 SPINE SCOLIOSIS MIN 6 VIEWS   $   132  
71130 STERNOCLAVICULAR JOINT(S) MIN 3 VIEWS   $     54  
71120 STERNUM MIN 2 VIEWS   $     45  
73590 TIBIA & FIBULA, 2 VIEWS   $     43  
70328 TMJ UNI   $     46  
70330 TMJ BILATERAL   $     71  
73660 TOES MIN 2 VIEWS   $     43  
73092 UPPER EXTREMITY INFANT (<1 YR) 2 VIEW   $     41  
73100 WRIST, 2 VIEWS   $     47  
73110 WRIST, COMPLETE MIN 3 VIEW   $     53  
         
  FLUOROSCOPY:      
CPT Description      
74270 BARIUM ENEMA-COLON   $   226  
74220 ESOPHAGRAM   $   133  
74250 SMALL BOWEL W/SERIAL FILM   $   156  
74241 UPPER GI WITH KUB   $   176  
74245 UGI W/SMALL BOWEL   $   257