| CT Scan |
| 1 |
CT without contrast any part |
2183 |
| 2 |
CT with contrast any part |
2933 |
| 3 |
CT Angiography |
3500 |
| MRI |
| 1 |
MRI without contrast any part |
2700 |
| 2 |
MRI with contrast any part |
3500 |
| Ultrasound (Sonography) |
| 1 |
Ultrasound abdomen, KUB or one organ |
921 |
| 2 |
Doppler any part except Extremity |
964 |
| 3 |
Doppler Extremity one side |
1184 |
| 4 |
Doppler Extremity both sides |
1717 |
| 5 |
Obstetric Ultrasound |
964 |
| 6 |
NT/Morphology/OB Doppler Scan |
964 |
| 7 |
NT Scan with double marker / Anomaly scan with triple marker |
1191 |
| 8 |
3D baby Ultrasound |
1184 |
| 9 |
4D baby Ultrasound |
1451 |
| 10 |
Ultrasound Breast |
921 |
| 11 |
Ultrasound Brest and Mammogram |
1520 |
| Plain X-ray |
| 1 |
One/Two Views |
554 |
| 2 |
Additional View |
215 |
| 3 |
IVU-IVP (intra venous urography) |
1717 |
| 4 |
Mammogram bilateral |
1480 |
| 5 |
Mammogram unilateral |
872 |
| Dental Exams |
| 1 |
OPG 2D (Panoramic) view |
520 |
| 2 |
Cephalometry View |
600 |
| 3 |
CBCT (Cone Beam CT) 3D Each arch |
1202 |
| Bone Density |
| 1 |
Computed tomography, bone mineral density study, 1 or more sites; axial skeleton (eg, hips, pelvis,spine) |
1658 |
| 2 |
Computed tomography, bone mineral density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel) |
1393 |
| 3 |
Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine) |
1792 |
| 4 |
Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel) |
1792 |
| 5 |
Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; vertebral fracture assessment |
2596 |
