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*** 
CPTDescription   
75635CTA ABDOMINAL AORTA W RUNOFF W CONTRAST $   665**
71275CTA CHEST W/O & W CONTRAST $   453**
70498CTA CAROTIDS (NECK) $   441**
70496CTA HEAD $   442**
     
74176CT ABDOMEN & PELVIS WO CONTRAST $   303 
74177CT ABDOMEN & PELVIS W CONTRAST $   470***
74178CT ABDOMEN & PELVIS WO & W CONTRAST $   533***
74150CT ABDOMEN WO CONTRAST $   226 
74160CT ABDOMEN W CONTRAST $   348***
74170CT ABDOMEN WO & W CONTRAST $   396***
     
71250CT CHEST WO CONTRAST $   246 
71260CT CHEST W CONTRAST $   296***
71270CT CHEST WO & W CONTRAST $   355***
70487CT FACIAL BONES / SINUS W CONTRAST $   253***
70486CT FACIAL BONES / SINUS WO CONTRAST $   210 
70488CT FACIAL BONES / SINUS WO & W CONTRAST $   308***
70470CT HEAD WO & W CONTRAST $   289***
70450CT HEAD WO CONTRAST $   175 
70460CT HEAD W CONTRAST $   246***
73700CT LOWER EXTREMITY WO CONTRAST $   271 
73701CT LOWER EXTREMITY W CONTRAST $   341***
73702CT LOWER EXTREMITY WO & W CONTRAST $   412***
70491CT NECK W/CONTRAST $   307***
70490CT NECK WO CONTRAST $   254 
70492CT NECK WO & W CONTRAST $   369***
70480CT ORBITS WO CONTRAST $   351 
70481CT ORBITS W CONTRAST $   416***
70482CT ORBITS W & W/O CONTRAST $   453***
72192CT PELVIS WO CONTRAST $   220 
72193CT PELVIS W CONTRAST $   341***
72194CT PELVIS WO & W CONTRAST $   392***
72125CT SPINE CERVICAL WO   CONTRAST $   278 
72126CT SPINE CERVICAL W CONTRAST $   344***
72127CT SPINE CERVICAL WO & W CONTRAST $   407***
72131CT SPINE LUMBAR WO CONTRAST $   271 
72132CT SPINE LUMBAR WCONTRAST $   344***
72133CT SPINE LUMBAR WO & W CONTRAST $   406***
72128CT SPINE THORACIC WO CONTRAST $   272 
72129CT SPINE THORACIC W CONTRAST $   345***
72130CT SPINE THORACIC WO & W CONTRAST $   410***
76377CT 3D RENDERING $   107 
 CT CONTRAST   
 Description   
**CTA CONTRAST CHARGE $   100 
***CT CONTRAST CHARGE $     75 
     
 Mammography:   
CPTDescription   
77067MAMMOGRAPHY: SCREENING BILAT DIGITAL $   208 
77065MAMMOGRAPHY: DIAGNOSTIC UNILAT DIGITAL $   204 
77066MAMMOGRAPHY: DIAGNOSTIC BILAT DIGITAL $   258 
     
 Bone Density   
CPTDescription   
77080DXA BONE DENSITY AXIAL SKELTON $     63 
 BODY COMPOSITION ANALYSIS $     50 
     
 Ultrasound   
CPTDescription   
76700US ABDOMINAL COMPLETE $   186 
76705US ABDOMINAL LTIMITED $   139 
76706US AORTA SCREENING AAA $   143 
76641US BREAST, UNI COMPLETE $   163 
76642US BREAST, UNI LIMITED $   134 
76604US CHEST (CHEST WALL/UPPER BACK) $   135 
76882US EXTRMITY NONVASCULAR (ie Bakers Cyst) $     87 
76770US KIDNEY & BLADDER $   172 
76775US KIDNEY LIMITED $     88 
76856US PELVIS NON OB $   167 
76830US TRANSVAGINAL $   186 
76857US PELVIS LIMITED $     74 
76870US TESTICULAR $   103 
76536US THYROID $   177 
76801OB US <14 WEEKS TRANSABDOMINAL $   188 
76817OB US TRANSVAGINAL $   148 
76802OB EACH ADDITIIONAL GESTATION 1st TRIMESTER $     99 
76805OB US > 14 WEEKS TRANSABDOMINAL $   216 
76810OB EACH ADDITIONAL GESTATION >14 WEEKS $   142 
76815OB US LIMITED $   128 
76816OB US FOLLOW-UP FROM PREVIOUS SCAN $   176 
     
     
 X-Ray   
 Definitions: Uni or Unilateral means 1 or one side. Bilateral means 2 or both sides 
CPTDescription   
74018ABDOMEN: 1 VIEW $    41 
74019ABDOMEN: 2 VIEWS $    50 
74021ABDOMEN: 3 OR MORE VIEWS $    59 
73050ACROMIOCLAVICULAR JOINTS $    54 
74022ACUTE ABDOMEN SERIES   W/CHEST 3 VIEWS $    67 
73600ANKLE 2 VIEWS $    45 
73610ANKLE COMPLETE $    47 
77072BONE AGE STUDIES $    35 
77073BONE LENGTH STUDIES $    54 
73650CALCANEOUS MIN 2 VIEWS $    41 
71045CHEST SINGLE FRONTAL VIEW $    30 
71046CHEST 2 VIEWS $    46 
71047CHEST 3V $    59 
71048CHEST 4 VIEWS or more $    63 
73000CLAVICLE $    42 
73070ELBOW 2 VIEWS $    41 
73080ELBOW COMPLETE, MIN 3 VIEWS $    47 
70150FACIAL BONES 3 VIEWS $     62 
73551FEMUR 1 VIEW $     42 
73552FEMUR 2 VIEWS $     50 
73140FINGERS MIN 2 VIEWS $     49 
73620FOOT 2 VIEWS $     39 
73630FOOT COMPLETE $     44 
73090FOREARM, 2 VIEWS $     39 
73120HAND 2 VIEWS $     43 
73130HAND COMPLETE $     48 
73521HIP, BILATERAL,W PELVIS, 2 VIEWS $     57 
73522HIP, BILATERAL, W PELVIS 3-4 VIEWS $     74 
73523HIP,BILATERAL, W PELVIS   MIN 5 VIEWS $     85 
73501HIP, UNI, W PELVIS, 1 VIEW $     45 
73502HIP, UNI,W PELVIS, 2-3 VIEWS $     62 
73503HIP, UNI, MIN of 4 VIEWS $     78 
73060HUMERUS MIN 2 VIEWS $     44 
73560KNEE, 1-2 VIEWS $     47 
73562KNEE, 3 VIEWS $     54 
73564KNEE, COMP 4 OR MORE VIEWS $     60 
73565KNEES, STANDING COMPARISON $     54 
73592LOWER EXTREMITY INFANT 2 VIEW (<1 YR) $     41 
70100MANDIBLE <4 VIEWS $     50 
70110MANDIBLE COMPLETE 4 OR MORE VIEWS $     57 
70120MASTOIDS < 3 VWS $     50 
70130MASTOID COMPLETE, MIN 3 VIEWS PER SIDE $     82 
70160NASAL BONES $     50 
70360NECK SOFT TISSUE $     43 
76010NOSE/RECTUM FOR CHILD FOREIGN BODY 1 VIEW $     39 
70200ORBITS COMPLETE $     64 
77074OSSEOUS SURVEY: LIMITED FOR METS $     97 
77075OSSEOUS SURVEY: COMPLETE AXIAL & APPENDICULAR$   132 
77076OSSEOUS SURVEY: INFANT ( <1 YR) $   144 
72170PELVIS 1 OR 2 VIEWS $     48 
72190PELVIS MIN 3 VIEWS $     57 
71110RIBS: BILATERAL 3 VIEWS $     60 
71111RIBS: BILATERAL W/CHEST, MIN 4 VIEWS $     71 
71100RIBS: UNILATERAL 2 VIEWS $     50 
71101RIBS: UNILATERAL W/CHEST MIN 3 VIEWS $     58 
72200SACROILIAC JOINTS 1 OR 2 VWS $     43 
72202SACROILIAC JOINTS 3 OR MORE $     50 
72220SACRUM AND COCCYX MIN 2 VIEWS $     43 
73010SCAPULA $     46 
70240SELLA TURCIA $     46 
73020SHOULDER, 1 VIEW $     35 
73030SHOULDER COMPLETE MIN 2 VIEWS $     44 
70210SINUS 1 VIEW $     45 
70220SINUS COMPLETE MN 3 VIEWS $     57 
70250SKULL < 4 VIEWS $     55 
70260SKULL COMPLETE MIN 4 VIEWS $     69 
72020SPINE: SINGLE VIEW, SPECIFY LEVEL $     34 
72040SPINE CERVICAL 2 OR 3 VWS $     50 
72050SPINE CERVICAL 4 or 5 VIEWS $     68 
72052SPINE CERVICAL 6 OR MORE VIEWS $     84 
72100SPINE LUMBAR 2 OR 3 VIEWS $     53 
72110SPINE LUMBAR MIN 4 VIEWS $     74 
72120SPINE LUMBAR BENDING 2 OR 3 VIEWS $     61 
72114SPINE LUMBAR COMP MIN 6 VIEWS $     93 
72070SPINE THORACIC 2 VIEWS $     51 
72072SPINE THORACIC 3 VIEWS $     52 
72074SPINE THORACIC MIN 4 VIEWS $     59 
72081SPINE SCOLIOSIS 1 VIEW $     58 
72082SPINE SCOLIOSIS 2-3 VIEWS $     94 
72083SPINE SCOLIOSIS 4-5 VIEWS $   113 
72084SPINE SCOLIOSIS MIN 6 VIEWS $   132 
71130STERNOCLAVICULAR JOINT(S) MIN 3 VIEWS $     54 
71120STERNUM MIN 2 VIEWS $     45 
73590TIBIA & FIBULA, 2 VIEWS $     43 
70328TMJ UNI $     46 
70330TMJ BILATERAL $     71 
73660TOES MIN 2 VIEWS $     43 
73092UPPER EXTREMITY INFANT (<1 YR) 2 VIEW $     41 
73100WRIST, 2 VIEWS $     47 
73110WRIST, COMPLETE MIN 3 VIEW $     53 
     
 FLUOROSCOPY:   
CPTDescription   
74270BARIUM ENEMA-COLON $   226 
74220ESOPHAGRAM $   133 
74250SMALL BOWEL W/SERIAL FILM $   156 
74241UPPER GI WITH KUB $   176 
74245UGI W/SMALL BOWEL $   257 

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*** 
CPTDescription   
75635CTA ABDOMINAL AORTA W RUNOFF W CONTRAST $   665**
71275CTA CHEST W/O & W CONTRAST $   453**
70498CTA CAROTIDS (NECK) $   441**
70496CTA HEAD $   442**
     
74176CT ABDOMEN & PELVIS WO CONTRAST $   303 
74177CT ABDOMEN & PELVIS W CONTRAST $   470***
74178CT ABDOMEN & PELVIS WO & W CONTRAST $   533***
74150CT ABDOMEN WO CONTRAST $   226 
74160CT ABDOMEN W CONTRAST $   348***
74170CT ABDOMEN WO & W CONTRAST $   396***
     
71250CT CHEST WO CONTRAST $   246 
71260CT CHEST W CONTRAST $   296***
71270CT CHEST WO & W CONTRAST $   355***
70487CT FACIAL BONES / SINUS W CONTRAST $   253***
70486CT FACIAL BONES / SINUS WO CONTRAST $   210 
70488CT FACIAL BONES / SINUS WO & W CONTRAST $   308***
70470CT HEAD WO & W CONTRAST $   289***
70450CT HEAD WO CONTRAST $   175 
70460CT HEAD W CONTRAST $   246***
73700CT LOWER EXTREMITY WO CONTRAST $   271 
73701CT LOWER EXTREMITY W CONTRAST $   341***
73702CT LOWER EXTREMITY WO & W CONTRAST $   412***
70491CT NECK W/CONTRAST $   307***
70490CT NECK WO CONTRAST $   254 
70492CT NECK WO & W CONTRAST $   369***
70480CT ORBITS WO CONTRAST $   351 
70481CT ORBITS W CONTRAST $   416***
70482CT ORBITS W & W/O CONTRAST $   453***
72192CT PELVIS WO CONTRAST $   220 
72193CT PELVIS W CONTRAST $   341***
72194CT PELVIS WO & W CONTRAST $   392***
72125CT SPINE CERVICAL WO   CONTRAST $   278 
72126CT SPINE CERVICAL W CONTRAST $   344***
72127CT SPINE CERVICAL WO & W CONTRAST $   407***
72131CT SPINE LUMBAR WO CONTRAST $   271 
72132CT SPINE LUMBAR WCONTRAST $   344***
72133CT SPINE LUMBAR WO & W CONTRAST $   406***
72128CT SPINE THORACIC WO CONTRAST $   272 
72129CT SPINE THORACIC W CONTRAST $   345***
72130CT SPINE THORACIC WO & W CONTRAST $   410***
76377CT 3D RENDERING $   107 
 CT CONTRAST   
 Description   
**CTA CONTRAST CHARGE $   100 
***CT CONTRAST CHARGE $     75 
     
 Mammography:   
CPTDescription   
77067MAMMOGRAPHY: SCREENING BILAT DIGITAL $   208 
77065MAMMOGRAPHY: DIAGNOSTIC UNILAT DIGITAL $   204 
77066MAMMOGRAPHY: DIAGNOSTIC BILAT DIGITAL $   258 
     
 Bone Density   
CPTDescription   
77080DXA BONE DENSITY AXIAL SKELTON $     63 
 BODY COMPOSITION ANALYSIS $     50 
     
 Ultrasound   
CPTDescription   
76700US ABDOMINAL COMPLETE $   186 
76705US ABDOMINAL LTIMITED $   139 
76706US AORTA SCREENING AAA $   143 
76641US BREAST, UNI COMPLETE $   163 
76642US BREAST, UNI LIMITED $   134 
76604US CHEST (CHEST WALL/UPPER BACK) $   135 
76882US EXTRMITY NONVASCULAR (ie Bakers Cyst) $     87 
76770US KIDNEY & BLADDER $   172 
76775US KIDNEY LIMITED $     88 
76856US PELVIS NON OB $   167 
76830US TRANSVAGINAL $   186 
76857US PELVIS LIMITED $     74 
76870US TESTICULAR $   103 
76536US THYROID $   177 
76801OB US <14 WEEKS TRANSABDOMINAL $   188 
76817OB US TRANSVAGINAL $   148 
76802OB EACH ADDITIIONAL GESTATION 1st TRIMESTER $     99 
76805OB US > 14 WEEKS TRANSABDOMINAL $   216 
76810OB EACH ADDITIONAL GESTATION >14 WEEKS $   142 
76815OB US LIMITED $   128 
76816OB US FOLLOW-UP FROM PREVIOUS SCAN $   176 
     
     
 X-Ray   
 Definitions: Uni or Unilateral means 1 or one side. Bilateral means 2 or both sides 
CPTDescription   
74018ABDOMEN: 1 VIEW $    41 
74019ABDOMEN: 2 VIEWS $    50 
74021ABDOMEN: 3 OR MORE VIEWS $    59 
73050ACROMIOCLAVICULAR JOINTS $    54 
74022ACUTE ABDOMEN SERIES   W/CHEST 3 VIEWS $    67 
73600ANKLE 2 VIEWS $    45 
73610ANKLE COMPLETE $    47 
77072BONE AGE STUDIES $    35 
77073BONE LENGTH STUDIES $    54 
73650CALCANEOUS MIN 2 VIEWS $    41 
71045CHEST SINGLE FRONTAL VIEW $    30 
71046CHEST 2 VIEWS $    46 
71047CHEST 3V $    59 
71048CHEST 4 VIEWS or more $    63 
73000CLAVICLE $    42 
73070ELBOW 2 VIEWS $    41 
73080ELBOW COMPLETE, MIN 3 VIEWS $    47 
70150FACIAL BONES 3 VIEWS $     62 
73551FEMUR 1 VIEW $     42 
73552FEMUR 2 VIEWS $     50 
73140FINGERS MIN 2 VIEWS $     49 
73620FOOT 2 VIEWS $     39 
73630FOOT COMPLETE $     44 
73090FOREARM, 2 VIEWS $     39 
73120HAND 2 VIEWS $     43 
73130HAND COMPLETE $     48 
73521HIP, BILATERAL,W PELVIS, 2 VIEWS $     57 
73522HIP, BILATERAL, W PELVIS 3-4 VIEWS $     74 
73523HIP,BILATERAL, W PELVIS   MIN 5 VIEWS $     85 
73501HIP, UNI, W PELVIS, 1 VIEW $     45 
73502HIP, UNI,W PELVIS, 2-3 VIEWS $     62 
73503HIP, UNI, MIN of 4 VIEWS $     78 
73060HUMERUS MIN 2 VIEWS $     44 
73560KNEE, 1-2 VIEWS $     47 
73562KNEE, 3 VIEWS $     54 
73564KNEE, COMP 4 OR MORE VIEWS $     60 
73565KNEES, STANDING COMPARISON $     54 
73592LOWER EXTREMITY INFANT 2 VIEW (<1 YR) $     41 
70100MANDIBLE <4 VIEWS $     50 
70110MANDIBLE COMPLETE 4 OR MORE VIEWS $     57 
70120MASTOIDS < 3 VWS $     50 
70130MASTOID COMPLETE, MIN 3 VIEWS PER SIDE $     82 
70160NASAL BONES $     50 
70360NECK SOFT TISSUE $     43 
76010NOSE/RECTUM FOR CHILD FOREIGN BODY 1 VIEW $     39 
70200ORBITS COMPLETE $     64 
77074OSSEOUS SURVEY: LIMITED FOR METS $     97 
77075OSSEOUS SURVEY: COMPLETE AXIAL & APPENDICULAR$   132 
77076OSSEOUS SURVEY: INFANT ( <1 YR) $   144 
72170PELVIS 1 OR 2 VIEWS $     48 
72190PELVIS MIN 3 VIEWS $     57 
71110RIBS: BILATERAL 3 VIEWS $     60 
71111RIBS: BILATERAL W/CHEST, MIN 4 VIEWS $     71 
71100RIBS: UNILATERAL 2 VIEWS $     50 
71101RIBS: UNILATERAL W/CHEST MIN 3 VIEWS $     58 
72200SACROILIAC JOINTS 1 OR 2 VWS $     43 
72202SACROILIAC JOINTS 3 OR MORE $     50 
72220SACRUM AND COCCYX MIN 2 VIEWS $     43 
73010SCAPULA $     46 
70240SELLA TURCIA $     46 
73020SHOULDER, 1 VIEW $     35 
73030SHOULDER COMPLETE MIN 2 VIEWS $     44 
70210SINUS 1 VIEW $     45 
70220SINUS COMPLETE MN 3 VIEWS $     57 
70250SKULL < 4 VIEWS $     55 
70260SKULL COMPLETE MIN 4 VIEWS $     69 
72020SPINE: SINGLE VIEW, SPECIFY LEVEL $     34 
72040SPINE CERVICAL 2 OR 3 VWS $     50 
72050SPINE CERVICAL 4 or 5 VIEWS $     68 
72052SPINE CERVICAL 6 OR MORE VIEWS $     84 
72100SPINE LUMBAR 2 OR 3 VIEWS $     53 
72110SPINE LUMBAR MIN 4 VIEWS $     74 
72120SPINE LUMBAR BENDING 2 OR 3 VIEWS $     61 
72114SPINE LUMBAR COMP MIN 6 VIEWS $     93 
72070SPINE THORACIC 2 VIEWS $     51 
72072SPINE THORACIC 3 VIEWS $     52 
72074SPINE THORACIC MIN 4 VIEWS $     59 
72081SPINE SCOLIOSIS 1 VIEW $     58 
72082SPINE SCOLIOSIS 2-3 VIEWS $     94 
72083SPINE SCOLIOSIS 4-5 VIEWS $   113 
72084SPINE SCOLIOSIS MIN 6 VIEWS $   132 
71130STERNOCLAVICULAR JOINT(S) MIN 3 VIEWS $     54 
71120STERNUM MIN 2 VIEWS $     45 
73590TIBIA & FIBULA, 2 VIEWS $     43 
70328TMJ UNI $     46 
70330TMJ BILATERAL $     71 
73660TOES MIN 2 VIEWS $     43 
73092UPPER EXTREMITY INFANT (<1 YR) 2 VIEW $     41 
73100WRIST, 2 VIEWS $     47 
73110WRIST, COMPLETE MIN 3 VIEW $     53 
     
 FLUOROSCOPY:   
CPTDescription   
74270BARIUM ENEMA-COLON $   226 
74220ESOPHAGRAM $   133 
74250SMALL BOWEL W/SERIAL FILM $   156 
74241UPPER GI WITH KUB $   176 
74245UGI W/SMALL BOWEL $   257