General X-ray

Description Charge Type CPT Code Christiana Facility Price
XRAY,ABDOMEN,COMPLETE,INCL DECUBITUS/ERECT VIEWS GLR Hospital 74021 $155.00
XRAY,ABDOMEN,COMPLETE,INCL DECUBITUS/ERECT VIEWS PFR Physician 74021 $42.00
XRAY,ABDOMEN,SINGLE ANTEROPOSTERIOR VIEW GLR Hospital 74018 $129.50
XRAY,ABDOMEN,SINGLE ANTEROPOSTERIOR VIEW PFR Physician 74018 $28.00
XRAY,CHEST,2 VIEWS,FRONTAL/LATERAL GLR Hospital 71046 $155.00
XRAY,CHEST,2 VIEWS,FRONTAL/LATERAL PFR Physician 71046 $35.00
XRAY,CHEST,SINGLE VIEW,FRONTAL GLR Hospital 71045 $117.50
XRAY,CHEST,SINGLE VIEW,FRONTAL PFR Physician 71045 $28.00
XRAY,FOOT,COMPLETE,MINIMUM 3 VIEWS,LT GLR Hospital 73630 $132.00
XRAY,FOOT,COMPLETE,MINIMUM 3 VIEWS,LT PFR Physician 73630 $27.00
XRAY,KNEE,1 OR 2 VIEWS,LEFT GLR Hospital 73560 $129.50
XRAY,KNEE,1 OR 2 VIEWS,LEFT PFR Physician 73560 $29.00
XRAY,PELVIS,1 OR 2 VIEWS GLR Hospital 72170 $129.50
XRAY,PELVIS,1 OR 2 VIEWS PFR Physician 72170 $29.00
XRAY,SPINE,CERVICAL,2 OR 3 VIEWS GLR Hospital 72040 $148.50
XRAY,SPINE,CERVICAL,2 OR 3 VIEWS PFR Physician 72040 $38.00
XRAY,SPINE,LUMBOSACRAL,2 OR 3 VIEWS GLR Hospital 72100 $165.00
XRAY,SPINE,LUMBOSACRAL,2 OR 3 VIEWS PFR Physician 72100 $38.00

CT Scan

Description Charge Type CPT Code Christiana Facility Price
CT,ABDOMEN,W/WO CONTRAST GLR Hospital 74170 $2122.00
CT,ABDOMEN,W/WO CONTRAST PFR Physician 74170 $220.00
CT,HEAD/BRAIN,W/WO CONTRAST GLR Hospital 70470 $1224.50
CT,HEAD/BRAIN,W/WO CONTRAST PFR Physician 70470 $199.00
CT,HEAD/BRAIN,WO CONTRAST GLR Hospital 70450 $820.00
CT,HEAD/BRAIN,WO CONTRAST PFR Physician 70450 $133.00
CTA,ABDOMEN/PELVIS,W/WO CONTRAST,IMG POSTPROCESSING GLR Hospital 74174 $3569.50
CTA,ABDOMEN/PELVIS,W/WO CONTRAST,IMG POSTPROCESSING PFR Physician 74174 $508.00
CTA,CHEST(NONCORONARY),W/WO CONTRAST GLR Hospital 71275 $1843.00
CTA,CHEST(NONCORONARY),W/WO CONTRAST PFR Physician 71275 $301.00
CTA,HEAD,W/WO CONTRAST GLR Hospital 70496 $1713.50
CTA,HEAD,W/WO CONTRAST PFR Physician 70496 $274.00

MRI

Description Charge Type CPT Code Christiana Facility Price
MRA,HEAD,W/WO CONTRAST GLR Hospital 70546 $3699.00
MRA,HEAD,W/WO CONTRAST PFR Physician 70546 $284.00
MRI,ABDOMEN,W/WO CONTRAST GLR Hospital 74183 $4138.00
MRI,ABDOMEN,W/WO CONTRAST PFR Physician 74183 $353.50
MRI,BRAIN,W/WO CONTRAST GLR Hospital 70553 $4222.00
MRI,BRAIN,W/WO CONTRAST PFR Physician 70553 $371.50
MRI,CHEST,W/WO CONTRAST GLR Hospital 71552 $4111.00
MRI,CHEST,W/WO CONTRAST PFR Physician 71552 $353.50
MRI,CHEST,WO CONTRAST GLR Hospital 71550 $1881.00
MRI,CHEST,WO CONTRAST PFR Physician 71550 $228.50

Ultrasound

Description Charge Type CPT Code Christiana Facility Price
US,ABDOMINAL,W IMAGE DOCUM,COMPLETE GLR Hospital 76700 $475.50
US,ABDOMINAL,W IMAGE DOCUM,COMPLETE PFR Physician 76700 $128.00
US,PELVIC,W IMAGE DOCUM,COMPLETE,NON-OB GLR Hospital 76856 $368.00
US,PELVIC,W IMAGE DOCUM,COMPLETE,NON-OB PFR Physician 76856 $107.50
US,PREGNANT UTERUS,FETAL & MATERNAL EVAL,TRANSABDOMINAL,AFTER 1ST TRIMESTER,1ST GESTATION GLR Hospital 76805 $506.00
US,PREGNANT UTERUS,FETAL & MATERNAL EVAL,TRANSABDOMINAL,AFTER 1ST TRIMESTER,1ST GESTATION PFR Physician 76805 $158.00

Mammography

Description Charge Type CPT Code Christiana Facility Price
MAMMOGRAM,DIAGNOSTIC,DIGITAL,BILATERAL GLR Hospital 77066 $427.00
MAMMOGRAM,DIAGNOSTIC,DIGITAL,BILATERAL PFR Physician 77066 $141.00
MAMMOGRAM,SCREENING,DIGITAL,BILATERAL GLR Hospital 77067 $363.50
MAMMOGRAM,SCREENING,DIGITAL,BILATERAL PFR Physician 77067 $113.00
TOMOSYNTHESIS,DIGITAL,BIL GLR Hospital 77062 $31.50
TOMOSYNTHESIS,DIGITAL,BIL PFR Physician 77062 $36.50
TOMOSYNTHESIS,DIGITAL,BIL,SCREENING GLR Hospital 77063 $32.50
TOMOSYNTHESIS,DIGITAL,BIL,SCREENING PFR Physician 77063 $34.50