| | LDCT-CHEST SCREENING | $350.00 | $350.00 | | | |
| | Mandible Radiologic examination, partial, less than 4 views | $44.16 | $44.16 | $17.38 | $37.40 | $17.39 |
| | Mandible Complete, minimum of 4 views | $44.16 | $44.16 | $20.37 | $43.20 | $20.37 |
| | Mastoids Radiologic examination, less than 3 views per side | $34.49 | $34.49 | $17.91 | $37.40 | $17.92 |
| | Mastoids Complete, minimum of 3 views per side | $53.49 | $53.49 | $29.24 | $61.00 | $29.24 |
| | Facial bones Radiologic examination, less than 3 views | $43.65 | $43.65 | $15.86 | $31.94 | $15.87 |
| | Facial bones Complete, minimum of 3 views | $43.65 | $43.65 | | $46.84 | $22.22 |
| | Nasal bones Radiologic examination, complete, minimum of 3 views | $35.00 | $35.00 | $17.13 | $37.04 | $17.13 |
| | Optic foramina Radiologic examination; optic foramina | $48.10 | $48.10 | $19.02 | $39.21 | $19.02 |
| | Orbits Complete, minimum of 4 views | $52.75 | $52.75 | $22.72 | $47.56 | $22.72 |
| | CT DORSAL SPINE W IV CONTRAST | $52.75 | $52.75 | $22.72 | $47.56 | $22.72 |
| | Paranasal sinuses Radiologic examination, less than 3 views | $48.59 | $48.59 | $15.72 | $31.59 | $15.72 |
| | Paranasal sinuses Radiologic examination, complete, minimum of 3 views | $41.10 | $41.10 | $20.20 | $37.39 | $20.20 |
| | Sella turcica Radiologic examination, sella turcica | $31.30 | $31.30 | $15.60 | $34.13 | $15.60 |
| | Skull Radiologic examination, less than 4 views | $50.18 | $50.18 | $19.41 | $36.31 | $19.42 |
| | Skull Complete, minimum of 4 views | $55.90 | $55.90 | $24.82 | $45.01 | $24.83 |
| | TMJ Radiologic examination, temporomandibular joint, open and close mouth; unilateral | $30.44 | $30.44 | $15.60 | $34.13 | $15.60 |
| | TMJ Radiologic examination, temporomandibular joint, open and close mouth; bilateral | $49.74 | $49.74 | $24.89 | $52.66 | $24.90 |
| | Neck soft tissue Radiologic examination | $33.12 | $33.12 | $13.66 | $31.22 | $13.65 |
| | CT SCAN BRAIN W/O | $385.00 | $385.00 | $63.44 | $117.94 | $63.45 |
| | CT SCAN BRAIN W IV CONTRAST | $385.00 | $385.00 | $88.03 | $166.61 | $88.03 |
| | CT SCAN BRAIN W/WO IV CONSTRAS | $385.00 | $385.00 | $103.98 | $195.30 | $103.98 |
| | CT ORBIT,SELLA,EAR,WO IV CONTR | $385.00 | $385.00 | $96.45 | $204.75 | $96.46 |
| | CT ORBIT,SELLA,EAR,W IV CONTRA | $385.00 | $385.00 | $146.57 | $228.45 | $146.57 |
| | CTORBIT,SELLA,EAR,W-WO IVCONTR | $385.00 | $385.00 | $159.52 | $253.13 | $159.53 |
| | CT FACIAL WO CONTRAST | $385.00 | $385.00 | $75.29 | $155.48 | $75.29 |
| | CT FACIAL/SINUS W IV CONTRAST | $385.00 | $385.00 | $91.39 | $170.61 | $91.39 |
| | CT FACIAL/SINUS W/WO IV CONTR | $385.00 | $385.00 | $110.52 | $208.03 | $110.52 |
| | CT SCAN NECK WO | $385.00 | $385.00 | $96.45 | $168.01 | $96.46 |
| | CT ANGIOGRAPHY | $385.00 | $385.00 | $158.00 | $303.17 | $158.01 |