|
MRI, brain, without contrast70551
|
10 |
$248 |
$1,248 |
$2,255 |
|
MRI, brain, with and without contrast70553
|
10 |
$363 |
$1,248 |
$2,255 |
|
MRI, lower spine, without contrast72148
|
10 |
$248 |
$1,248 |
$2,255 |
|
MRI, knee, without contrast73721
|
10 |
$248 |
$1,248 |
$2,255 |
|
X-ray, chest, 2 views71046
|
10 |
$87 |
$168 |
$279 |
|
CT scan, abdomen and pelvis, without contrast74176
|
10 |
$248 |
$800 |
$1,934 |
|
X-ray, facial bones70150
|
10 |
$107 |
$283 |
$476 |
|
X-ray, nasal bones70160
|
10 |
$89 |
$206 |
$367 |
|
X-ray, sinuses70220
|
10 |
$89 |
$253 |
$448 |
|
X-ray, skull, limited70250
|
10 |
$104 |
$244 |
$339 |
|
X-ray, soft tissues of the neck70360
|
10 |
$87 |
$178 |
$266 |
|
CT scan, head, without contrast70450
|
10 |
$109 |
$800 |
$1,934 |
|
CT scan, head, with contrast70460
|
10 |
$178 |
$800 |
$1,934 |
|
CT scan, head, with and without contrast70470
|
10 |
$183 |
$800 |
$1,934 |
|
CT scan, eye socket and inner ear, without contrast70480
|
10 |
$109 |
$800 |
$1,934 |
|
CT scan, eye socket and inner ear, with contrast70481
|
10 |
$183 |
$800 |
$1,934 |
|
CT scan, face and jaw, without contrast70486
|
10 |
$109 |
$800 |
$1,746 |
|
CT scan, face and jaw, with contrast70487
|
10 |
$183 |
$800 |
$1,934 |
|
CT scan, soft tissues of the neck, without contrast70490
|
10 |
$109 |
$800 |
$1,843 |
|
CT scan, soft tissues of the neck, with contrast70491
|
10 |
$183 |
$800 |
$1,934 |
|
CT angiogram, head70496
|
10 |
$183 |
$800 |
$1,934 |
|
CT angiogram, neck70498
|
10 |
$183 |
$800 |
$1,934 |
|
MRI, eye socket, face and neck, with and without contrast70543
|
10 |
$363 |
$1,248 |
$2,255 |
|
MR angiogram, head, without contrast70544
|
10 |
$248 |
$1,248 |
$2,267 |
|
MR angiogram, neck, without contrast70547
|
10 |
$248 |
$1,248 |
$2,281 |
|
MR angiogram, neck, with and without contrast70549
|
10 |
$363 |
$1,248 |
$2,338 |
|
MRI, brain, with contrast70552
|
10 |
$363 |
$1,248 |
$2,255 |
|
X-ray, chest, 1 view71045
|
10 |
$57 |
$118 |
$820 |
|
X-ray, chest, 3 views71047
|
10 |
$89 |
$211 |
$285 |
|
X-ray, ribs, one side71100
|
10 |
$89 |
$194 |
$357 |
|
X-ray, ribs one side, with chest71101
|
10 |
$107 |
$240 |
$435 |
|
X-ray, ribs both sides, with chest71111
|
10 |
$107 |
$251 |
$509 |
|
CT scan, chest, without contrast71250
|
10 |
$109 |
$800 |
$1,934 |
|
CT scan, chest, with contrast71260
|
10 |
$183 |
$800 |
$1,934 |
|
CT scan, chest, with and without contrast71270
|
10 |
$183 |
$800 |
$1,934 |
|
CT scan, chest, low-dose lung cancer screening71271
|
10 |
$109 |
$545 |
$593 |
|
CT angiogram, chest71275
|
10 |
$183 |
$940 |
$1,934 |
|
X-ray, spine, single view72020
|
10 |
$77 |
$201 |
$334 |
|
X-ray, neck spine, 2-3 views72040
|
10 |
$89 |
$249 |
$435 |
|
X-ray, neck spine, 4-5 views72050
|
10 |
$107 |
$308 |
$551 |
|
X-ray, mid-back spine, 2 views72070
|
10 |
$99 |
$197 |
$399 |
|
X-ray, mid-back spine, 3 views72072
|
10 |
$105 |
$234 |
$435 |
|
X-ray, mid and lower back spine, 2 views72080
|
10 |
$89 |
$259 |
$421 |
|
X-ray, entire spine, 1 view72081
|
10 |
$89 |
$183 |
$283 |
|
X-ray, entire spine, 2-3 views72082
|
10 |
$114 |
$258 |
$347 |
|
X-ray, lower back spine, 2-3 views72100
|
10 |
$107 |
$247 |
$411 |
|
X-ray, lower back spine, 4 or more views72110
|
10 |
$107 |
$311 |
$525 |
|
CT scan, neck spine, without contrast72125
|
10 |
$107 |
$800 |
$1,934 |
|
CT scan, mid-back spine, without contrast72128
|
10 |
$107 |
$800 |
$1,934 |
|
CT scan, lower back spine, without contrast72131
|
10 |
$109 |
$800 |
$1,835 |
|
CT scan, lower back spine, with contrast72132
|
10 |
$363 |
$1,037 |
$1,934 |
|
MRI, neck spine, without contrast72141
|
10 |
$248 |
$1,248 |
$2,255 |
|
MRI, mid-back spine, without contrast72146
|
10 |
$248 |
$1,248 |
$2,255 |
|
MRI, neck spine, with and without contrast72156
|
10 |
$363 |
$1,248 |
$2,255 |
|
MRI, mid-back spine, with and without contrast72157
|
10 |
$363 |
$1,248 |
$2,255 |
|
MRI, lower back spine, with and without contrast72158
|
10 |
$363 |
$1,248 |
$2,255 |
|
X-ray, pelvis72170
|
10 |
$86 |
$168 |
$323 |
|
CT scan, pelvis, without contrast72192
|
10 |
$109 |
$800 |
$1,934 |
|
CT scan, pelvis, with contrast72193
|
10 |
$183 |
$800 |
$1,934 |
|
MRI, pelvis, without contrast72195
|
10 |
$248 |
$1,248 |
$2,255 |
|
MRI, pelvis, with and without contrast72197
|
10 |
$363 |
$1,274 |
$2,255 |
|
X-ray, sacroiliac joints72202
|
10 |
$105 |
$213 |
$366 |
|
X-ray, tailbone72220
|
10 |
$89 |
$194 |
$392 |
|
X-ray, collarbone73000
|
10 |
$89 |
$162 |
$323 |
|
X-ray, shoulder, 1 view73020
|
10 |
$73 |
$145 |
$310 |
|
X-ray, shoulder, 2 or more views73030
|
10 |
$89 |
$160 |
$355 |
|
X-ray, upper arm bone73060
|
10 |
$89 |
$181 |
$383 |
|
X-ray, elbow, 2 views73070
|
10 |
$86 |
$141 |
$320 |
|
X-ray, elbow, 3 or more views73080
|
10 |
$87 |
$183 |
$370 |
|
X-ray, forearm73090
|
10 |
$87 |
$159 |
$339 |
|
X-ray, wrist, 2 views73100
|
10 |
$89 |
$135 |
$290 |
|
X-ray, wrist, 3 or more views73110
|
10 |
$89 |
$165 |
$332 |
|
X-ray, hand, 2 views73120
|
10 |
$95 |
$152 |
$322 |
|
X-ray, hand, 3 or more views73130
|
10 |
$89 |
$186 |
$324 |
|
X-ray, finger73140
|
10 |
$89 |
$154 |
$307 |
|
CT scan, arm, without contrast73200
|
10 |
$109 |
$800 |
$1,597 |
|
CT scan, arm, with contrast73201
|
10 |
$363 |
$1,037 |
$1,678 |
|
MRI, arm, without contrast73218
|
10 |
$248 |
$1,248 |
$2,255 |
|
MRI, joint of the arm, without contrast73221
|
10 |
$248 |
$1,248 |
$2,255 |
|
MRI, joint of the arm, with contrast73222
|
10 |
$794 |
$1,961 |
$2,267 |
|
X-ray, hip, one side, 2-3 views73502
|
10 |
$91 |
$159 |
$325 |
|
X-ray, both hips, 2 views73521
|
10 |
$107 |
$237 |
$363 |
|
X-ray, both hips, 3-4 views73522
|
10 |
$107 |
$233 |
$397 |
|
X-ray, thigh bone, 2 or more views73552
|
10 |
$89 |
$175 |
$462 |
|
X-ray, knee, 1-2 views73560
|
10 |
$89 |
$165 |
$323 |
|
X-ray, knee, 3 views73562
|
10 |
$89 |
$250 |
$383 |
|
X-ray, knee, 4 or more views73564
|
10 |
$107 |
$270 |
$421 |
|
X-ray, lower leg73590
|
10 |
$88 |
$155 |
$341 |
|
X-ray, ankle, 2 views73600
|
10 |
$89 |
$155 |
$363 |
|
X-ray, ankle, 3 or more views73610
|
10 |
$89 |
$194 |
$427 |
|
X-ray, foot, 2 views73620
|
10 |
$86 |
$155 |
$287 |
|
X-ray, foot, 3 or more views73630
|
10 |
$89 |
$186 |
$359 |
|
X-ray, heel73650
|
10 |
$86 |
$144 |
$296 |
|
X-ray, toe73660
|
10 |
$87 |
$137 |
$262 |
|
CT scan, leg, without contrast73700
|
10 |
$109 |
$800 |
$1,667 |
|
CT scan, leg, with contrast73701
|
10 |
$183 |
$800 |
$1,744 |
|
CT angiogram, leg73706
|
10 |
$183 |
$938 |
$1,825 |
|
MRI, leg, without contrast73718
|
10 |
$248 |
$1,248 |
$2,255 |
|
X-ray, abdomen, 1 view74018
|
10 |
$87 |
$159 |
$336 |
|
X-ray, abdomen, 2 views74019
|
10 |
$104 |
$198 |
$376 |
|
X-ray, abdomen, 3 or more views74021
|
10 |
$107 |
$268 |
$407 |
|
CT scan, abdomen, without contrast74150
|
10 |
$109 |
$800 |
$1,934 |
|
CT scan, abdomen, with contrast74160
|
10 |
$183 |
$800 |
$1,934 |
|
CT scan, abdomen, with and without contrast74170
|
10 |
$183 |
$800 |
$1,934 |
|
CT angiogram, abdomen and pelvis74174
|
10 |
$363 |
$1,037 |
$1,934 |
|
CT scan, abdomen and pelvis, with contrast74177
|
10 |
$363 |
$1,037 |
$1,934 |
|
CT scan, abdomen and pelvis, with and without contrast74178
|
10 |
$363 |
$1,037 |
$1,934 |
|
MRI, abdomen, without contrast74181
|
10 |
$248 |
$1,248 |
$2,255 |
|
MRI, abdomen, with and without contrast74183
|
10 |
$363 |
$1,248 |
$2,255 |
|
Swallowing study, video X-ray74230
|
10 |
$217 |
$438 |
$552 |
|
Upper GI series with air contrast74246
|
10 |
$210 |
$521 |
$862 |
|
Small bowel X-ray series74250
|
10 |
$184 |
$384 |
$778 |
|
CT angiogram, heart arteries75574
|
10 |
$356 |
$912 |
$1,153 |
|
X-ray, infant, chest and abdomen76010
|
10 |
$86 |
$109 |
$268 |
|
Ultrasound, soft tissues of the head and neck76536
|
10 |
$110 |
$389 |
$665 |
|
Ultrasound, chest76604
|
10 |
$102 |
$277 |
$435 |
|
Ultrasound, breast, complete76641
|
10 |
$110 |
$313 |
$422 |
|
Ultrasound, breast, limited76642
|
10 |
$85 |
$270 |
$345 |
|
Ultrasound, abdomen, complete76700
|
10 |
$110 |
$364 |
$891 |
|
Ultrasound, abdomen, limited76705
|
10 |
$110 |
$286 |
$457 |
|
Ultrasound, kidneys and back of the abdomen, complete76770
|
10 |
$110 |
$331 |
$643 |
|
Ultrasound, kidneys and back of the abdomen, limited76775
|
10 |
$105 |
$285 |
$480 |
|
Pregnancy ultrasound, before 14 weeks76801
|
10 |
$110 |
$321 |
$478 |
|
Pregnancy ultrasound, transvaginal76817
|
10 |
$110 |
$291 |
$380 |
|
Transvaginal ultrasound76830
|
10 |
$110 |
$392 |
$548 |
|
Pelvic ultrasound, complete76856
|
10 |
$110 |
$311 |
$634 |
|
Pelvic ultrasound, limited76857
|
10 |
$100 |
$277 |
$357 |
|
Ultrasound, scrotum76870
|
10 |
$110 |
$311 |
$662 |
|
Ultrasound, joint or limb, limited76882
|
10 |
$105 |
$285 |
$514 |
|
Diagnostic mammogram, one breast77065
|
10 |
$171 |
$252 |
$365 |
|
Diagnostic mammogram, both breasts77066
|
10 |
$217 |
$275 |
$471 |
|
Bone age X-ray77072
|
10 |
$69 |
$213 |
$292 |
|
Whole-body bone survey X-ray77075
|
10 |
$151 |
$336 |
$841 |
|
Bone density scan (DEXA), spine and hip77080
|
10 |
$107 |
$311 |
$603 |
|
Bone density scan (DEXA), wrist, heel or finger77081
|
10 |
$87 |
$129 |
$292 |
|
Nuclear stress test, heart blood flow78452
|
10 |
$256 |
$1,761 |
$4,023 |
|
Mammogram, screening, both breasts77067
|
9 |
$81 |
$250 |
$436 |
|
X-ray, chest, 4 or more views71048
|
9 |
$105 |
$140 |
$567 |
|
X-ray, lower back spine, bending views72120
|
9 |
$105 |
$222 |
$563 |
|
X-ray, pelvis, 3 or more views72190
|
9 |
$105 |
$154 |
$439 |
|
X-ray, hip, one side, 1 view73501
|
9 |
$87 |
$143 |
$342 |
|
Upper GI series (barium swallow)74240
|
9 |
$182 |
$353 |
$850 |
|
Cardiac MRI, with contrast75561
|
9 |
$337 |
$1,248 |
$2,260 |
|
Heart CT calcium score75571
|
9 |
$89 |
$236 |
$1,093 |
|
CT scan, heart, with contrast75572
|
9 |
$314 |
$991 |
$1,579 |
|
Pregnancy ultrasound, limited76815
|
9 |
$106 |
$277 |
$480 |
|
Fetal wellbeing scan with non-stress test76818
|
9 |
$133 |
$311 |
$1,510 |
|
Bile duct X-ray during surgery74300
|
8 |
$16 |
$441 |
$1,543 |
|
Angiogram, artery of one arm or leg75710
|
8 |
$456 |
$1,479 |
$9,387 |
|
Ultrasound, brain (through the skull)76506
|
8 |
$177 |
$364 |
$2,278 |
|
Ultrasound guidance for placing an IV line76937
|
8 |
$14 |
$657 |
$946 |
|
Joint survey X-ray, 2 or more joints77077
|
8 |
$105 |
$126 |
$280 |
|
Panoramic dental X-ray70355
|
7 |
$51 |
$88 |
$365 |
|
Ultrasound, infant hips76885
|
7 |
$90 |
$421 |
$976 |