|
MRI, brain, without contrast70551
|
26 |
$253 |
$1,581 |
$2,309 |
|
MRI, brain, with and without contrast70553
|
26 |
$402 |
$1,581 |
$2,958 |
|
MRI, lower spine, without contrast72148
|
26 |
$253 |
$1,581 |
$2,367 |
|
MRI, knee, without contrast73721
|
26 |
$266 |
$1,658 |
$2,533 |
|
X-ray, chest, 2 views71046
|
26 |
$51 |
$96 |
$400 |
|
CT scan, abdomen and pelvis, without contrast74176
|
26 |
$253 |
$1,185 |
$2,301 |
|
X-ray, facial bones70150
|
26 |
$76 |
$143 |
$483 |
|
X-ray, nasal bones70160
|
26 |
$64 |
$121 |
$380 |
|
X-ray, sinuses70220
|
26 |
$59 |
$112 |
$420 |
|
X-ray, skull, limited70250
|
26 |
$59 |
$114 |
$392 |
|
Panoramic dental X-ray70355
|
26 |
$19 |
$93 |
$208 |
|
X-ray, soft tissues of the neck70360
|
26 |
$49 |
$94 |
$248 |
|
CT scan, head, without contrast70450
|
26 |
$125 |
$1,128 |
$1,561 |
|
CT scan, head, with and without contrast70470
|
26 |
$213 |
$1,128 |
$2,115 |
|
CT scan, eye socket and inner ear, without contrast70480
|
26 |
$172 |
$1,128 |
$1,895 |
|
CT scan, eye socket and inner ear, with contrast70481
|
26 |
$232 |
$1,128 |
$2,033 |
|
CT scan, face and jaw, without contrast70486
|
26 |
$156 |
$1,128 |
$1,626 |
|
CT scan, face and jaw, with contrast70487
|
26 |
$192 |
$1,128 |
$1,993 |
|
CT scan, soft tissues of the neck, without contrast70490
|
26 |
$159 |
$1,128 |
$1,635 |
|
CT scan, soft tissues of the neck, with contrast70491
|
26 |
$221 |
$1,128 |
$1,981 |
|
CT angiogram, head70496
|
26 |
$308 |
$1,128 |
$2,057 |
|
CT angiogram, neck70498
|
26 |
$308 |
$1,128 |
$2,078 |
|
MRI, eye socket, face and neck, with and without contrast70543
|
26 |
$441 |
$1,581 |
$2,825 |
|
MR angiogram, head, without contrast70544
|
26 |
$296 |
$1,754 |
$2,449 |
|
MR angiogram, neck, without contrast70547
|
26 |
$296 |
$1,754 |
$2,475 |
|
MR angiogram, neck, with and without contrast70549
|
26 |
$474 |
$1,754 |
$3,042 |
|
MRI, brain, with contrast70552
|
26 |
$370 |
$1,581 |
$2,366 |
|
X-ray, chest, 1 view71045
|
26 |
$38 |
$92 |
$315 |
|
X-ray, chest, 3 views71047
|
26 |
$64 |
$121 |
$459 |
|
X-ray, chest, 4 or more views71048
|
26 |
$68 |
$126 |
$503 |
|
X-ray, ribs, one side71100
|
26 |
$57 |
$107 |
$369 |
|
X-ray, ribs one side, with chest71101
|
26 |
$64 |
$121 |
$419 |
|
X-ray, ribs both sides, with chest71111
|
26 |
$81 |
$154 |
$502 |
|
CT scan, chest, without contrast71250
|
26 |
$148 |
$1,128 |
$1,641 |
|
CT scan, chest, with contrast71260
|
26 |
$210 |
$1,128 |
$1,906 |
|
CT scan, chest, with and without contrast71270
|
26 |
$247 |
$1,128 |
$2,144 |
|
CT angiogram, chest71275
|
26 |
$308 |
$1,141 |
$2,121 |
|
X-ray, neck spine, 2-3 views72040
|
26 |
$63 |
$118 |
$409 |
|
X-ray, neck spine, 4-5 views72050
|
26 |
$89 |
$162 |
$569 |
|
X-ray, mid-back spine, 2 views72070
|
26 |
$51 |
$112 |
$366 |
|
X-ray, mid-back spine, 3 views72072
|
26 |
$63 |
$118 |
$442 |
|
X-ray, mid and lower back spine, 2 views72080
|
26 |
$53 |
$102 |
$443 |
|
X-ray, entire spine, 1 view72081
|
26 |
$66 |
$124 |
$283 |
|
X-ray, entire spine, 2-3 views72082
|
26 |
$107 |
$227 |
$379 |
|
X-ray, lower back spine, 2-3 views72100
|
26 |
$64 |
$118 |
$395 |
|
X-ray, lower back spine, 4 or more views72110
|
26 |
$86 |
$156 |
$510 |
|
CT scan, neck spine, without contrast72125
|
26 |
$149 |
$1,128 |
$1,706 |
|
CT scan, mid-back spine, without contrast72128
|
26 |
$149 |
$1,128 |
$1,762 |
|
CT scan, lower back spine, without contrast72131
|
26 |
$148 |
$1,128 |
$1,648 |
|
MRI, neck spine, without contrast72141
|
26 |
$253 |
$1,581 |
$2,381 |
|
MRI, mid-back spine, without contrast72146
|
26 |
$253 |
$1,581 |
$2,367 |
|
MRI, neck spine, with and without contrast72156
|
26 |
$404 |
$1,581 |
$3,056 |
|
MRI, mid-back spine, with and without contrast72157
|
26 |
$405 |
$1,581 |
$3,106 |
|
MRI, lower back spine, with and without contrast72158
|
26 |
$403 |
$1,581 |
$2,659 |
|
X-ray, pelvis72170
|
26 |
$43 |
$112 |
$310 |
|
CT scan, pelvis, without contrast72192
|
26 |
$148 |
$1,128 |
$1,660 |
|
CT scan, pelvis, with contrast72193
|
26 |
$299 |
$1,128 |
$2,112 |
|
MRI, pelvis, without contrast72195
|
26 |
$298 |
$1,581 |
$2,293 |
|
MRI, pelvis, with and without contrast72197
|
26 |
$435 |
$1,581 |
$2,978 |
|
X-ray, sacroiliac joints72202
|
26 |
$62 |
$116 |
$377 |
|
X-ray, tailbone72220
|
26 |
$53 |
$99 |
$360 |
|
X-ray, collarbone73000
|
26 |
$53 |
$101 |
$318 |
|
X-ray, shoulder, 1 view73020
|
26 |
$31 |
$93 |
$322 |
|
X-ray, shoulder, 2 or more views73030
|
26 |
$56 |
$104 |
$463 |
|
X-ray, upper arm bone73060
|
26 |
$53 |
$101 |
$411 |
|
X-ray, elbow, 2 views73070
|
26 |
$46 |
$95 |
$350 |
|
X-ray, elbow, 3 or more views73080
|
26 |
$53 |
$98 |
$436 |
|
X-ray, forearm73090
|
26 |
$47 |
$95 |
$371 |
|
X-ray, wrist, 2 views73100
|
26 |
$56 |
$107 |
$355 |
|
X-ray, wrist, 3 or more views73110
|
26 |
$72 |
$132 |
$439 |
|
X-ray, hand, 3 or more views73130
|
26 |
$63 |
$115 |
$447 |
|
X-ray, finger73140
|
26 |
$69 |
$126 |
$320 |
|
CT scan, arm, without contrast73200
|
26 |
$184 |
$1,117 |
$1,580 |
|
CT scan, arm, with contrast73201
|
26 |
$370 |
$1,152 |
$1,654 |
|
MRI, arm, without contrast73218
|
26 |
$409 |
$1,658 |
$2,273 |
|
MRI, joint of the arm, without contrast73221
|
26 |
$267 |
$1,658 |
$2,414 |
|
MRI, joint of the arm, with contrast73222
|
26 |
$822 |
$1,678 |
$2,670 |
|
X-ray, hip, one side, 1 view73501
|
26 |
$52 |
$98 |
$330 |
|
X-ray, hip, one side, 2-3 views73502
|
26 |
$80 |
$150 |
$389 |
|
X-ray, both hips, 2 views73521
|
26 |
$66 |
$126 |
$428 |
|
X-ray, thigh bone, 2 or more views73552
|
26 |
$59 |
$112 |
$485 |
|
X-ray, knee, 1-2 views73560
|
26 |
$57 |
$110 |
$402 |
|
X-ray, knee, 3 views73562
|
26 |
$69 |
$131 |
$539 |
|
X-ray, lower leg73590
|
26 |
$52 |
$99 |
$411 |
|
X-ray, ankle, 2 views73600
|
26 |
$53 |
$102 |
$374 |
|
X-ray, ankle, 3 or more views73610
|
26 |
$61 |
$115 |
$486 |
|
X-ray, foot, 2 views73620
|
26 |
$46 |
$93 |
$349 |
|
X-ray, foot, 3 or more views73630
|
26 |
$57 |
$107 |
$421 |
|
X-ray, heel73650
|
26 |
$46 |
$95 |
$295 |
|
X-ray, toe73660
|
26 |
$50 |
$95 |
$231 |
|
CT scan, leg, without contrast73700
|
26 |
$148 |
$1,141 |
$1,637 |
|
CT scan, leg, with contrast73701
|
26 |
$210 |
$1,152 |
$1,717 |
|
CT angiogram, leg73706
|
26 |
$308 |
$1,232 |
$2,143 |
|
MRI, leg, without contrast73718
|
26 |
$297 |
$1,658 |
$2,350 |
|
X-ray, abdomen, 1 view74018
|
26 |
$47 |
$93 |
$327 |
|
X-ray, abdomen, 2 views74019
|
26 |
$56 |
$112 |
$369 |
|
CT scan, abdomen, without contrast74150
|
26 |
$146 |
$1,128 |
$1,986 |
|
CT scan, abdomen, with contrast74160
|
26 |
$299 |
$1,128 |
$2,090 |
|
CT scan, abdomen, with and without contrast74170
|
26 |
$308 |
$1,156 |
$2,393 |
|
CT angiogram, abdomen and pelvis74174
|
26 |
$380 |
$1,269 |
$2,474 |
|
CT scan, abdomen and pelvis, with contrast74177
|
26 |
$380 |
$1,269 |
$3,094 |
|
CT scan, abdomen and pelvis, with and without contrast74178
|
26 |
$380 |
$1,269 |
$3,234 |
|
MRI, abdomen, without contrast74181
|
26 |
$253 |
$1,581 |
$2,457 |
|
MRI, abdomen, with and without contrast74183
|
26 |
$437 |
$1,581 |
$3,045 |
|
Swallowing study, video X-ray74230
|
26 |
$184 |
$403 |
$825 |
|
Upper GI series (barium swallow)74240
|
26 |
$179 |
$353 |
$850 |
|
Upper GI series with air contrast74246
|
26 |
$181 |
$412 |
$842 |
|
Small bowel X-ray series74250
|
26 |
$179 |
$354 |
$783 |
|
CT angiogram, heart arteries75574
|
26 |
$380 |
$932 |
$1,547 |
|
Angiogram, artery of one arm or leg75710
|
26 |
$150 |
$2,591 |
$6,960 |
|
X-ray, infant, chest and abdomen76010
|
26 |
$46 |
$93 |
$325 |
|
Ultrasound, brain (through the skull)76506
|
26 |
$128 |
$285 |
$517 |
|
Ultrasound, soft tissues of the head and neck76536
|
26 |
$136 |
$285 |
$610 |
|
Ultrasound, chest76604
|
26 |
$105 |
$249 |
$312 |
|
Ultrasound, breast, complete76641
|
26 |
$116 |
$285 |
$417 |
|
Ultrasound, breast, limited76642
|
26 |
$93 |
$257 |
$378 |
|
Ultrasound, abdomen, complete76700
|
26 |
$128 |
$285 |
$734 |
|
Ultrasound, abdomen, limited76705
|
26 |
$110 |
$275 |
$564 |
|
Ultrasound, kidneys and back of the abdomen, complete76770
|
26 |
$121 |
$285 |
$467 |
|
Ultrasound, kidneys and back of the abdomen, limited76775
|
26 |
$105 |
$212 |
$452 |
|
Pregnancy ultrasound, limited76815
|
26 |
$108 |
$253 |
$387 |
|
Transvaginal ultrasound76830
|
26 |
$141 |
$285 |
$543 |
|
Pelvic ultrasound, complete76856
|
26 |
$120 |
$285 |
$579 |
|
Pelvic ultrasound, limited76857
|
26 |
$105 |
$191 |
$285 |
|
Ultrasound, scrotum76870
|
26 |
$118 |
$285 |
$596 |
|
Ultrasound, joint or limb, limited76882
|
26 |
$105 |
$221 |
$452 |
|
Ultrasound, infant hips76885
|
26 |
$156 |
$262 |
$469 |
|
Bone age X-ray77072
|
26 |
$37 |
$110 |
$270 |
|
Whole-body bone survey X-ray77075
|
26 |
$115 |
$262 |
$621 |
|
Bone density scan (DEXA), spine and hip77080
|
26 |
$64 |
$144 |
$600 |
|
CT scan, head, with contrast70460
|
25 |
$186 |
$278 |
$1,729 |
|
X-ray, spine, single view72020
|
25 |
$36 |
$93 |
$306 |
|
CT scan, lower back spine, with contrast72132
|
25 |
$370 |
$409 |
$1,745 |
|
X-ray, pelvis, 3 or more views72190
|
25 |
$66 |
$120 |
$424 |
|
X-ray, hand, 2 views73120
|
25 |
$51 |
$110 |
$349 |
|
X-ray, knee, 4 or more views73564
|
25 |
$79 |
$120 |
$522 |
|
Cardiac MRI, with contrast75561
|
25 |
$474 |
$1,581 |
$2,496 |
|
CT scan, heart, with contrast75572
|
25 |
$370 |
$468 |
$1,203 |
|
Ultrasound guidance for placing an IV line76937
|
25 |
$46 |
$88 |
$542 |
|
Bone density scan (DEXA), wrist, heel or finger77081
|
25 |
$48 |
$93 |
$444 |
|
Mammogram, screening, both breasts77067
|
24 |
$130 |
$147 |
$264 |
|
CT scan, chest, low-dose lung cancer screening71271
|
24 |
$144 |
$187 |
$584 |
|
X-ray, lower back spine, bending views72120
|
24 |
$65 |
$124 |
$469 |
|
X-ray, abdomen, 3 or more views74021
|
24 |
$66 |
$114 |
$374 |
|
Bile duct X-ray during surgery74300
|
24 |
$45 |
$333 |
$1,543 |
|
Heart CT calcium score75571
|
24 |
$124 |
$165 |
$1,055 |
|
Pregnancy ultrasound, before 14 weeks76801
|
24 |
$115 |
$171 |
$338 |
|
Pregnancy ultrasound, transvaginal76817
|
24 |
$108 |
$138 |
$291 |
|
Fetal wellbeing scan with non-stress test76818
|
24 |
$112 |
$187 |
$331 |
|
Diagnostic mammogram, one breast77065
|
24 |
$123 |
$147 |
$397 |
|
Diagnostic mammogram, both breasts77066
|
24 |
$157 |
$165 |
$401 |
|
Joint survey X-ray, 2 or more joints77077
|
24 |
$66 |
$126 |
$280 |
|
Nuclear stress test, heart blood flow78452
|
24 |
$777 |
$1,512 |
$5,372 |
|
X-ray, both hips, 3-4 views73522
|
23 |
$87 |
$118 |
$421 |