|
MRI, brain, without contrast70551
|
5 |
$320 |
$1,277 |
$1,780 |
|
MRI, brain, with and without contrast70553
|
5 |
$479 |
$2,094 |
$2,847 |
|
MRI, lower spine, without contrast72148
|
5 |
$313 |
$1,627 |
$1,820 |
|
MRI, knee, without contrast73721
|
5 |
$324 |
$1,441 |
$1,784 |
|
X-ray, chest, 2 views71046
|
5 |
$54 |
$128 |
$167 |
|
CT scan, abdomen and pelvis, without contrast74176
|
5 |
$298 |
$1,750 |
$2,082 |
|
Mammogram, screening, both breasts77067
|
5 |
$139 |
$179 |
$271 |
|
X-ray, facial bones70150
|
5 |
$77 |
$224 |
$292 |
|
X-ray, nasal bones70160
|
5 |
$61 |
$148 |
$224 |
|
X-ray, sinuses70220
|
5 |
$62 |
$210 |
$319 |
|
X-ray, skull, limited70250
|
5 |
$59 |
$168 |
$229 |
|
X-ray, soft tissues of the neck70360
|
5 |
$51 |
$138 |
$216 |
|
CT scan, head, without contrast70450
|
5 |
$142 |
$1,011 |
$1,069 |
|
CT scan, head, with contrast70460
|
5 |
$239 |
$1,070 |
$1,213 |
|
CT scan, head, with and without contrast70470
|
5 |
$239 |
$1,208 |
$1,534 |
|
CT scan, eye socket and inner ear, without contrast70480
|
5 |
$165 |
$1,127 |
$1,188 |
|
CT scan, eye socket and inner ear, with contrast70481
|
5 |
$240 |
$1,213 |
$1,357 |
|
CT scan, face and jaw, without contrast70486
|
5 |
$165 |
$820 |
$980 |
|
CT scan, face and jaw, with contrast70487
|
5 |
$239 |
$1,168 |
$1,224 |
|
CT scan, soft tissues of the neck, without contrast70490
|
5 |
$165 |
$871 |
$933 |
|
CT scan, soft tissues of the neck, with contrast70491
|
5 |
$239 |
$1,004 |
$1,147 |
|
CT angiogram, head70496
|
5 |
$277 |
$941 |
$1,559 |
|
CT angiogram, neck70498
|
5 |
$277 |
$1,006 |
$1,662 |
|
MRI, eye socket, face and neck, with and without contrast70543
|
5 |
$479 |
$1,944 |
$2,365 |
|
MR angiogram, head, without contrast70544
|
5 |
$324 |
$1,392 |
$1,520 |
|
MR angiogram, neck, without contrast70547
|
5 |
$324 |
$1,210 |
$1,354 |
|
MR angiogram, neck, with and without contrast70549
|
5 |
$479 |
$1,825 |
$2,291 |
|
MRI, brain, with contrast70552
|
5 |
$441 |
$1,702 |
$1,852 |
|
X-ray, chest, 1 view71045
|
5 |
$41 |
$114 |
$136 |
|
X-ray, chest, 3 views71047
|
5 |
$67 |
$122 |
$179 |
|
X-ray, chest, 4 or more views71048
|
5 |
$74 |
$156 |
$201 |
|
X-ray, ribs, one side71100
|
5 |
$72 |
$172 |
$244 |
|
X-ray, ribs one side, with chest71101
|
5 |
$83 |
$222 |
$285 |
|
X-ray, ribs both sides, with chest71111
|
5 |
$84 |
$243 |
$352 |
|
CT scan, chest, without contrast71250
|
5 |
$157 |
$955 |
$1,301 |
|
CT scan, chest, with contrast71260
|
5 |
$239 |
$1,216 |
$1,439 |
|
CT scan, chest, with and without contrast71270
|
5 |
$261 |
$1,445 |
$1,721 |
|
CT scan, chest, low-dose lung cancer screening71271
|
5 |
$133 |
$197 |
$273 |
|
CT angiogram, chest71275
|
5 |
$277 |
$1,033 |
$1,463 |
|
X-ray, spine, single view72020
|
5 |
$39 |
$125 |
$222 |
|
X-ray, neck spine, 2-3 views72040
|
5 |
$65 |
$190 |
$272 |
|
X-ray, neck spine, 4-5 views72050
|
5 |
$90 |
$237 |
$334 |
|
X-ray, mid-back spine, 2 views72070
|
5 |
$54 |
$208 |
$262 |
|
X-ray, mid-back spine, 3 views72072
|
5 |
$64 |
$195 |
$289 |
|
X-ray, mid and lower back spine, 2 views72080
|
5 |
$57 |
$189 |
$265 |
|
X-ray, entire spine, 1 view72081
|
5 |
$27 |
$99 |
$196 |
|
X-ray, entire spine, 2-3 views72082
|
5 |
$115 |
$137 |
$281 |
|
X-ray, lower back spine, 2-3 views72100
|
5 |
$66 |
$239 |
$339 |
|
X-ray, lower back spine, 4 or more views72110
|
5 |
$88 |
$269 |
$423 |
|
X-ray, lower back spine, bending views72120
|
5 |
$63 |
$241 |
$345 |
|
CT scan, neck spine, without contrast72125
|
5 |
$159 |
$1,131 |
$1,250 |
|
CT scan, mid-back spine, without contrast72128
|
5 |
$158 |
$1,093 |
$1,308 |
|
CT scan, lower back spine, without contrast72131
|
5 |
$157 |
$867 |
$1,293 |
|
CT scan, lower back spine, with contrast72132
|
5 |
$276 |
$995 |
$1,608 |
|
MRI, neck spine, without contrast72141
|
5 |
$312 |
$1,447 |
$1,691 |
|
MRI, mid-back spine, without contrast72146
|
5 |
$311 |
$1,527 |
$1,767 |
|
MRI, neck spine, with and without contrast72156
|
5 |
$479 |
$2,166 |
$2,715 |
|
MRI, mid-back spine, with and without contrast72157
|
5 |
$479 |
$2,055 |
$2,711 |
|
MRI, lower back spine, with and without contrast72158
|
5 |
$479 |
$2,010 |
$2,630 |
|
X-ray, pelvis72170
|
5 |
$46 |
$157 |
$223 |
|
X-ray, pelvis, 3 or more views72190
|
5 |
$71 |
$186 |
$258 |
|
CT scan, pelvis, without contrast72192
|
5 |
$156 |
$1,008 |
$1,242 |
|
CT scan, pelvis, with contrast72193
|
5 |
$277 |
$1,266 |
$1,360 |
|
MRI, pelvis, without contrast72195
|
5 |
$324 |
$1,546 |
$1,882 |
|
MRI, pelvis, with and without contrast72197
|
5 |
$479 |
$1,910 |
$2,515 |
|
X-ray, sacroiliac joints72202
|
5 |
$57 |
$179 |
$255 |
|
X-ray, tailbone72220
|
5 |
$53 |
$188 |
$250 |
|
X-ray, collarbone73000
|
5 |
$87 |
$170 |
$229 |
|
X-ray, shoulder, 1 view73020
|
5 |
$84 |
$127 |
$209 |
|
X-ray, shoulder, 2 or more views73030
|
5 |
$87 |
$169 |
$216 |
|
X-ray, upper arm bone73060
|
5 |
$87 |
$162 |
$233 |
|
X-ray, elbow, 2 views73070
|
5 |
$87 |
$164 |
$214 |
|
X-ray, elbow, 3 or more views73080
|
5 |
$87 |
$158 |
$219 |
|
X-ray, forearm73090
|
5 |
$87 |
$160 |
$216 |
|
X-ray, wrist, 2 views73100
|
5 |
$87 |
$135 |
$197 |
|
X-ray, wrist, 3 or more views73110
|
5 |
$87 |
$150 |
$214 |
|
X-ray, hand, 2 views73120
|
5 |
$97 |
$142 |
$222 |
|
X-ray, hand, 3 or more views73130
|
5 |
$87 |
$148 |
$210 |
|
X-ray, finger73140
|
5 |
$87 |
$139 |
$209 |
|
CT scan, arm, without contrast73200
|
5 |
$165 |
$747 |
$989 |
|
CT scan, arm, with contrast73201
|
5 |
$371 |
$916 |
$1,214 |
|
MRI, arm, without contrast73218
|
5 |
$376 |
$1,347 |
$2,028 |
|
MRI, joint of the arm, without contrast73221
|
5 |
$324 |
$1,342 |
$1,762 |
|
MRI, joint of the arm, with contrast73222
|
5 |
$583 |
$1,711 |
$2,032 |
|
X-ray, hip, one side, 1 view73501
|
5 |
$63 |
$153 |
$207 |
|
X-ray, hip, one side, 2-3 views73502
|
5 |
$91 |
$163 |
$213 |
|
X-ray, both hips, 2 views73521
|
5 |
$69 |
$210 |
$288 |
|
X-ray, both hips, 3-4 views73522
|
5 |
$89 |
$203 |
$288 |
|
X-ray, thigh bone, 2 or more views73552
|
5 |
$99 |
$197 |
$280 |
|
X-ray, knee, 1-2 views73560
|
5 |
$87 |
$149 |
$212 |
|
X-ray, knee, 3 views73562
|
5 |
$87 |
$175 |
$224 |
|
X-ray, knee, 4 or more views73564
|
5 |
$102 |
$198 |
$262 |
|
X-ray, lower leg73590
|
5 |
$87 |
$168 |
$216 |
|
X-ray, ankle, 2 views73600
|
5 |
$87 |
$163 |
$222 |
|
X-ray, ankle, 3 or more views73610
|
5 |
$87 |
$170 |
$258 |
|
X-ray, foot, 2 views73620
|
5 |
$84 |
$134 |
$194 |
|
X-ray, foot, 3 or more views73630
|
5 |
$84 |
$157 |
$216 |
|
X-ray, heel73650
|
5 |
$87 |
$152 |
$210 |
|
X-ray, toe73660
|
5 |
$87 |
$138 |
$200 |
|
CT scan, leg, without contrast73700
|
5 |
$165 |
$780 |
$960 |
|
CT scan, leg, with contrast73701
|
5 |
$277 |
$819 |
$1,120 |
|
CT angiogram, leg73706
|
5 |
$277 |
$895 |
$933 |
|
MRI, leg, without contrast73718
|
5 |
$324 |
$1,508 |
$1,976 |
|
X-ray, abdomen, 1 view74018
|
5 |
$49 |
$144 |
$216 |
|
X-ray, abdomen, 2 views74019
|
5 |
$59 |
$209 |
$262 |
|
X-ray, abdomen, 3 or more views74021
|
5 |
$69 |
$215 |
$264 |
|
CT scan, abdomen, without contrast74150
|
5 |
$158 |
$1,093 |
$1,151 |
|
CT scan, abdomen, with contrast74160
|
5 |
$277 |
$1,328 |
$1,379 |
|
CT scan, abdomen, with and without contrast74170
|
5 |
$277 |
$1,459 |
$2,264 |
|
CT angiogram, abdomen and pelvis74174
|
5 |
$523 |
$1,162 |
$2,155 |
|
CT scan, abdomen and pelvis, with contrast74177
|
5 |
$479 |
$1,941 |
$2,421 |
|
CT scan, abdomen and pelvis, with and without contrast74178
|
5 |
$479 |
$1,941 |
$2,822 |
|
MRI, abdomen, without contrast74181
|
5 |
$317 |
$1,446 |
$1,683 |
|
MRI, abdomen, with and without contrast74183
|
5 |
$479 |
$1,996 |
$2,461 |
|
Swallowing study, video X-ray74230
|
5 |
$198 |
$225 |
$351 |
|
Upper GI series (barium swallow)74240
|
5 |
$179 |
$333 |
$400 |
|
Upper GI series with air contrast74246
|
5 |
$180 |
$297 |
$639 |
|
Small bowel X-ray series74250
|
5 |
$179 |
$194 |
$476 |
|
Bile duct X-ray during surgery74300
|
5 |
$110 |
$269 |
$454 |
|
Heart CT calcium score75571
|
5 |
$114 |
$157 |
$331 |
|
CT scan, heart, with contrast75572
|
5 |
$281 |
$453 |
$693 |
|
CT angiogram, heart arteries75574
|
5 |
$403 |
$520 |
$668 |
|
Angiogram, artery of one arm or leg75710
|
5 |
$1,292 |
$2,057 |
$3,071 |
|
X-ray, infant, chest and abdomen76010
|
5 |
$47 |
$115 |
$198 |
|
Ultrasound, brain (through the skull)76506
|
5 |
$135 |
$280 |
$999 |
|
Ultrasound, soft tissues of the head and neck76536
|
5 |
$155 |
$359 |
$629 |
|
Ultrasound, chest76604
|
5 |
$129 |
$257 |
$338 |
|
Ultrasound, breast, complete76641
|
5 |
$156 |
$281 |
$475 |
|
Ultrasound, breast, limited76642
|
5 |
$126 |
$277 |
$376 |
|
Ultrasound, abdomen, complete76700
|
5 |
$158 |
$426 |
$595 |
|
Ultrasound, abdomen, limited76705
|
5 |
$144 |
$426 |
$471 |
|
Ultrasound, kidneys and back of the abdomen, complete76770
|
5 |
$158 |
$426 |
$724 |
|
Ultrasound, kidneys and back of the abdomen, limited76775
|
5 |
$131 |
$406 |
$504 |
|
Pregnancy ultrasound, before 14 weeks76801
|
5 |
$157 |
$286 |
$441 |
|
Pregnancy ultrasound, limited76815
|
5 |
$120 |
$203 |
$232 |
|
Pregnancy ultrasound, transvaginal76817
|
5 |
$127 |
$277 |
$426 |
|
Transvaginal ultrasound76830
|
5 |
$146 |
$359 |
$499 |
|
Pelvic ultrasound, complete76856
|
5 |
$155 |
$409 |
$493 |
|
Pelvic ultrasound, limited76857
|
5 |
$119 |
$277 |
$397 |
|
Ultrasound, scrotum76870
|
5 |
$138 |
$360 |
$614 |
|
Ultrasound, joint or limb, limited76882
|
5 |
$105 |
$337 |
$571 |
|
Ultrasound, infant hips76885
|
5 |
$120 |
$211 |
$428 |
|
Ultrasound guidance for placing an IV line76937
|
5 |
$69 |
$401 |
$641 |
|
Diagnostic mammogram, one breast77065
|
5 |
$123 |
$187 |
$230 |
|
Diagnostic mammogram, both breasts77066
|
5 |
$157 |
$208 |
$303 |
|
Bone age X-ray77072
|
5 |
$41 |
$97 |
$161 |
|
Whole-body bone survey X-ray77075
|
5 |
$138 |
$348 |
$547 |
|
Bone density scan (DEXA), spine and hip77080
|
5 |
$64 |
$233 |
$367 |
|
Bone density scan (DEXA), wrist, heel or finger77081
|
5 |
$48 |
$123 |
$193 |
|
Nuclear stress test, heart blood flow78452
|
5 |
$1,475 |
$1,749 |
$2,629 |