|
CT scan, abdomen and pelvis, without contrast74176
|
6 |
$217 |
$584 |
$1,994 |
|
CT scan, head, without contrast70450
|
6 |
$95 |
$521 |
$1,067 |
|
X-ray, chest, 1 view71045
|
6 |
$56 |
$113 |
$150 |
|
CT scan, chest, low-dose lung cancer screening71271
|
6 |
$92 |
$211 |
$465 |
|
CT scan, lower back spine, with contrast72132
|
6 |
$315 |
$829 |
$1,308 |
|
CT scan, abdomen and pelvis, with contrast74177
|
6 |
$318 |
$829 |
$2,266 |
|
CT scan, abdomen and pelvis, with and without contrast74178
|
6 |
$318 |
$853 |
$2,628 |
|
Ultrasound, kidneys and back of the abdomen, limited76775
|
6 |
$93 |
$213 |
$552 |
|
Pregnancy ultrasound, limited76815
|
6 |
$95 |
$215 |
$277 |
|
Ultrasound guidance for placing an IV line76937
|
6 |
$29 |
$181 |
$575 |
|
Whole-body bone survey X-ray77075
|
6 |
$95 |
$239 |
$887 |
|
MRI, brain, without contrast70551
|
5 |
$217 |
$446 |
$955 |
|
MRI, brain, with and without contrast70553
|
5 |
$318 |
$689 |
$955 |
|
MRI, lower spine, without contrast72148
|
5 |
$217 |
$274 |
$955 |
|
MRI, knee, without contrast73721
|
5 |
$217 |
$274 |
$955 |
|
X-ray, chest, 2 views71046
|
5 |
$76 |
$85 |
$188 |
|
X-ray, facial bones70150
|
5 |
$93 |
$102 |
$262 |
|
X-ray, nasal bones70160
|
5 |
$78 |
$85 |
$216 |
|
X-ray, sinuses70220
|
5 |
$78 |
$85 |
$216 |
|
X-ray, skull, limited70250
|
5 |
$89 |
$96 |
$250 |
|
X-ray, soft tissues of the neck70360
|
5 |
$75 |
$78 |
$216 |
|
CT scan, head, with contrast70460
|
5 |
$154 |
$171 |
$567 |
|
CT scan, head, with and without contrast70470
|
5 |
$160 |
$316 |
$567 |
|
CT scan, eye socket and inner ear, without contrast70480
|
5 |
$96 |
$126 |
$567 |
|
CT scan, eye socket and inner ear, with contrast70481
|
5 |
$161 |
$316 |
$567 |
|
CT scan, face and jaw, without contrast70486
|
5 |
$92 |
$102 |
$567 |
|
CT scan, face and jaw, with contrast70487
|
5 |
$154 |
$171 |
$567 |
|
CT scan, soft tissues of the neck, without contrast70490
|
5 |
$92 |
$102 |
$567 |
|
CT scan, soft tissues of the neck, with contrast70491
|
5 |
$154 |
$171 |
$567 |
|
CT angiogram, head70496
|
5 |
$161 |
$488 |
$598 |
|
CT angiogram, neck70498
|
5 |
$161 |
$331 |
$638 |
|
MRI, eye socket, face and neck, with and without contrast70543
|
5 |
$321 |
$343 |
$955 |
|
MR angiogram, head, without contrast70544
|
5 |
$220 |
$446 |
$955 |
|
MR angiogram, neck, without contrast70547
|
5 |
$206 |
$232 |
$955 |
|
MR angiogram, neck, with and without contrast70549
|
5 |
$321 |
$343 |
$955 |
|
MRI, brain, with contrast70552
|
5 |
$318 |
$480 |
$955 |
|
X-ray, chest, 3 views71047
|
5 |
$76 |
$85 |
$201 |
|
X-ray, chest, 4 or more views71048
|
5 |
$89 |
$102 |
$226 |
|
X-ray, ribs one side, with chest71101
|
5 |
$93 |
$102 |
$262 |
|
X-ray, ribs both sides, with chest71111
|
5 |
$93 |
$102 |
$262 |
|
CT scan, chest, without contrast71250
|
5 |
$96 |
$186 |
$567 |
|
CT scan, chest, with contrast71260
|
5 |
$154 |
$171 |
$567 |
|
CT scan, chest, with and without contrast71270
|
5 |
$161 |
$316 |
$576 |
|
CT angiogram, chest71275
|
5 |
$161 |
$521 |
$567 |
|
X-ray, spine, single view72020
|
5 |
$71 |
$85 |
$216 |
|
X-ray, neck spine, 2-3 views72040
|
5 |
$78 |
$85 |
$216 |
|
X-ray, neck spine, 4-5 views72050
|
5 |
$93 |
$102 |
$262 |
|
X-ray, mid-back spine, 2 views72070
|
5 |
$81 |
$96 |
$262 |
|
X-ray, mid-back spine, 3 views72072
|
5 |
$93 |
$96 |
$262 |
|
X-ray, mid and lower back spine, 2 views72080
|
5 |
$78 |
$85 |
$216 |
|
X-ray, entire spine, 1 view72081
|
5 |
$76 |
$98 |
$235 |
|
X-ray, entire spine, 2-3 views72082
|
5 |
$96 |
$102 |
$262 |
|
X-ray, lower back spine, 2-3 views72100
|
5 |
$93 |
$102 |
$262 |
|
X-ray, lower back spine, 4 or more views72110
|
5 |
$93 |
$102 |
$262 |
|
CT scan, neck spine, without contrast72125
|
5 |
$92 |
$102 |
$567 |
|
CT scan, mid-back spine, without contrast72128
|
5 |
$92 |
$102 |
$567 |
|
CT scan, lower back spine, without contrast72131
|
5 |
$92 |
$102 |
$567 |
|
MRI, neck spine, without contrast72141
|
5 |
$217 |
$274 |
$955 |
|
MRI, mid-back spine, without contrast72146
|
5 |
$217 |
$274 |
$955 |
|
MRI, neck spine, with and without contrast72156
|
5 |
$318 |
$343 |
$955 |
|
MRI, mid-back spine, with and without contrast72157
|
5 |
$318 |
$343 |
$955 |
|
MRI, lower back spine, with and without contrast72158
|
5 |
$318 |
$480 |
$955 |
|
X-ray, pelvis72170
|
5 |
$64 |
$96 |
$247 |
|
X-ray, pelvis, 3 or more views72190
|
5 |
$93 |
$98 |
$248 |
|
CT scan, pelvis, without contrast72192
|
5 |
$96 |
$188 |
$567 |
|
CT scan, pelvis, with contrast72193
|
5 |
$161 |
$316 |
$567 |
|
MRI, pelvis, without contrast72195
|
5 |
$206 |
$232 |
$955 |
|
MRI, pelvis, with and without contrast72197
|
5 |
$321 |
$657 |
$955 |
|
X-ray, sacroiliac joints72202
|
5 |
$93 |
$102 |
$262 |
|
X-ray, tailbone72220
|
5 |
$78 |
$85 |
$216 |
|
X-ray, collarbone73000
|
5 |
$78 |
$85 |
$216 |
|
X-ray, hand, 2 views73120
|
5 |
$65 |
$93 |
$246 |
|
X-ray, finger73140
|
5 |
$78 |
$102 |
$216 |
|
CT scan, arm, without contrast73200
|
5 |
$96 |
$163 |
$567 |
|
CT scan, arm, with contrast73201
|
5 |
$315 |
$343 |
$916 |
|
MRI, arm, without contrast73218
|
5 |
$220 |
$262 |
$955 |
|
MRI, joint of the arm, without contrast73221
|
5 |
$217 |
$355 |
$955 |
|
MRI, joint of the arm, with contrast73222
|
5 |
$708 |
$1,068 |
$1,907 |
|
X-ray, both hips, 2 views73521
|
5 |
$95 |
$99 |
$259 |
|
X-ray, heel73650
|
5 |
$68 |
$85 |
$216 |
|
X-ray, toe73660
|
5 |
$75 |
$85 |
$212 |
|
CT scan, leg, without contrast73700
|
5 |
$96 |
$163 |
$567 |
|
CT scan, leg, with contrast73701
|
5 |
$154 |
$171 |
$567 |
|
CT angiogram, leg73706
|
5 |
$161 |
$236 |
$567 |
|
MRI, leg, without contrast73718
|
5 |
$206 |
$232 |
$955 |
|
X-ray, abdomen, 1 view74018
|
5 |
$69 |
$85 |
$216 |
|
X-ray, abdomen, 2 views74019
|
5 |
$84 |
$96 |
$262 |
|
CT scan, abdomen, without contrast74150
|
5 |
$96 |
$188 |
$567 |
|
CT scan, abdomen, with contrast74160
|
5 |
$154 |
$171 |
$567 |
|
CT scan, abdomen, with and without contrast74170
|
5 |
$161 |
$414 |
$581 |
|
CT angiogram, abdomen and pelvis74174
|
5 |
$318 |
$525 |
$916 |
|
MRI, abdomen, without contrast74181
|
5 |
$206 |
$232 |
$955 |
|
MRI, abdomen, with and without contrast74183
|
5 |
$321 |
$659 |
$955 |
|
Upper GI series (barium swallow)74240
|
5 |
$158 |
$268 |
$427 |
|
Upper GI series with air contrast74246
|
5 |
$158 |
$187 |
$438 |
|
Small bowel X-ray series74250
|
5 |
$154 |
$171 |
$438 |
|
Bile duct X-ray during surgery74300
|
5 |
$41 |
$318 |
$398 |
|
Heart CT calcium score75571
|
5 |
$80 |
$148 |
$240 |
|
Ultrasound, soft tissues of the head and neck76536
|
5 |
$96 |
$203 |
$689 |
|
Ultrasound, chest76604
|
5 |
$94 |
$171 |
$390 |
|
Ultrasound, breast, complete76641
|
5 |
$95 |
$203 |
$520 |
|
Ultrasound, abdomen, complete76700
|
5 |
$95 |
$180 |
$651 |
|
Ultrasound, abdomen, limited76705
|
5 |
$95 |
$171 |
$516 |
|
Ultrasound, kidneys and back of the abdomen, complete76770
|
5 |
$95 |
$230 |
$561 |
|
Pregnancy ultrasound, before 14 weeks76801
|
5 |
$95 |
$159 |
$483 |
|
Pregnancy ultrasound, transvaginal76817
|
5 |
$95 |
$226 |
$432 |
|
Transvaginal ultrasound76830
|
5 |
$96 |
$203 |
$547 |
|
Pelvic ultrasound, complete76856
|
5 |
$95 |
$250 |
$540 |
|
Ultrasound, scrotum76870
|
5 |
$94 |
$192 |
$672 |
|
Ultrasound, joint or limb, limited76882
|
5 |
$93 |
$203 |
$625 |
|
Diagnostic mammogram, one breast77065
|
5 |
$74 |
$121 |
$289 |
|
Diagnostic mammogram, both breasts77066
|
5 |
$94 |
$115 |
$382 |
|
Bone age X-ray77072
|
5 |
$55 |
$93 |
$181 |
|
Bone density scan (DEXA), spine and hip77080
|
5 |
$92 |
$102 |
$262 |
|
Nuclear stress test, heart blood flow78452
|
5 |
$1,157 |
$1,255 |
$2,961 |