|
X-ray, chest, 2 views71046
|
9 |
$40 |
$79 |
$158 |
|
CT scan, abdomen and pelvis, without contrast74176
|
9 |
$85 |
$533 |
$1,941 |
|
X-ray, skull, limited70250
|
9 |
$38 |
$92 |
$118 |
|
X-ray, soft tissues of the neck70360
|
9 |
$34 |
$68 |
$117 |
|
CT scan, head, without contrast70450
|
9 |
$85 |
$290 |
$1,941 |
|
CT scan, head, with contrast70460
|
9 |
$85 |
$300 |
$1,941 |
|
CT scan, head, with and without contrast70470
|
9 |
$85 |
$369 |
$1,941 |
|
CT scan, eye socket and inner ear, without contrast70480
|
9 |
$85 |
$289 |
$1,941 |
|
CT scan, face and jaw, without contrast70486
|
9 |
$85 |
$285 |
$1,797 |
|
CT scan, soft tissues of the neck, without contrast70490
|
9 |
$85 |
$284 |
$1,887 |
|
CT scan, soft tissues of the neck, with contrast70491
|
9 |
$85 |
$327 |
$1,941 |
|
X-ray, chest, 1 view71045
|
9 |
$28 |
$61 |
$85 |
|
X-ray, ribs, one side71100
|
9 |
$46 |
$79 |
$127 |
|
X-ray, ribs one side, with chest71101
|
9 |
$43 |
$95 |
$180 |
|
X-ray, ribs both sides, with chest71111
|
9 |
$73 |
$85 |
$252 |
|
CT scan, chest, without contrast71250
|
9 |
$85 |
$315 |
$1,941 |
|
CT scan, chest, with contrast71260
|
9 |
$85 |
$381 |
$1,941 |
|
CT angiogram, chest71275
|
9 |
$85 |
$482 |
$1,941 |
|
X-ray, spine, single view72020
|
9 |
$32 |
$79 |
$166 |
|
X-ray, neck spine, 2-3 views72040
|
9 |
$44 |
$85 |
$159 |
|
X-ray, neck spine, 4-5 views72050
|
9 |
$58 |
$95 |
$201 |
|
X-ray, entire spine, 1 view72081
|
9 |
$44 |
$85 |
$117 |
|
X-ray, lower back spine, 2-3 views72100
|
9 |
$40 |
$85 |
$198 |
|
X-ray, lower back spine, 4 or more views72110
|
9 |
$70 |
$95 |
$247 |
|
CT scan, neck spine, without contrast72125
|
9 |
$85 |
$342 |
$1,941 |
|
CT scan, mid-back spine, without contrast72128
|
9 |
$85 |
$308 |
$1,941 |
|
CT scan, lower back spine, without contrast72131
|
9 |
$85 |
$323 |
$1,882 |
|
X-ray, pelvis72170
|
9 |
$36 |
$85 |
$158 |
|
CT scan, pelvis, without contrast72192
|
9 |
$85 |
$257 |
$1,941 |
|
CT scan, pelvis, with contrast72193
|
9 |
$85 |
$325 |
$1,941 |
|
X-ray, tailbone72220
|
9 |
$43 |
$85 |
$164 |
|
X-ray, collarbone73000
|
9 |
$37 |
$79 |
$134 |
|
X-ray, shoulder, 1 view73020
|
9 |
$26 |
$61 |
$109 |
|
X-ray, shoulder, 2 or more views73030
|
9 |
$46 |
$79 |
$121 |
|
X-ray, upper arm bone73060
|
9 |
$34 |
$79 |
$158 |
|
X-ray, elbow, 2 views73070
|
9 |
$34 |
$61 |
$107 |
|
X-ray, elbow, 3 or more views73080
|
9 |
$46 |
$79 |
$128 |
|
X-ray, forearm73090
|
9 |
$34 |
$68 |
$120 |
|
X-ray, wrist, 3 or more views73110
|
9 |
$43 |
$79 |
$118 |
|
X-ray, hand, 3 or more views73130
|
9 |
$38 |
$71 |
$111 |
|
X-ray, finger73140
|
9 |
$35 |
$79 |
$158 |
|
CT scan, arm, without contrast73200
|
9 |
$85 |
$249 |
$1,636 |
|
CT scan, arm, with contrast73201
|
9 |
$85 |
$348 |
$1,719 |
|
X-ray, hip, one side, 1 view73501
|
9 |
$34 |
$79 |
$107 |
|
X-ray, both hips, 2 views73521
|
9 |
$85 |
$95 |
$127 |
|
X-ray, thigh bone, 2 or more views73552
|
9 |
$66 |
$81 |
$164 |
|
X-ray, knee, 1-2 views73560
|
9 |
$36 |
$68 |
$113 |
|
X-ray, knee, 3 views73562
|
9 |
$47 |
$80 |
$131 |
|
X-ray, knee, 4 or more views73564
|
9 |
$48 |
$91 |
$144 |
|
X-ray, lower leg73590
|
9 |
$34 |
$68 |
$119 |
|
X-ray, ankle, 3 or more views73610
|
9 |
$37 |
$68 |
$151 |
|
X-ray, foot, 3 or more views73630
|
9 |
$34 |
$79 |
$126 |
|
X-ray, heel73650
|
9 |
$34 |
$79 |
$148 |
|
X-ray, toe73660
|
9 |
$34 |
$79 |
$116 |
|
CT scan, leg, without contrast73700
|
9 |
$85 |
$249 |
$1,708 |
|
X-ray, abdomen, 1 view74018
|
9 |
$32 |
$70 |
$120 |
|
X-ray, abdomen, 2 views74019
|
9 |
$38 |
$85 |
$160 |
|
CT scan, abdomen, without contrast74150
|
9 |
$85 |
$278 |
$1,941 |
|
CT scan, abdomen, with contrast74160
|
9 |
$85 |
$391 |
$1,941 |
|
CT scan, abdomen, with and without contrast74170
|
9 |
$85 |
$441 |
$1,941 |
|
CT scan, abdomen and pelvis, with contrast74177
|
9 |
$85 |
$633 |
$1,941 |
|
CT scan, abdomen and pelvis, with and without contrast74178
|
9 |
$85 |
$788 |
$1,941 |
|
Ultrasound, soft tissues of the head and neck76536
|
9 |
$85 |
$123 |
$386 |
|
Ultrasound, abdomen, complete76700
|
9 |
$85 |
$120 |
$375 |
|
Ultrasound, abdomen, limited76705
|
9 |
$85 |
$104 |
$382 |
|
Ultrasound, kidneys and back of the abdomen, limited76775
|
9 |
$85 |
$114 |
$352 |
|
Pelvic ultrasound, complete76856
|
9 |
$85 |
$123 |
$362 |
|
Pelvic ultrasound, limited76857
|
9 |
$77 |
$104 |
$352 |
|
Ultrasound, scrotum76870
|
9 |
$85 |
$105 |
$380 |
|
Ultrasound, joint or limb, limited76882
|
9 |
$75 |
$95 |
$368 |
|
Bone age X-ray77072
|
9 |
$16 |
$73 |
$106 |
|
Mammogram, screening, both breasts77067
|
8 |
$85 |
$115 |
$275 |
|
X-ray, facial bones70150
|
8 |
$54 |
$95 |
$236 |
|
X-ray, nasal bones70160
|
8 |
$38 |
$85 |
$158 |
|
X-ray, sinuses70220
|
8 |
$54 |
$79 |
$187 |
|
CT scan, eye socket and inner ear, with contrast70481
|
8 |
$85 |
$333 |
$1,941 |
|
CT scan, face and jaw, with contrast70487
|
8 |
$85 |
$298 |
$1,941 |
|
CT angiogram, head70496
|
8 |
$165 |
$815 |
$1,941 |
|
CT angiogram, neck70498
|
8 |
$165 |
$779 |
$1,941 |
|
CT scan, chest, with and without contrast71270
|
8 |
$85 |
$436 |
$1,941 |
|
X-ray, mid-back spine, 2 views72070
|
8 |
$52 |
$85 |
$148 |
|
X-ray, mid-back spine, 3 views72072
|
8 |
$49 |
$95 |
$154 |
|
X-ray, mid and lower back spine, 2 views72080
|
8 |
$54 |
$85 |
$148 |
|
CT scan, lower back spine, with contrast72132
|
8 |
$85 |
$377 |
$1,941 |
|
X-ray, pelvis, 3 or more views72190
|
8 |
$53 |
$85 |
$116 |
|
X-ray, sacroiliac joints72202
|
8 |
$49 |
$95 |
$177 |
|
X-ray, wrist, 2 views73100
|
8 |
$35 |
$79 |
$102 |
|
X-ray, hand, 2 views73120
|
8 |
$34 |
$95 |
$114 |
|
X-ray, hip, one side, 2-3 views73502
|
8 |
$48 |
$85 |
$133 |
|
X-ray, ankle, 2 views73600
|
8 |
$34 |
$79 |
$129 |
|
X-ray, foot, 2 views73620
|
8 |
$34 |
$79 |
$143 |
|
CT scan, leg, with contrast73701
|
8 |
$85 |
$312 |
$1,794 |
|
CT angiogram, abdomen and pelvis74174
|
8 |
$328 |
$689 |
$1,941 |
|
Ultrasound, chest76604
|
8 |
$85 |
$104 |
$352 |
|
Ultrasound, breast, complete76641
|
8 |
$85 |
$104 |
$420 |
|
Ultrasound, breast, limited76642
|
8 |
$80 |
$167 |
$352 |
|
Ultrasound, kidneys and back of the abdomen, complete76770
|
8 |
$105 |
$148 |
$416 |
|
Pregnancy ultrasound, before 14 weeks76801
|
8 |
$85 |
$123 |
$356 |
|
Pregnancy ultrasound, limited76815
|
8 |
$85 |
$109 |
$344 |
|
Pregnancy ultrasound, transvaginal76817
|
8 |
$85 |
$113 |
$352 |
|
Transvaginal ultrasound76830
|
8 |
$85 |
$128 |
$388 |
|
Diagnostic mammogram, one breast77065
|
8 |
$82 |
$128 |
$275 |
|
Diagnostic mammogram, both breasts77066
|
8 |
$85 |
$161 |
$275 |
|
Whole-body bone survey X-ray77075
|
8 |
$85 |
$108 |
$663 |
|
MRI, brain, without contrast70551
|
7 |
$224 |
$495 |
$2,260 |
|
MRI, brain, with and without contrast70553
|
7 |
$328 |
$797 |
$2,260 |
|
MRI, lower spine, without contrast72148
|
7 |
$224 |
$454 |
$2,260 |
|
MRI, knee, without contrast73721
|
7 |
$224 |
$387 |
$2,260 |
|
MRI, eye socket, face and neck, with and without contrast70543
|
7 |
$328 |
$668 |
$2,260 |
|
MR angiogram, head, without contrast70544
|
7 |
$224 |
$460 |
$2,260 |
|
MR angiogram, neck, without contrast70547
|
7 |
$224 |
$460 |
$2,260 |
|
MR angiogram, neck, with and without contrast70549
|
7 |
$268 |
$348 |
$2,260 |
|
MRI, brain, with contrast70552
|
7 |
$328 |
$543 |
$2,260 |
|
X-ray, chest, 4 or more views71048
|
7 |
$54 |
$85 |
$112 |
|
CT scan, chest, low-dose lung cancer screening71271
|
7 |
$85 |
$124 |
$556 |
|
X-ray, entire spine, 2-3 views72082
|
7 |
$71 |
$104 |
$262 |
|
X-ray, lower back spine, bending views72120
|
7 |
$66 |
$85 |
$192 |
|
MRI, neck spine, without contrast72141
|
7 |
$224 |
$438 |
$2,260 |
|
MRI, mid-back spine, without contrast72146
|
7 |
$224 |
$478 |
$2,260 |
|
MRI, neck spine, with and without contrast72156
|
7 |
$328 |
$631 |
$2,260 |
|
MRI, mid-back spine, with and without contrast72157
|
7 |
$328 |
$658 |
$2,260 |
|
MRI, lower back spine, with and without contrast72158
|
7 |
$328 |
$631 |
$2,260 |
|
MRI, pelvis, without contrast72195
|
7 |
$224 |
$548 |
$2,260 |
|
MRI, pelvis, with and without contrast72197
|
7 |
$328 |
$623 |
$2,260 |
|
MRI, arm, without contrast73218
|
7 |
$224 |
$382 |
$2,260 |
|
MRI, joint of the arm, without contrast73221
|
7 |
$224 |
$372 |
$2,260 |
|
CT angiogram, leg73706
|
7 |
$165 |
$441 |
$1,877 |
|
MRI, leg, without contrast73718
|
7 |
$224 |
$396 |
$2,260 |
|
MRI, abdomen, without contrast74181
|
7 |
$224 |
$500 |
$2,260 |
|
MRI, abdomen, with and without contrast74183
|
7 |
$328 |
$623 |
$2,260 |
|
Swallowing study, video X-ray74230
|
7 |
$85 |
$112 |
$405 |
|
Small bowel X-ray series74250
|
7 |
$85 |
$128 |
$316 |
|
Ultrasound guidance for placing an IV line76937
|
7 |
$35 |
$43 |
$619 |
|
Bone density scan (DEXA), spine and hip77080
|
7 |
$83 |
$104 |
$214 |
|
Bone density scan (DEXA), wrist, heel or finger77081
|
7 |
$28 |
$79 |
$88 |
|
Panoramic dental X-ray70355
|
6 |
$18 |
$79 |
$119 |
|
X-ray, chest, 3 views71047
|
6 |
$51 |
$79 |
$108 |
|
MRI, joint of the arm, with contrast73222
|
6 |
$592 |
$770 |
$2,260 |
|
X-ray, both hips, 3-4 views73522
|
6 |
$95 |
$105 |
$146 |
|
X-ray, abdomen, 3 or more views74021
|
6 |
$53 |
$95 |
$140 |
|
Upper GI series (barium swallow)74240
|
6 |
$118 |
$162 |
$314 |
|
Upper GI series with air contrast74246
|
6 |
$134 |
$162 |
$373 |
|
Bile duct X-ray during surgery74300
|
6 |
$38 |
$76 |
$151 |
|
Cardiac MRI, with contrast75561
|
6 |
$263 |
$328 |
$2,260 |
|
Heart CT calcium score75571
|
6 |
$75 |
$90 |
$216 |
|
CT scan, heart, with contrast75572
|
6 |
$161 |
$328 |
$1,941 |
|
CT angiogram, heart arteries75574
|
6 |
$232 |
$348 |
$1,941 |
|
Angiogram, artery of one arm or leg75710
|
6 |
$135 |
$1,400 |
$2,857 |
|
X-ray, infant, chest and abdomen76010
|
6 |
$40 |
$79 |
$83 |
|
Ultrasound, brain (through the skull)76506
|
6 |
$82 |
$121 |
$484 |
|
Fetal wellbeing scan with non-stress test76818
|
6 |
$102 |
$108 |
$376 |
|
Ultrasound, infant hips76885
|
6 |
$86 |
$131 |
$423 |
|
Joint survey X-ray, 2 or more joints77077
|
6 |
$34 |
$95 |
$112 |
|
Nuclear stress test, heart blood flow78452
|
6 |
$349 |
$1,171 |
$1,570 |