|
MRI, brain, without contrast70551
|
7 |
$180 |
$372 |
$1,754 |
|
MRI, brain, with and without contrast70553
|
7 |
$298 |
$544 |
$1,771 |
|
MRI, lower spine, without contrast72148
|
7 |
$172 |
$372 |
$1,754 |
|
MRI, knee, without contrast73721
|
7 |
$197 |
$372 |
$1,754 |
|
X-ray, chest, 2 views71046
|
7 |
$32 |
$90 |
$332 |
|
CT scan, abdomen and pelvis, without contrast74176
|
7 |
$145 |
$260 |
$1,765 |
|
Mammogram, screening, both breasts77067
|
7 |
$95 |
$139 |
$252 |
|
X-ray, facial bones70150
|
7 |
$47 |
$163 |
$224 |
|
X-ray, nasal bones70160
|
7 |
$41 |
$136 |
$244 |
|
X-ray, sinuses70220
|
7 |
$38 |
$136 |
$368 |
|
X-ray, skull, limited70250
|
7 |
$38 |
$121 |
$295 |
|
Panoramic dental X-ray70355
|
7 |
$13 |
$88 |
$136 |
|
X-ray, soft tissues of the neck70360
|
7 |
$31 |
$109 |
$136 |
|
CT scan, head, without contrast70450
|
7 |
$94 |
$163 |
$1,390 |
|
CT scan, head, with contrast70460
|
7 |
$135 |
$273 |
$1,488 |
|
CT scan, head, with and without contrast70470
|
7 |
$161 |
$273 |
$1,574 |
|
CT scan, eye socket and inner ear, without contrast70480
|
7 |
$108 |
$163 |
$1,409 |
|
CT scan, eye socket and inner ear, with contrast70481
|
7 |
$180 |
$273 |
$1,519 |
|
CT scan, face and jaw, without contrast70486
|
7 |
$108 |
$163 |
$1,525 |
|
CT scan, face and jaw, with contrast70487
|
7 |
$140 |
$273 |
$1,426 |
|
CT scan, soft tissues of the neck, without contrast70490
|
7 |
$108 |
$163 |
$1,411 |
|
CT scan, soft tissues of the neck, with contrast70491
|
7 |
$169 |
$273 |
$1,445 |
|
CT angiogram, head70496
|
7 |
$181 |
$274 |
$1,679 |
|
CT angiogram, neck70498
|
7 |
$181 |
$274 |
$1,684 |
|
MRI, eye socket, face and neck, with and without contrast70543
|
7 |
$335 |
$544 |
$1,948 |
|
MR angiogram, head, without contrast70544
|
7 |
$225 |
$372 |
$1,754 |
|
MR angiogram, neck, without contrast70547
|
7 |
$225 |
$372 |
$1,754 |
|
MR angiogram, neck, with and without contrast70549
|
7 |
$363 |
$544 |
$1,851 |
|
MRI, brain, with contrast70552
|
7 |
$229 |
$448 |
$1,754 |
|
X-ray, chest, 1 view71045
|
7 |
$24 |
$90 |
$207 |
|
X-ray, chest, 3 views71047
|
7 |
$40 |
$108 |
$277 |
|
X-ray, ribs, one side71100
|
7 |
$36 |
$102 |
$280 |
|
X-ray, ribs one side, with chest71101
|
7 |
$41 |
$163 |
$347 |
|
X-ray, ribs both sides, with chest71111
|
7 |
$51 |
$163 |
$447 |
|
CT scan, chest, without contrast71250
|
7 |
$108 |
$163 |
$1,432 |
|
CT scan, chest, with contrast71260
|
7 |
$158 |
$273 |
$1,487 |
|
CT scan, chest, with and without contrast71270
|
7 |
$181 |
$273 |
$1,534 |
|
CT scan, chest, low-dose lung cancer screening71271
|
7 |
$107 |
$138 |
$556 |
|
CT angiogram, chest71275
|
7 |
$181 |
$277 |
$1,688 |
|
X-ray, spine, single view72020
|
7 |
$23 |
$109 |
$144 |
|
X-ray, neck spine, 2-3 views72040
|
7 |
$40 |
$136 |
$223 |
|
X-ray, neck spine, 4-5 views72050
|
7 |
$57 |
$163 |
$476 |
|
X-ray, mid-back spine, 2 views72070
|
7 |
$32 |
$107 |
$223 |
|
X-ray, mid-back spine, 3 views72072
|
7 |
$40 |
$163 |
$333 |
|
X-ray, mid and lower back spine, 2 views72080
|
7 |
$34 |
$136 |
$203 |
|
X-ray, entire spine, 1 view72081
|
7 |
$42 |
$111 |
$316 |
|
X-ray, entire spine, 2-3 views72082
|
7 |
$76 |
$183 |
$262 |
|
X-ray, lower back spine, 2-3 views72100
|
7 |
$40 |
$157 |
$280 |
|
X-ray, lower back spine, 4 or more views72110
|
7 |
$54 |
$163 |
$403 |
|
X-ray, lower back spine, bending views72120
|
7 |
$42 |
$142 |
$231 |
|
CT scan, neck spine, without contrast72125
|
7 |
$108 |
$163 |
$1,375 |
|
CT scan, mid-back spine, without contrast72128
|
7 |
$108 |
$163 |
$1,476 |
|
CT scan, lower back spine, without contrast72131
|
7 |
$108 |
$163 |
$1,376 |
|
CT scan, lower back spine, with contrast72132
|
7 |
$158 |
$448 |
$1,429 |
|
MRI, neck spine, without contrast72141
|
7 |
$171 |
$372 |
$1,754 |
|
MRI, mid-back spine, without contrast72146
|
7 |
$171 |
$372 |
$1,754 |
|
MRI, neck spine, with and without contrast72156
|
7 |
$299 |
$544 |
$1,787 |
|
MRI, mid-back spine, with and without contrast72157
|
7 |
$300 |
$544 |
$1,838 |
|
MRI, lower back spine, with and without contrast72158
|
7 |
$298 |
$544 |
$1,844 |
|
X-ray, pelvis72170
|
7 |
$27 |
$119 |
$226 |
|
X-ray, pelvis, 3 or more views72190
|
7 |
$42 |
$110 |
$207 |
|
CT scan, pelvis, without contrast72192
|
7 |
$108 |
$163 |
$1,441 |
|
CT scan, pelvis, with contrast72193
|
7 |
$181 |
$273 |
$1,521 |
|
MRI, pelvis, without contrast72195
|
7 |
$225 |
$372 |
$1,754 |
|
MRI, pelvis, with and without contrast72197
|
7 |
$328 |
$544 |
$1,844 |
|
X-ray, sacroiliac joints72202
|
7 |
$40 |
$121 |
$163 |
|
X-ray, tailbone72220
|
7 |
$34 |
$136 |
$256 |
|
X-ray, collarbone73000
|
7 |
$34 |
$124 |
$195 |
|
X-ray, shoulder, 1 view73020
|
7 |
$20 |
$89 |
$136 |
|
X-ray, shoulder, 2 or more views73030
|
7 |
$36 |
$113 |
$265 |
|
X-ray, upper arm bone73060
|
7 |
$34 |
$115 |
$226 |
|
X-ray, elbow, 2 views73070
|
7 |
$30 |
$127 |
$157 |
|
X-ray, elbow, 3 or more views73080
|
7 |
$34 |
$121 |
$257 |
|
X-ray, forearm73090
|
7 |
$30 |
$112 |
$240 |
|
X-ray, wrist, 2 views73100
|
7 |
$36 |
$110 |
$158 |
|
X-ray, wrist, 3 or more views73110
|
7 |
$46 |
$119 |
$301 |
|
X-ray, hand, 2 views73120
|
7 |
$32 |
$112 |
$182 |
|
X-ray, hand, 3 or more views73130
|
7 |
$40 |
$119 |
$272 |
|
X-ray, finger73140
|
7 |
$44 |
$112 |
$179 |
|
CT scan, arm, without contrast73200
|
7 |
$108 |
$163 |
$1,342 |
|
CT scan, arm, with contrast73201
|
7 |
$205 |
$430 |
$1,429 |
|
MRI, arm, without contrast73218
|
7 |
$246 |
$372 |
$1,754 |
|
MRI, joint of the arm, without contrast73221
|
7 |
$198 |
$372 |
$1,754 |
|
MRI, joint of the arm, with contrast73222
|
7 |
$330 |
$964 |
$2,084 |
|
X-ray, hip, one side, 1 view73501
|
7 |
$34 |
$90 |
$163 |
|
X-ray, hip, one side, 2-3 views73502
|
7 |
$51 |
$133 |
$277 |
|
X-ray, both hips, 2 views73521
|
7 |
$42 |
$112 |
$284 |
|
X-ray, both hips, 3-4 views73522
|
7 |
$55 |
$146 |
$357 |
|
X-ray, thigh bone, 2 or more views73552
|
7 |
$37 |
$144 |
$197 |
|
X-ray, knee, 1-2 views73560
|
7 |
$36 |
$112 |
$144 |
|
X-ray, knee, 3 views73562
|
7 |
$44 |
$122 |
$152 |
|
X-ray, knee, 4 or more views73564
|
7 |
$50 |
$163 |
$333 |
|
X-ray, lower leg73590
|
7 |
$33 |
$113 |
$250 |
|
X-ray, ankle, 2 views73600
|
7 |
$34 |
$109 |
$153 |
|
X-ray, ankle, 3 or more views73610
|
7 |
$39 |
$125 |
$209 |
|
X-ray, foot, 2 views73620
|
7 |
$29 |
$110 |
$149 |
|
X-ray, foot, 3 or more views73630
|
7 |
$36 |
$120 |
$273 |
|
X-ray, heel73650
|
7 |
$29 |
$100 |
$226 |
|
X-ray, toe73660
|
7 |
$31 |
$97 |
$168 |
|
CT scan, leg, without contrast73700
|
7 |
$108 |
$163 |
$1,344 |
|
CT scan, leg, with contrast73701
|
7 |
$158 |
$273 |
$1,426 |
|
CT angiogram, leg73706
|
7 |
$181 |
$330 |
$1,587 |
|
MRI, leg, without contrast73718
|
7 |
$224 |
$372 |
$1,754 |
|
X-ray, abdomen, 1 view74018
|
7 |
$30 |
$95 |
$297 |
|
X-ray, abdomen, 2 views74019
|
7 |
$36 |
$145 |
$312 |
|
X-ray, abdomen, 3 or more views74021
|
7 |
$42 |
$178 |
$322 |
|
CT scan, abdomen, without contrast74150
|
7 |
$108 |
$163 |
$1,447 |
|
CT scan, abdomen, with contrast74160
|
7 |
$181 |
$273 |
$1,524 |
|
CT scan, abdomen, with and without contrast74170
|
7 |
$181 |
$273 |
$1,606 |
|
CT angiogram, abdomen and pelvis74174
|
7 |
$363 |
$462 |
$1,537 |
|
CT scan, abdomen and pelvis, with contrast74177
|
7 |
$304 |
$439 |
$2,194 |
|
CT scan, abdomen and pelvis, with and without contrast74178
|
7 |
$343 |
$544 |
$2,265 |
|
MRI, abdomen, without contrast74181
|
7 |
$180 |
$372 |
$1,754 |
|
MRI, abdomen, with and without contrast74183
|
7 |
$330 |
$544 |
$1,824 |
|
Swallowing study, video X-ray74230
|
7 |
$133 |
$207 |
$405 |
|
Upper GI series (barium swallow)74240
|
7 |
$114 |
$273 |
$347 |
|
Upper GI series with air contrast74246
|
7 |
$130 |
$273 |
$435 |
|
Small bowel X-ray series74250
|
7 |
$113 |
$207 |
$328 |
|
Cardiac MRI, with contrast75561
|
7 |
$337 |
$363 |
$1,754 |
|
Heart CT calcium score75571
|
7 |
$87 |
$103 |
$221 |
|
CT scan, heart, with contrast75572
|
7 |
$207 |
$363 |
$1,104 |
|
CT angiogram, heart arteries75574
|
7 |
$298 |
$381 |
$1,011 |
|
Angiogram, artery of one arm or leg75710
|
7 |
$93 |
$3,113 |
$4,922 |
|
X-ray, infant, chest and abdomen76010
|
7 |
$29 |
$96 |
$167 |
|
Ultrasound, brain (through the skull)76506
|
7 |
$105 |
$187 |
$405 |
|
Ultrasound, soft tissues of the head and neck76536
|
7 |
$107 |
$190 |
$412 |
|
Ultrasound, chest76604
|
7 |
$43 |
$163 |
$314 |
|
Ultrasound, breast, complete76641
|
7 |
$93 |
$183 |
$418 |
|
Ultrasound, breast, limited76642
|
7 |
$72 |
$148 |
$325 |
|
Ultrasound, abdomen, complete76700
|
7 |
$107 |
$177 |
$497 |
|
Ultrasound, abdomen, limited76705
|
7 |
$82 |
$163 |
$556 |
|
Ultrasound, kidneys and back of the abdomen, complete76770
|
7 |
$101 |
$168 |
$547 |
|
Ultrasound, kidneys and back of the abdomen, limited76775
|
7 |
$46 |
$163 |
$514 |
|
Pregnancy ultrasound, before 14 weeks76801
|
7 |
$96 |
$163 |
$430 |
|
Pregnancy ultrasound, limited76815
|
7 |
$69 |
$163 |
$347 |
|
Pregnancy ultrasound, transvaginal76817
|
7 |
$78 |
$163 |
$275 |
|
Fetal wellbeing scan with non-stress test76818
|
7 |
$96 |
$163 |
$316 |
|
Transvaginal ultrasound76830
|
7 |
$108 |
$196 |
$443 |
|
Pelvic ultrasound, complete76856
|
7 |
$100 |
$164 |
$386 |
|
Pelvic ultrasound, limited76857
|
7 |
$37 |
$163 |
$293 |
|
Ultrasound, scrotum76870
|
7 |
$96 |
$163 |
$556 |
|
Ultrasound, joint or limb, limited76882
|
7 |
$44 |
$163 |
$278 |
|
Ultrasound, infant hips76885
|
7 |
$87 |
$137 |
$421 |
|
Ultrasound guidance for placing an IV line76937
|
7 |
$35 |
$57 |
$742 |
|
Diagnostic mammogram, one breast77065
|
7 |
$79 |
$121 |
$252 |
|
Diagnostic mammogram, both breasts77066
|
7 |
$102 |
$154 |
$267 |
|
Bone age X-ray77072
|
7 |
$23 |
$163 |
$223 |
|
Whole-body bone survey X-ray77075
|
7 |
$101 |
$165 |
$404 |
|
Joint survey X-ray, 2 or more joints77077
|
7 |
$42 |
$108 |
$207 |
|
Bone density scan (DEXA), spine and hip77080
|
7 |
$42 |
$151 |
$217 |
|
Bone density scan (DEXA), wrist, heel or finger77081
|
7 |
$31 |
$87 |
$136 |
|
Nuclear stress test, heart blood flow78452
|
7 |
$480 |
$1,341 |
$2,115 |
|
X-ray, chest, 4 or more views71048
|
6 |
$43 |
$112 |
$207 |
|
Bile duct X-ray during surgery74300
|
5 |
$19 |
$33 |
$1,089 |