|
MRI, brain, without contrast70551
|
4 |
$213 |
$420 |
$472 |
|
MRI, brain, with and without contrast70553
|
4 |
$328 |
$639 |
$661 |
|
MRI, lower spine, without contrast72148
|
4 |
$210 |
$444 |
$524 |
|
MRI, knee, without contrast73721
|
4 |
$219 |
$447 |
$498 |
|
X-ray, chest, 2 views71046
|
4 |
$24 |
$84 |
$163 |
|
CT scan, abdomen and pelvis, without contrast74176
|
4 |
$181 |
$308 |
$459 |
|
Mammogram, screening, both breasts77067
|
4 |
$96 |
$178 |
$200 |
|
X-ray, facial bones70150
|
4 |
$38 |
$101 |
$197 |
|
X-ray, nasal bones70160
|
4 |
$31 |
$84 |
$163 |
|
X-ray, sinuses70220
|
4 |
$37 |
$84 |
$163 |
|
X-ray, skull, limited70250
|
4 |
$32 |
$101 |
$189 |
|
X-ray, soft tissues of the neck70360
|
4 |
$26 |
$84 |
$156 |
|
CT scan, head, without contrast70450
|
4 |
$98 |
$226 |
$367 |
|
CT scan, head, with contrast70460
|
4 |
$151 |
$301 |
$426 |
|
CT scan, head, with and without contrast70470
|
4 |
$163 |
$302 |
$472 |
|
CT scan, eye socket and inner ear, without contrast70480
|
4 |
$149 |
$291 |
$406 |
|
CT scan, eye socket and inner ear, with contrast70481
|
4 |
$182 |
$360 |
$459 |
|
CT scan, face and jaw, without contrast70486
|
4 |
$108 |
$270 |
$367 |
|
CT scan, face and jaw, with contrast70487
|
4 |
$158 |
$329 |
$426 |
|
CT scan, soft tissues of the neck, without contrast70490
|
4 |
$130 |
$261 |
$372 |
|
CT scan, soft tissues of the neck, with contrast70491
|
4 |
$171 |
$321 |
$459 |
|
CT angiogram, head70496
|
4 |
$230 |
$410 |
$544 |
|
CT angiogram, neck70498
|
4 |
$229 |
$410 |
$544 |
|
MRI, eye socket, face and neck, with and without contrast70543
|
4 |
$350 |
$661 |
$768 |
|
MR angiogram, head, without contrast70544
|
4 |
$245 |
$426 |
$543 |
|
MR angiogram, neck, without contrast70547
|
4 |
$246 |
$426 |
$524 |
|
MR angiogram, neck, with and without contrast70549
|
4 |
$389 |
$661 |
$859 |
|
MRI, brain, with contrast70552
|
4 |
$302 |
$579 |
$660 |
|
X-ray, chest, 1 view71045
|
4 |
$26 |
$84 |
$158 |
|
X-ray, chest, 3 views71047
|
4 |
$41 |
$83 |
$156 |
|
X-ray, chest, 4 or more views71048
|
4 |
$31 |
$100 |
$189 |
|
X-ray, ribs, one side71100
|
4 |
$26 |
$84 |
$226 |
|
X-ray, ribs one side, with chest71101
|
4 |
$30 |
$101 |
$315 |
|
X-ray, ribs both sides, with chest71111
|
4 |
$38 |
$101 |
$197 |
|
CT scan, chest, without contrast71250
|
4 |
$122 |
$261 |
$459 |
|
CT scan, chest, with contrast71260
|
4 |
$170 |
$321 |
$498 |
|
CT scan, chest, with and without contrast71270
|
4 |
$187 |
$391 |
$619 |
|
CT scan, chest, low-dose lung cancer screening71271
|
4 |
$102 |
$184 |
$197 |
|
CT angiogram, chest71275
|
4 |
$232 |
$410 |
$809 |
|
X-ray, spine, single view72020
|
4 |
$18 |
$83 |
$156 |
|
X-ray, neck spine, 2-3 views72040
|
4 |
$29 |
$83 |
$163 |
|
X-ray, neck spine, 4-5 views72050
|
4 |
$40 |
$101 |
$197 |
|
X-ray, mid-back spine, 3 views72072
|
4 |
$29 |
$100 |
$197 |
|
X-ray, mid and lower back spine, 2 views72080
|
4 |
$26 |
$84 |
$157 |
|
X-ray, entire spine, 2-3 views72082
|
4 |
$56 |
$102 |
$197 |
|
X-ray, lower back spine, 2-3 views72100
|
4 |
$29 |
$101 |
$190 |
|
X-ray, lower back spine, 4 or more views72110
|
4 |
$38 |
$101 |
$197 |
|
X-ray, lower back spine, bending views72120
|
4 |
$34 |
$101 |
$189 |
|
CT scan, neck spine, without contrast72125
|
4 |
$121 |
$263 |
$459 |
|
CT scan, mid-back spine, without contrast72128
|
4 |
$121 |
$262 |
$459 |
|
CT scan, lower back spine, without contrast72131
|
4 |
$121 |
$262 |
$459 |
|
CT scan, lower back spine, with contrast72132
|
4 |
$196 |
$392 |
$661 |
|
MRI, neck spine, without contrast72141
|
4 |
$210 |
$424 |
$472 |
|
MRI, mid-back spine, without contrast72146
|
4 |
$210 |
$444 |
$524 |
|
MRI, neck spine, with and without contrast72156
|
4 |
$328 |
$640 |
$661 |
|
MRI, mid-back spine, with and without contrast72157
|
4 |
$328 |
$640 |
$661 |
|
MRI, lower back spine, with and without contrast72158
|
4 |
$328 |
$638 |
$661 |
|
X-ray, pelvis72170
|
4 |
$22 |
$100 |
$189 |
|
X-ray, pelvis, 3 or more views72190
|
4 |
$30 |
$101 |
$197 |
|
CT scan, pelvis, without contrast72192
|
4 |
$102 |
$250 |
$459 |
|
CT scan, pelvis, with contrast72193
|
4 |
$201 |
$338 |
$738 |
|
MRI, pelvis, without contrast72195
|
4 |
$245 |
$426 |
$524 |
|
MRI, pelvis, with and without contrast72197
|
4 |
$351 |
$661 |
$781 |
|
X-ray, sacroiliac joints72202
|
4 |
$38 |
$101 |
$189 |
|
X-ray, tailbone72220
|
4 |
$24 |
$84 |
$163 |
|
X-ray, collarbone73000
|
4 |
$25 |
$84 |
$180 |
|
X-ray, shoulder, 1 view73020
|
4 |
$16 |
$84 |
$167 |
|
X-ray, shoulder, 2 or more views73030
|
4 |
$25 |
$84 |
$196 |
|
X-ray, upper arm bone73060
|
4 |
$25 |
$84 |
$180 |
|
X-ray, elbow, 2 views73070
|
4 |
$22 |
$83 |
$164 |
|
X-ray, elbow, 3 or more views73080
|
4 |
$24 |
$84 |
$211 |
|
X-ray, forearm73090
|
4 |
$22 |
$84 |
$191 |
|
X-ray, wrist, 2 views73100
|
4 |
$26 |
$83 |
$163 |
|
X-ray, wrist, 3 or more views73110
|
4 |
$32 |
$84 |
$196 |
|
X-ray, hand, 2 views73120
|
4 |
$24 |
$100 |
$189 |
|
X-ray, hand, 3 or more views73130
|
4 |
$28 |
$84 |
$196 |
|
X-ray, finger73140
|
4 |
$30 |
$84 |
$163 |
|
CT scan, arm, without contrast73200
|
4 |
$140 |
$261 |
$887 |
|
CT scan, arm, with contrast73201
|
4 |
$206 |
$389 |
$993 |
|
MRI, arm, without contrast73218
|
4 |
$311 |
$447 |
$543 |
|
MRI, joint of the arm, without contrast73221
|
4 |
$219 |
$447 |
$498 |
|
MRI, joint of the arm, with contrast73222
|
4 |
$364 |
$778 |
$1,462 |
|
X-ray, hip, one side, 1 view73501
|
4 |
$26 |
$83 |
$203 |
|
X-ray, hip, one side, 2-3 views73502
|
4 |
$37 |
$83 |
$226 |
|
X-ray, both hips, 2 views73521
|
4 |
$35 |
$100 |
$197 |
|
X-ray, both hips, 3-4 views73522
|
4 |
$44 |
$101 |
$197 |
|
X-ray, thigh bone, 2 or more views73552
|
4 |
$28 |
$83 |
$451 |
|
X-ray, knee, 1-2 views73560
|
4 |
$27 |
$84 |
$163 |
|
X-ray, knee, 3 views73562
|
4 |
$32 |
$84 |
$211 |
|
X-ray, knee, 4 or more views73564
|
4 |
$35 |
$100 |
$208 |
|
X-ray, lower leg73590
|
4 |
$24 |
$84 |
$180 |
|
X-ray, ankle, 2 views73600
|
4 |
$25 |
$84 |
$163 |
|
X-ray, ankle, 3 or more views73610
|
4 |
$28 |
$84 |
$196 |
|
X-ray, foot, 2 views73620
|
4 |
$22 |
$84 |
$163 |
|
X-ray, foot, 3 or more views73630
|
4 |
$26 |
$84 |
$196 |
|
X-ray, heel73650
|
4 |
$22 |
$84 |
$163 |
|
X-ray, toe73660
|
4 |
$23 |
$84 |
$163 |
|
CT scan, leg, without contrast73700
|
4 |
$121 |
$261 |
$862 |
|
CT scan, leg, with contrast73701
|
4 |
$171 |
$322 |
$997 |
|
CT angiogram, leg73706
|
4 |
$274 |
$410 |
$1,885 |
|
MRI, leg, without contrast73718
|
4 |
$243 |
$447 |
$543 |
|
X-ray, abdomen, 1 view74018
|
4 |
$25 |
$84 |
$163 |
|
X-ray, abdomen, 2 views74019
|
4 |
$29 |
$101 |
$197 |
|
CT scan, abdomen, without contrast74150
|
4 |
$102 |
$245 |
$459 |
|
CT scan, abdomen, with contrast74160
|
4 |
$200 |
$329 |
$342 |
|
CT scan, abdomen, with and without contrast74170
|
4 |
$227 |
$393 |
$827 |
|
CT angiogram, abdomen and pelvis74174
|
4 |
$336 |
$680 |
$1,157 |
|
CT scan, abdomen and pelvis, with contrast74177
|
4 |
$278 |
$481 |
$923 |
|
CT scan, abdomen and pelvis, with and without contrast74178
|
4 |
$325 |
$553 |
$1,041 |
|
MRI, abdomen, without contrast74181
|
4 |
$226 |
$424 |
$524 |
|
MRI, abdomen, with and without contrast74183
|
4 |
$352 |
$661 |
$784 |
|
Swallowing study, video X-ray74230
|
4 |
$112 |
$177 |
$315 |
|
Upper GI series (barium swallow)74240
|
4 |
$87 |
$173 |
$329 |
|
Upper GI series with air contrast74246
|
4 |
$103 |
$190 |
$329 |
|
Small bowel X-ray series74250
|
4 |
$89 |
$174 |
$315 |
|
Bile duct X-ray during surgery74300
|
4 |
$19 |
$230 |
$692 |
|
Cardiac MRI, with contrast75561
|
4 |
$344 |
$594 |
$660 |
|
Heart CT calcium score75571
|
4 |
$83 |
$86 |
$433 |
|
CT scan, heart, with contrast75572
|
4 |
$219 |
$400 |
$487 |
|
CT angiogram, heart arteries75574
|
4 |
$328 |
$501 |
$788 |
|
Angiogram, artery of one arm or leg75710
|
4 |
$151 |
$2,975 |
$4,208 |
|
Ultrasound, soft tissues of the head and neck76536
|
4 |
$100 |
$168 |
$197 |
|
Ultrasound, chest76604
|
4 |
$80 |
$108 |
$197 |
|
Ultrasound, breast, complete76641
|
4 |
$87 |
$142 |
$376 |
|
Ultrasound, breast, limited76642
|
4 |
$72 |
$108 |
$163 |
|
Ultrasound, abdomen, complete76700
|
4 |
$100 |
$168 |
$518 |
|
Ultrasound, abdomen, limited76705
|
4 |
$92 |
$127 |
$429 |
|
Ultrasound, kidneys and back of the abdomen, complete76770
|
4 |
$94 |
$156 |
$197 |
|
Ultrasound, kidneys and back of the abdomen, limited76775
|
4 |
$51 |
$101 |
$197 |
|
Pregnancy ultrasound, before 14 weeks76801
|
4 |
$100 |
$134 |
$197 |
|
Pregnancy ultrasound, limited76815
|
4 |
$85 |
$107 |
$189 |
|
Pregnancy ultrasound, transvaginal76817
|
4 |
$97 |
$122 |
$197 |
|
Transvaginal ultrasound76830
|
4 |
$100 |
$174 |
$411 |
|
Pelvic ultrasound, complete76856
|
4 |
$100 |
$152 |
$411 |
|
Pelvic ultrasound, limited76857
|
4 |
$49 |
$100 |
$189 |
|
Ultrasound, scrotum76870
|
4 |
$98 |
$126 |
$301 |
|
Ultrasound, joint or limb, limited76882
|
4 |
$53 |
$101 |
$197 |
|
Ultrasound guidance for placing an IV line76937
|
4 |
$28 |
$267 |
$955 |
|
Diagnostic mammogram, one breast77065
|
4 |
$91 |
$179 |
$190 |
|
Diagnostic mammogram, both breasts77066
|
4 |
$116 |
$217 |
$243 |
|
Bone age X-ray77072
|
4 |
$18 |
$100 |
$189 |
|
Whole-body bone survey X-ray77075
|
4 |
$73 |
$133 |
$189 |
|
Bone density scan (DEXA), spine and hip77080
|
4 |
$39 |
$101 |
$189 |
|
Bone density scan (DEXA), wrist, heel or finger77081
|
4 |
$26 |
$83 |
$156 |
|
Nuclear stress test, heart blood flow78452
|
4 |
$433 |
$1,234 |
$2,415 |
|
Panoramic dental X-ray70355
|
3 |
$18 |
$81 |
$156 |
|
X-ray, mid-back spine, 2 views72070
|
3 |
$24 |
$97 |
$189 |
|
X-ray, entire spine, 1 view72081
|
3 |
$33 |
$81 |
$156 |
|
X-ray, abdomen, 3 or more views74021
|
3 |
$42 |
$97 |
$189 |
|
X-ray, infant, chest and abdomen76010
|
3 |
$24 |
$81 |
$156 |
|
Ultrasound, brain (through the skull)76506
|
3 |
$94 |
$100 |
$189 |
|
Fetal wellbeing scan with non-stress test76818
|
3 |
$100 |
$120 |
$189 |
|
Ultrasound, infant hips76885
|
3 |
$83 |
$116 |
$156 |
|
Joint survey X-ray, 2 or more joints77077
|
3 |
$34 |
$97 |
$189 |