| CT scan of abdomen and pelvis, with contrast dye
CPT 74177
CT ABD PELVIS W/CONTRAST 74177 |
$2,354.00 |
$5,885.00 |
60% |
| CT scan of abdomen and pelvis, with contrast dye
CPT 74177
CT ABD PELVIS W/CONTRAST 74177 |
$2,354.00 |
$5,885.00 |
60% |
| CT scan of abdomen and pelvis, with contrast dye inpatient
CPT 74177
CT ABD PELVIS W/CONTRAST 74177 |
$2,354.00 |
$5,885.00 |
60% |
| CT scan of abdomen and pelvis, with contrast dye inpatient
CPT 74177
CT ABD PELVIS W/CONTRAST 74177 |
$2,354.00 |
$5,885.00 |
60% |
| CT scan of the head or brain, no contrast dye
CPT 70450
CT HEAD W/O CONTRAST |
$1,018.00 |
$2,545.00 |
60% |
| CT scan of the head or brain, no contrast dye
CPT 70450
CT HEAD W/O CONTRAST |
$1,018.00 |
$2,545.00 |
60% |
| CT scan of the head or brain, no contrast dye inpatient
CPT 70450
CT HEAD W/O CONTRAST |
$1,018.00 |
$2,545.00 |
60% |
| CT scan of the head or brain, no contrast dye inpatient
CPT 70450
CT HEAD W/O CONTRAST |
$1,018.00 |
$2,545.00 |
60% |
| CT scan of the pelvis, with contrast dye
CPT 72193
CT PELVIS W/ CONTRAST |
$1,230.80 |
$3,077.00 |
60% |
| CT scan of the pelvis, with contrast dye
CPT 72193
CT PELVIS W/ CONTRAST |
$1,230.80 |
$3,077.00 |
60% |
| CT scan of the pelvis, with contrast dye inpatient
CPT 72193
CT PELVIS W/ CONTRAST |
$1,230.80 |
$3,077.00 |
60% |
| CT scan of the pelvis, with contrast dye inpatient
CPT 72193
CT PELVIS W/ CONTRAST |
$1,230.80 |
$3,077.00 |
60% |
| Diagnostic mammogram, both breasts both sides
CPT 77066
DX MAMMO INCL CAD BI 77066 |
$228.80 |
$572.00 |
60% |
| Diagnostic mammogram, both breasts inpatient both sides
CPT 77066
DX MAMMO INCL CAD BI 77066 |
$228.80 |
$572.00 |
60% |
| Diagnostic mammogram, one breast
CPT 77065
DX MAMMO INCL CAD UNI 77065 |
$181.60 |
$454.00 |
60% |
| Diagnostic mammogram, one breast inpatient
CPT 77065
DX MAMMO INCL CAD UNI 77065 |
$181.60 |
$454.00 |
60% |
| MRI of knee or other lower-limb joint, no contrast dye one side
CPT 73721
HIP RT W/O 73721RT |
$1,610.80 |
$4,027.00 |
60% |
| MRI of knee or other lower-limb joint, no contrast dye one side
CPT 73721
KNEE RT W/O 73721RT |
$1,610.80 |
$4,027.00 |
60% |
| MRI of knee or other lower-limb joint, no contrast dye one side
CPT 73721
KNEE LT W/O 73721LT |
$1,610.80 |
$4,027.00 |
60% |
| MRI of knee or other lower-limb joint, no contrast dye one side
CPT 73721
KNEE RT W/O 73721RT |
$1,610.80 |
$4,027.00 |
60% |
| MRI of knee or other lower-limb joint, no contrast dye one side
CPT 73721
KNEE LT W/O 73721LT |
$1,610.80 |
$4,027.00 |
60% |
| MRI of knee or other lower-limb joint, no contrast dye one side
CPT 73721
ANKLE RT W/O 73721RT |
$1,610.80 |
$4,027.00 |
60% |
| MRI of knee or other lower-limb joint, no contrast dye one side
CPT 73721
ANKLE RT W/O 73721RT |
$1,610.80 |
$4,027.00 |
60% |
| MRI of knee or other lower-limb joint, no contrast dye one side
CPT 73721
ANKLE LT W/O 73721LT |
$1,610.80 |
$4,027.00 |
60% |
| MRI of knee or other lower-limb joint, no contrast dye one side
CPT 73721
ANKLE LT W/O 73721LT |
$1,610.80 |
$4,027.00 |
60% |
| MRI of knee or other lower-limb joint, no contrast dye one side
CPT 73721
HIP LT W/O 73721LT |
$1,610.80 |
$4,027.00 |
60% |
| MRI of knee or other lower-limb joint, no contrast dye one side
CPT 73721
HIP LT W/O 73721LT |
$1,610.80 |
$4,027.00 |
60% |
| MRI of knee or other lower-limb joint, no contrast dye one side
CPT 73721
HIP RT W/O 73721RT |
$1,610.80 |
$4,027.00 |
60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side
CPT 73721
ANKLE RT W/O 73721RT |
$1,610.80 |
$4,027.00 |
60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side
CPT 73721
KNEE RT W/O 73721RT |
$1,610.80 |
$4,027.00 |
60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side
CPT 73721
KNEE LT W/O 73721LT |
$1,610.80 |
$4,027.00 |
60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side
CPT 73721
ANKLE LT W/O 73721LT |
$1,610.80 |
$4,027.00 |
60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side
CPT 73721
HIP RT W/O 73721RT |
$1,610.80 |
$4,027.00 |
60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side
CPT 73721
KNEE RT W/O 73721RT |
$1,610.80 |
$4,027.00 |
60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side
CPT 73721
KNEE LT W/O 73721LT |
$1,610.80 |
$4,027.00 |
60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side
CPT 73721
ANKLE RT W/O 73721RT |
$1,610.80 |
$4,027.00 |
60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side
CPT 73721
ANKLE LT W/O 73721LT |
$1,610.80 |
$4,027.00 |
60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side
CPT 73721
HIP LT W/O 73721LT |
$1,610.80 |
$4,027.00 |
60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side
CPT 73721
HIP RT W/O 73721RT |
$1,610.80 |
$4,027.00 |
60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side
CPT 73723
HIP RT W & W/O 73723RT |
$2,250.00 |
$5,625.00 |
60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side
CPT 73723
HIP RT W & W/O 73723RT |
$2,250.00 |
$5,625.00 |
60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side
CPT 73723
ANKLE RT W & W/O 73723RT |
$2,403.20 |
$6,008.00 |
60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side
CPT 73723
KNEE RT W & W/O 73723RT |
$2,403.20 |
$6,008.00 |
60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side
CPT 73723
ANKLE RT W & W/O 73723RT |
$2,403.20 |
$6,008.00 |
60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side
CPT 73723
KNEE RT W & W/O 73723RT |
$2,403.20 |
$6,008.00 |
60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side
CPT 73723
HIP LT W & W/O 73723LT |
$2,475.20 |
$6,188.00 |
60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side
CPT 73723
HIP LT W & W/O 73723LT |
$2,475.20 |
$6,188.00 |
60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side
CPT 73723
HIP RT W & W/O 73723RT |
$2,250.00 |
$5,625.00 |
60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side
CPT 73723
KNEE RT W & W/O 73723RT |
$2,403.20 |
$6,008.00 |
60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side
CPT 73723
ANKLE RT W & W/O 73723RT |
$2,403.20 |
$6,008.00 |
60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side
CPT 73723
HIP LT W & W/O 73723LT |
$2,475.20 |
$6,188.00 |
60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side
CPT 73723
HIP LT W & W/O 73723LT |
$2,475.20 |
$6,188.00 |
60% |
| MRI of the brain, no contrast dye
CPT 70551
BRAIN W/O 70551 |
$1,402.00 |
$3,505.00 |
60% |
| MRI of the brain, no contrast dye
CPT 70551
BRAIN W/O 70551 |
$1,402.00 |
$3,505.00 |
60% |
| MRI of the brain, no contrast dye inpatient
CPT 70551
BRAIN W/O 70551 |
$1,402.00 |
$3,505.00 |
60% |
| MRI of the brain, with and without contrast dye
CPT 70553
BRAIN W & W/O 70553 |
$1,762.80 |
$4,407.00 |
60% |
| MRI of the brain, with and without contrast dye
CPT 70553
BRAIN W & W/O 70553 |
$1,762.80 |
$4,407.00 |
60% |
| MRI of the brain, with and without contrast dye inpatient
CPT 70553
BRAIN W & W/O 70553 |
$1,762.80 |
$4,407.00 |
60% |
| MRI of the brain, with and without contrast dye inpatient
CPT 70553
BRAIN W & W/O 70553 |
$1,762.80 |
$4,407.00 |
60% |
| MRI of the lower back, no contrast dye
CPT 72148
MRI-L-SPINE W/O 72148 |
$1,694.40 |
$4,236.00 |
60% |
| MRI of the lower back, no contrast dye
CPT 72148
MRI-L-SPINE W/O 72148 |
$1,694.40 |
$4,236.00 |
60% |
| MRI of the lower back, no contrast dye inpatient
CPT 72148
MRI-L-SPINE W/O 72148 |
$1,694.40 |
$4,236.00 |
60% |
| Pregnancy ultrasound after 14 weeks, one baby
CPT 76805
OB AFTER FIRST TRIMESTER >14WK |
$504.00 |
$1,260.00 |
60% |
| Pregnancy ultrasound after 14 weeks, one baby
CPT 76805
OB AFTER FIRST TRIMESTER >14WK |
$504.00 |
$1,260.00 |
60% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient
CPT 76805
OB AFTER FIRST TRIMESTER >14WK |
$504.00 |
$1,260.00 |
60% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient
CPT 76805
OB AFTER FIRST TRIMESTER >14WK |
$504.00 |
$1,260.00 |
60% |
| Screening mammogram, both breasts both sides
CPT 77067
SCR MAMMO BI W/CAD 77067 |
$188.80 |
$472.00 |
60% |
| Screening mammogram, both breasts one side
CPT 77067
SCR MAMMO UNI LT W/CAD 77067 |
$148.40 |
$371.00 |
60% |
| Screening mammogram, both breasts one side
CPT 77067
SCR MAMMO UNI RT W/CAD 77067 |
$148.40 |
$371.00 |
60% |
| Screening mammogram, both breasts inpatient one side
CPT 77067
SCR MAMMO UNI LT W/CAD 77067 |
$148.40 |
$371.00 |
60% |
| Sleep study in a lab (polysomnography)
CPT 95810
POLYSOMNOGRAM TECHNICAL COMP |
$1,174.40 |
$2,936.00 |
60% |
| Sleep study in a lab (polysomnography)
CPT 95810
POLYSOMNOGRAM TECHNICAL COMP |
$1,174.40 |
$2,936.00 |
60% |
| Sleep study in a lab (polysomnography) inpatient
CPT 95810
POLYSOMNOGRAM TECHNICAL COMP |
$1,174.40 |
$2,936.00 |
60% |
| Sleep study in a lab (polysomnography) inpatient
CPT 95810
POLYSOMNOGRAM TECHNICAL COMP |
$1,174.40 |
$2,936.00 |
60% |
| Transvaginal pelvic ultrasound
CPT 76830
TRANSVAGINAL ECHO 76830 |
$234.80 |
$587.00 |
60% |
| Transvaginal pelvic ultrasound
CPT 76830
TRANSVAGINAL ECHO 76830 |
$234.80 |
$587.00 |
60% |
| Transvaginal pelvic ultrasound inpatient
CPT 76830
TRANSVAGINAL ECHO 76830 |
$234.80 |
$587.00 |
60% |
| Ultrasound of the abdomen, complete
CPT 76700
ABDOMEN COMPLETE 76700 |
$554.40 |
$1,386.00 |
60% |
| Ultrasound of the abdomen, complete
CPT 76700
ABDOMEN COMPLETE 76700 |
$554.40 |
$1,386.00 |
60% |
| Ultrasound of the abdomen, complete inpatient
CPT 76700
ABDOMEN COMPLETE 76700 |
$554.40 |
$1,386.00 |
60% |
| X-ray of the lower back, 4 or more views
CPT 72110
L-SPINE MIN 4 VIEWS 72110 |
$397.20 |
$993.00 |
60% |
| X-ray of the lower back, 4 or more views
CPT 72110
L-SPINE MIN 4 VIEWS 72110 |
$397.20 |
$993.00 |
60% |
| X-ray of the lower back, 4 or more views inpatient
CPT 72110
L-SPINE MIN 4 VIEWS 72110 |
$397.20 |
$993.00 |
60% |