|
Xpos opn fmrl eprst aor uni add-on
|
$9,045.00 |
$9,045.00 |
$9,045.00 |
$2,160.89
|
|
X-ray abdomen 1 view
|
$887.00 |
$887.00 |
$4,063.74 |
$255.00
|
|
X-ray abdomen 2 views
|
$1,091.00 |
$1,091.00 |
$4,415.30 |
$312.36
|
|
X-ray abdomen >=3 views
|
$1,091.00 |
$1,091.00 |
$4,761.24 |
$332.15
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$1,091.00 |
$1,091.00 |
$3,987.36 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$868.00 |
$868.00 |
$868.00 |
$271.44
|
|
X-ray ankle 2 views (both sides)
|
$745.00 |
$745.00 |
$745.00 |
$283.00
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$1,705.00 |
$1,705.00 |
$1,705.00 |
$768.30
|
|
X-ray bone age studies
|
$659.00 |
$659.00 |
$659.00 |
$246.75
|
|
X-ray bone length studies
|
$1,400.00 |
$1,400.00 |
$1,400.00 |
$287.25
|
|
X-ray bone survey complete
|
$2,891.00 |
$2,891.00 |
$6,371.91 |
$666.60
|
|
X-ray bone survey infant
|
$871.00 |
$871.00 |
$871.00 |
$410.73
|
|
X-ray cervical spine 2-3 views
|
$947.00 |
$947.00 |
$2,405.89 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$1,165.00 |
$1,165.00 |
$3,823.37 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$1,165.00 |
$1,165.00 |
$4,848.85 |
$515.35
|
|
X-ray clavicle complete (both sides)
|
$724.00 |
$724.00 |
$724.00 |
$299.65
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$1,873.00 |
$6,748.19 |
$7,666.80 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$2,125.00 |
$2,125.00 |
$7,887.00 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$689.00 |
$689.00 |
$689.00 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$752.00 |
$752.00 |
$752.00 |
$342.00
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$1,175.00 |
$4,782.59 |
$5,434.00 |
$486.24
|
|
X-ray exam entire spi 4/5 vw
|
$923.00 |
$923.00 |
$923.00 |
$486.01
|
|
X-ray exam entire spi 6/> vw
|
$923.00 |
$923.00 |
$923.00 |
$575.76
|
|
X-ray exam of arm infant
|
$723.00 |
$723.00 |
$723.00 |
$248.82
|
|
X-ray exam of eye sockets
|
$1,351.00 |
$1,351.00 |
$4,669.14 |
$349.05
|
|
X-ray exam of femur 1
|
$773.00 |
$773.00 |
$773.00 |
$232.36
|
|
X-ray exam of jaw joint
|
$1,436.00 |
$1,436.00 |
$1,436.00 |
$192.39
|
|
X-ray exam of penis
|
$2,183.00 |
$2,183.00 |
$2,183.00 |
$565.20
|
|
X-ray exam of perineum
|
$1,873.00 |
$1,873.00 |
$1,873.00 |
$420.93
|
|
X-ray exam of sinuses
|
$693.00 |
$693.00 |
$693.00 |
$211.00
|
|
X-ray exam of tear duct
|
$4,613.00 |
$4,613.00 |
$4,613.00 |
$340.70
|
|
X-ray exam of teeth
|
$331.00 |
$331.00 |
$331.00 |
$286.04
|
|
X-ray exam si joints
|
$421.20 |
$421.20 |
$536.00 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$1,368.00 |
$1,368.00 |
$1,368.00 |
$395.59
|
|
X-ray eye detection foreign body (both sides)
|
$598.00 |
$598.00 |
$598.00 |
$235.00
|
|
X-ray facial bones complete > 3 views
|
$1,368.00 |
$1,368.00 |
$4,388.34 |
$366.60
|
|
X-ray fallopian tube
|
$2,264.00 |
$2,264.00 |
$2,264.00 |
$501.00
|
|
X-ray femur >=2 views (both sides)
|
$773.00 |
$773.00 |
$773.00 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$469.00 |
$469.00 |
$469.00 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$712.00 |
$712.00 |
$712.00 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$696.00 |
$696.00 |
$696.00 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$622.00 |
$622.00 |
$622.00 |
$316.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$712.00 |
$712.00 |
$712.00 |
$270.00
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$1,757.00 |
$1,757.00 |
$1,757.00 |
$370.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$2,184.00 |
$2,184.00 |
$3,326.92 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$758.00 |
$758.00 |
$2,492.38 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$2,184.00 |
$2,184.00 |
$2,184.00 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$832.00 |
$832.00 |
$832.00 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$723.00 |
$723.00 |
$723.00 |
$304.15
|
|
X-ray knee 1-2 views (both sides)
|
$769.00 |
$769.00 |
$769.00 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$769.00 |
$769.00 |
$769.00 |
$353.25
|
|
X-ray knee ap standing bilateral
|
$850.00 |
$850.00 |
$2,841.65 |
$276.25
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$743.00 |
$743.00 |
$743.00 |
$249.13
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$1,063.00 |
$1,063.00 |
$1,063.00 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$1,368.00 |
$1,368.00 |
$4,369.25 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$1,368.00 |
$1,368.00 |
$1,368.00 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$1,147.00 |
$1,147.00 |
$4,687.11 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$1,134.00 |
$1,134.00 |
$1,134.00 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$838.00 |
$838.00 |
$3,439.24 |
$277.70
|
|
X-ray neck soft tissue
|
$708.00 |
$708.00 |
$2,929.31 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$696.00 |
$696.00 |
$696.00 |
$225.96
|
|
X-ray of mammary ducts
|
$1,658.00 |
$1,658.00 |
$1,658.00 |
$473.55
|
|
X-ray pelvis 1-2 views
|
$730.00 |
$730.00 |
$3,082.06 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$903.00 |
$903.00 |
$903.00 |
$342.30
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$1,395.00 |
$1,395.00 |
$1,395.00 |
$742.00
|
|
X-ray ribs 2 views left
|
$842.00 |
$842.00 |
$842.00 |
$296.32
|
|
X-ray ribs 3 views bilateral
|
$1,219.00 |
$1,219.00 |
$3,761.60 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$992.00 |
$992.00 |
$992.00 |
$359.47
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$1,271.00 |
$1,271.00 |
$4,949.94 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$911.00 |
$911.00 |
$2,026.25 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$820.00 |
$820.00 |
$4,085.08 |
$285.60
|
|
X-ray scapula complete (both sides)
|
$723.00 |
$723.00 |
$723.00 |
$292.50
|
|
X-ray shoulder 1 view (both sides)
|
$687.00 |
$687.00 |
$687.00 |
$264.48
|
|
X-ray sinuses paranasal complete > 3 views
|
$1,224.00 |
$1,224.00 |
$4,098.56 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$1,118.00 |
$1,118.00 |
$1,118.00 |
$601.30
|
|
X-ray skull < 4 views
|
$1,093.00 |
$1,093.00 |
$2,905.72 |
$291.78
|
|
X-ray skull > 4 views complete
|
$1,370.00 |
$1,370.00 |
$3,681.85 |
$414.60
|
|
X-ray slg plne bdy sect without urogr
|
$1,940.00 |
$1,940.00 |
$1,940.00 |
$387.00
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$1,608.00 |
$6,943.62 |
$7,888.60 |
$557.70
|
|
X-ray small intestine follow-through study
|
$883.96 |
$883.96 |
$2,778.00 |
$504.14
|
|
X-ray spine single view
|
$555.00 |
$555.00 |
$555.00 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$878.00 |
$878.00 |
$3,277.05 |
$263.49
|
|
X-ray sternum > 2 views
|
$865.00 |
$865.00 |
$3,506.63 |
$269.75
|
|
X-ray surgical specimen
|
$486.00 |
$486.00 |
$1,318.64 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$1,783.00 |
$4,498.42 |
$5,109.80 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$1,436.00 |
$1,436.00 |
$1,436.00 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$709.00 |
$709.00 |
$3,351.63 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$849.00 |
$849.00 |
$3,265.14 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$585.00 |
$585.00 |
$585.00 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$751.00 |
$751.00 |
$751.00 |
$256.85
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$923.00 |
$923.00 |
$4,718.56 |
$385.80
|
|
X-ray tibia/fibula 2 views (both sides)
|
$723.00 |
$723.00 |
$723.00 |
$328.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$469.00 |
$469.00 |
$469.00 |
$264.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$2,461.00 |
$6,820.07 |
$8,368.55 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$2,079.00 |
$12,621.40 |
$14,340.25 |
$555.04
|
|
X-ray wrist 2 views (both sides)
|
$709.00 |
$709.00 |
$709.00 |
$290.40
|
|
X-ray xm phrnx&/crv esoph c+
|
$1,175.00 |
$1,175.00 |
$1,175.00 |
$324.20
|
|
Xylose absorption test blood &/or urine
|
$21.45 |
$21.45 |
$21.45 |
$64.28
|
|
Yersinia antibody
|
$68.85 |
$68.85 |
$191.00 |
$66.95
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$187.85 |
$187.85 |
$237.00 |
$106.94
|
