|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$752.39 |
$752.39 |
$752.39 |
$271.44
|
|
X-ray ankle 2 views (both sides)
|
$1,287.76 |
$1,287.76 |
$1,287.76 |
$283.00
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$2,035.68 |
$2,035.68 |
$2,035.68 |
$768.30
|
|
X-ray bone age studies
|
$1,189.80 |
$1,189.80 |
$1,189.80 |
$246.75
|
|
X-ray bone length studies
|
$800.25 |
$800.25 |
$800.25 |
$287.25
|
|
X-ray bone survey complete
|
$2,189.91 |
$2,189.91 |
$2,189.91 |
$666.60
|
|
X-ray bone survey infant
|
$1,009.49 |
$1,009.49 |
$1,009.49 |
$410.73
|
|
X-ray cervical spine 2-3 views
|
$1,826.77 |
$1,826.77 |
$1,826.77 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$2,725.38 |
$2,725.38 |
$2,725.38 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$1,976.69 |
$1,976.69 |
$1,976.69 |
$515.35
|
|
X-ray clavicle complete (both sides)
|
$1,238.37 |
$1,238.37 |
$1,238.37 |
$299.65
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$1,849.81 |
$1,849.81 |
$1,849.81 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$3,179.84 |
$3,179.84 |
$3,179.84 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$1,056.17 |
$1,056.17 |
$1,056.17 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$1,621.20 |
$1,621.20 |
$1,621.20 |
$342.00
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$1,672.90 |
$1,672.90 |
$1,672.90 |
$486.24
|
|
X-ray exam entire spi 4/5 vw
|
$3,222.14 |
$3,222.14 |
$3,222.14 |
$486.01
|
|
X-ray exam entire spi 6/> vw
|
$4,027.95 |
$4,027.95 |
$4,027.95 |
$575.76
|
|
X-ray exam of arm infant
|
$1,286.38 |
$1,286.38 |
$1,286.38 |
$248.82
|
|
X-ray exam of eye sockets
|
$1,845.35 |
$1,845.35 |
$1,845.35 |
$349.05
|
|
X-ray exam of femur 1
|
$1,099.64 |
$1,099.64 |
$1,099.64 |
$232.36
|
|
X-ray exam of jaw joint
|
$977.21 |
$977.21 |
$977.21 |
$192.39
|
|
X-ray exam of jaw joint
|
$1,025.07 |
$1,025.07 |
$1,025.07 |
$354.79
|
|
X-ray exam of sinuses
|
$907.10 |
$907.10 |
$907.10 |
$211.00
|
|
X-ray exam si joints
|
$1,045.11 |
$1,045.11 |
$1,045.11 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$3,779.75 |
$3,779.75 |
$3,779.75 |
$395.59
|
|
X-ray eye detection foreign body (both sides)
|
$944.94 |
$944.94 |
$944.94 |
$235.00
|
|
X-ray facial bones complete > 3 views
|
$1,574.42 |
$1,574.42 |
$1,574.42 |
$366.60
|
|
X-ray femur >=2 views (both sides)
|
$1,432.74 |
$1,432.74 |
$1,432.74 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$1,159.59 |
$1,159.59 |
$1,159.59 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$854.92 |
$854.92 |
$854.92 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$1,519.42 |
$1,519.42 |
$1,519.42 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$1,238.77 |
$1,238.77 |
$1,238.77 |
$316.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$809.98 |
$809.98 |
$809.98 |
$270.00
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$2,069.27 |
$2,069.27 |
$2,069.27 |
$370.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$4,459.68 |
$4,459.68 |
$4,459.68 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$1,603.97 |
$1,603.97 |
$1,603.97 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$2,512.42 |
$2,512.42 |
$2,512.42 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$1,013.10 |
$1,013.10 |
$1,013.10 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$1,555.67 |
$1,555.67 |
$1,555.67 |
$304.15
|
|
X-ray knee 1-2 views (both sides)
|
$951.77 |
$951.77 |
$951.77 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$1,402.00 |
$1,402.00 |
$1,402.00 |
$353.25
|
|
X-ray knee ap standing bilateral
|
$1,529.26 |
$1,529.26 |
$1,529.26 |
$276.25
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$1,131.27 |
$1,131.27 |
$1,131.27 |
$249.13
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$1,247.67 |
$1,247.67 |
$1,247.67 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$3,190.70 |
$3,190.70 |
$3,190.70 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$1,663.94 |
$1,663.94 |
$1,663.94 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$1,925.49 |
$1,925.49 |
$1,925.49 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$902.31 |
$902.31 |
$902.31 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$1,262.99 |
$1,262.99 |
$1,262.99 |
$277.70
|
|
X-ray neck soft tissue
|
$1,391.01 |
$1,391.01 |
$1,391.01 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$796.91 |
$796.91 |
$796.91 |
$225.96
|
|
X-ray of mammary ducts
|
$1,025.07 |
$1,025.07 |
$1,025.07 |
$473.55
|
|
X-ray pelvis 1-2 views
|
$1,431.63 |
$1,431.63 |
$1,431.63 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$1,320.02 |
$1,320.02 |
$1,320.02 |
$342.30
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$2,778.32 |
$2,778.32 |
$2,778.32 |
$742.00
|
|
X-ray ribs 2 views left
|
$1,276.52 |
$1,276.52 |
$1,276.52 |
$296.32
|
|
X-ray ribs 3 views bilateral
|
$1,511.64 |
$1,511.64 |
$1,511.64 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$1,908.39 |
$1,908.39 |
$1,908.39 |
$359.47
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$3,816.78 |
$3,816.78 |
$3,816.78 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$1,086.95 |
$1,086.95 |
$1,086.95 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$1,619.97 |
$1,619.97 |
$1,619.97 |
$285.60
|
|
X-ray scapula complete (both sides)
|
$1,469.79 |
$1,469.79 |
$1,469.79 |
$292.50
|
|
X-ray sella turcica
|
$1,823.09 |
$1,823.09 |
$1,823.09 |
$162.50
|
|
X-ray shoulder 1 view (both sides)
|
$719.00 |
$719.00 |
$719.00 |
$264.48
|
|
X-ray sinuses paranasal complete > 3 views
|
$1,823.09 |
$1,823.09 |
$1,823.09 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$1,378.20 |
$1,378.20 |
$1,378.20 |
$601.30
|
|
X-ray skull < 4 views
|
$1,025.41 |
$1,025.41 |
$1,025.41 |
$291.78
|
|
X-ray skull > 4 views complete
|
$2,005.27 |
$2,005.27 |
$2,005.27 |
$414.60
|
|
X-ray slg plne bdy sect without urogr
|
$485.27 |
$485.27 |
$485.27 |
$387.00
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$1,814.46 |
$1,814.46 |
$1,814.46 |
$557.70
|
|
X-ray small intestine follow-through study
|
$914.55 |
$914.55 |
$914.55 |
$504.14
|
|
X-ray spine single view
|
$1,016.79 |
$1,016.79 |
$1,016.79 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$1,268.82 |
$1,268.82 |
$1,268.82 |
$263.49
|
|
X-ray sternum > 2 views
|
$1,571.96 |
$1,571.96 |
$1,571.96 |
$269.75
|
|
X-ray surgical specimen
|
$3,221.47 |
$3,221.47 |
$3,221.47 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$2,621.98 |
$2,621.98 |
$2,621.98 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$1,303.32 |
$1,303.32 |
$1,303.32 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$1,654.43 |
$1,654.43 |
$1,654.43 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$2,672.45 |
$2,672.45 |
$2,672.45 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$1,228.75 |
$1,228.75 |
$1,228.75 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$3,948.92 |
$3,948.92 |
$3,948.92 |
$256.85
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$2,001.17 |
$2,001.17 |
$2,001.17 |
$385.80
|
|
X-ray tibia/fibula 2 views (both sides)
|
$1,526.05 |
$1,526.05 |
$1,526.05 |
$328.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$945.39 |
$945.39 |
$945.39 |
$264.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$2,373.32 |
$2,373.32 |
$2,373.32 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$1,530.38 |
$1,530.38 |
$1,530.38 |
$555.04
|
|
X-ray wrist 2 views (both sides)
|
$1,004.20 |
$1,004.20 |
$1,004.20 |
$290.40
|
|
Yersinia antibody
|
$46.17 |
$46.17 |
$46.17 |
$66.95
|
|
Zika virus dna/rna amp probe
|
$342.80 |
$342.80 |
$342.80 |
$175.00
|
|
Zika virus igm antibody
|
$112.41 |
$112.41 |
$112.41 |
$75.40
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$416.81 |
$416.81 |
$416.81 |
$405.10
|