|
X-ray ankle 2 views (both sides)
|
$1,028.66 |
$1,028.66 |
$1,028.66 |
$283.00
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$1,337.76 |
$1,337.76 |
$1,337.76 |
$768.30
|
|
X-ray bone age studies
|
$773.97 |
$773.97 |
$3,682.94 |
$246.75
|
|
X-ray bone length studies
|
$895.42 |
$895.42 |
$3,668.12 |
$287.25
|
|
X-ray bone survey complete
|
$875.44 |
$875.44 |
$13,323.01 |
$666.60
|
|
X-ray bone survey infant
|
$1,422.31 |
$1,422.31 |
$3,870.79 |
$410.73
|
|
X-ray cervical spine 2-3 views
|
$2,020.82 |
$2,020.82 |
$4,435.56 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$2,243.62 |
$2,243.62 |
$4,325.45 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$2,476.05 |
$2,476.05 |
$4,325.45 |
$515.35
|
|
X-ray clavicle complete (both sides)
|
$1,063.59 |
$1,063.59 |
$1,063.59 |
$299.65
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$1,594.07 |
$1,594.07 |
$6,500.12 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$2,258.21 |
$2,258.21 |
$7,050.37 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$1,197.98 |
$1,197.98 |
$1,197.98 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$1,259.62 |
$1,259.62 |
$1,259.62 |
$342.00
|
|
Xray endovasc thor ao repr
|
$1,778.33 |
$1,778.33 |
$1,778.33 |
$1,889.01
|
|
Xray endovasc thor ao repr
|
$10,853.31 |
$10,853.31 |
$10,853.31 |
$2,266.32
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$1,102.75 |
$1,102.75 |
$4,685.12 |
$486.24
|
|
X-ray exam entire spi 4/5 vw
|
$3,120.93 |
$3,120.93 |
$4,390.84 |
$486.01
|
|
X-ray exam entire spi 6/> vw
|
$3,139.90 |
$3,139.90 |
$3,139.90 |
$575.76
|
|
X-ray exam of arm infant
|
$837.89 |
$837.89 |
$837.89 |
$248.82
|
|
X-ray exam of eye sockets
|
$1,956.71 |
$1,956.71 |
$5,251.40 |
$349.05
|
|
X-ray exam of femur 1
|
$954.28 |
$954.28 |
$2,145.33 |
$232.36
|
|
X-ray exam of jaw joint
|
$1,096.69 |
$1,096.69 |
$1,096.69 |
$192.39
|
|
X-ray exam of penis
|
$1,344.82 |
$1,344.82 |
$1,344.82 |
$565.20
|
|
X-ray exam of perineum
|
$2,833.35 |
$2,833.35 |
$2,833.35 |
$420.93
|
|
X-ray exam of sinuses
|
$1,056.67 |
$1,056.67 |
$2,897.95 |
$211.00
|
|
X-ray exam of tear duct
|
$2,833.35 |
$2,833.35 |
$2,833.35 |
$340.70
|
|
X-ray exam of teeth
|
$812.98 |
$812.98 |
$3,149.19 |
$286.04
|
|
X-ray exam si joints
|
$664.50 |
$664.50 |
$1,481.95 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$2,282.84 |
$2,282.84 |
$2,282.84 |
$395.59
|
|
X-ray eye detection foreign body (both sides)
|
$986.70 |
$986.70 |
$986.70 |
$235.00
|
|
X-ray facial bones complete > 3 views
|
$2,646.40 |
$2,646.40 |
$5,701.83 |
$366.60
|
|
X-ray fallopian tube
|
$1,004.82 |
$1,004.82 |
$1,004.82 |
$501.00
|
|
X-ray femur >=2 views (both sides)
|
$1,433.45 |
$1,433.45 |
$2,131.73 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$955.54 |
$955.54 |
$955.54 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$1,031.47 |
$1,031.47 |
$1,031.47 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$1,282.89 |
$1,282.89 |
$1,282.89 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$1,125.12 |
$1,125.12 |
$1,125.12 |
$316.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$962.28 |
$962.28 |
$962.28 |
$270.00
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$2,728.35 |
$2,728.35 |
$4,490.01 |
$370.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$1,269.31 |
$1,269.31 |
$4,159.68 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$1,665.96 |
$1,665.96 |
$4,830.32 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$1,784.97 |
$1,784.97 |
$5,723.91 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$1,707.62 |
$1,707.62 |
$2,701.33 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$1,493.37 |
$1,493.37 |
$1,493.37 |
$304.15
|
|
X-ray joint survey 1 view
|
$12,140.54 |
$12,140.54 |
$12,140.54 |
$211.00
|
|
X-ray knee 1-2 views (both sides)
|
$1,233.39 |
$1,233.39 |
$1,233.39 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$1,478.60 |
$1,478.60 |
$1,478.60 |
$353.25
|
|
X-ray knee ap standing bilateral
|
$2,366.62 |
$2,366.62 |
$3,239.78 |
$276.25
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$1,026.00 |
$1,026.00 |
$1,026.00 |
$249.13
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$431.61 |
$431.61 |
$2,646.88 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$2,605.26 |
$2,605.26 |
$6,400.30 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$2,843.17 |
$2,843.17 |
$7,644.48 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$2,445.26 |
$2,445.26 |
$4,382.93 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$1,043.34 |
$1,043.34 |
$2,165.60 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$1,341.54 |
$1,341.54 |
$2,790.87 |
$277.70
|
|
X-ray neck soft tissue
|
$716.34 |
$716.34 |
$2,124.76 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$506.47 |
$506.47 |
$2,363.74 |
$225.96
|
|
X-ray of mammary ducts
|
$2,833.35 |
$2,833.35 |
$2,833.35 |
$473.55
|
|
X-ray pelvis 1-2 views
|
$1,280.97 |
$1,280.97 |
$2,834.73 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$1,967.61 |
$1,967.61 |
$2,982.96 |
$342.30
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$1,252.72 |
$5,509.41 |
$5,968.93 |
$742.00
|
|
X-ray ribs 2 views left
|
$1,044.77 |
$1,044.77 |
$1,044.77 |
$296.32
|
|
X-ray ribs 3 views bilateral
|
$1,468.50 |
$1,468.50 |
$3,753.42 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$2,223.77 |
$2,223.77 |
$2,223.77 |
$359.47
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$2,447.82 |
$2,447.82 |
$5,493.71 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$1,123.95 |
$1,123.95 |
$2,946.35 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$1,662.46 |
$1,662.46 |
$2,717.36 |
$285.60
|
|
X-ray scapula complete (both sides)
|
$923.52 |
$923.52 |
$923.52 |
$292.50
|
|
X-ray shoulder 1 view (both sides)
|
$566.11 |
$566.11 |
$566.11 |
$264.48
|
|
X-ray sinuses paranasal complete > 3 views
|
$2,055.21 |
$2,055.21 |
$4,382.93 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$1,761.45 |
$1,837.79 |
$7,644.48 |
$601.30
|
|
X-ray skull < 4 views
|
$2,046.21 |
$2,046.21 |
$5,251.40 |
$291.78
|
|
X-ray skull > 4 views complete
|
$2,283.89 |
$2,283.89 |
$5,095.92 |
$414.60
|
|
X-ray slg plne bdy sect without urogr
|
$1,344.82 |
$1,344.82 |
$9,854.24 |
$387.00
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$1,903.56 |
$1,903.56 |
$4,946.18 |
$557.70
|
|
X-ray small intestine follow-through study
|
$1.58 |
$2,276.26 |
$9,198.42 |
$504.14
|
|
X-ray spine single view
|
$1,134.39 |
$1,134.39 |
$2,702.84 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$982.20 |
$2,671.99 |
$2,897.95 |
$263.49
|
|
X-ray sternum > 2 views
|
$1,580.12 |
$1,580.12 |
$2,897.95 |
$269.75
|
|
X-ray surgical specimen
|
$1,761.45 |
$1,837.79 |
$3,864.74 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$1,139.09 |
$1,139.09 |
$14,775.62 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$1,096.69 |
$1,096.69 |
$4,382.93 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$1,187.03 |
$1,187.03 |
$2,790.87 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$2,117.56 |
$2,117.56 |
$4,199.31 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$1,631.43 |
$1,631.43 |
$2,363.74 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$1,556.42 |
$1,556.42 |
$2,962.39 |
$256.85
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$2,188.66 |
$2,188.66 |
$5,251.40 |
$385.80
|
|
X-ray tibia/fibula 2 views (both sides)
|
$1,418.45 |
$1,418.45 |
$1,418.45 |
$328.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$888.16 |
$888.16 |
$888.16 |
$264.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$2,057.13 |
$2,057.13 |
$7,530.14 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$1,516.80 |
$1,516.80 |
$6,971.12 |
$555.04
|
|
X-ray wrist 2 views (both sides)
|
$1,329.28 |
$1,329.28 |
$1,329.28 |
$290.40
|
|
X-ray xm phrnx&/crv esoph c+
|
$1,646.31 |
$1,646.31 |
$2,792.04 |
$324.20
|
|
Xylose absorption test blood &/or urine
|
$9.78 |
$9.78 |
$270.24 |
$64.28
|
|
Yersinia antibody
|
$203.58 |
$203.58 |
$203.58 |
$66.95
|
|
Zika virus dna/rna amp probe
|
$175.00 |
$208.00 |
$791.97 |
$175.00
|
|
Zika virus igm antibody
|
$260.09 |
$260.09 |
$260.09 |
$75.40
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$612.11 |
$612.11 |
$681.00 |
$121.56
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$549.16 |
$634.91 |
$3,831.00 |
$405.10
|