|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$168.64 |
$168.64 |
$240.00 |
|
|
X-ray ankle 2 views (both sides)
|
$147.52 |
$147.52 |
$232.50 |
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$577.60 |
$577.60 |
$1,026.00 |
|
|
X-ray assay calculus
|
$13.76 |
$13.76 |
$75.75 |
|
|
X-ray bone age studies
|
$150.08 |
$150.08 |
$298.50 |
|
|
X-ray bone length studies
|
$276.75 |
$276.75 |
$287.04 |
|
|
X-ray bone survey complete
|
$354.56 |
$354.56 |
$708.00 |
|
|
X-ray bone survey infant
|
$305.25 |
$305.25 |
$305.25 |
|
|
X-ray cervical spine 2-3 views
|
$129.92 |
$129.92 |
$306.00 |
|
|
X-ray cervical spine 4-5 views
|
$171.84 |
$171.84 |
$372.75 |
|
|
X-ray cervical spine >= 6 views
|
$200.96 |
$200.96 |
$356.25 |
|
|
X-ray clavicle complete (both sides)
|
$163.20 |
$163.20 |
$264.75 |
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$393.60 |
$393.60 |
$509.25 |
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$368.00 |
$368.00 |
$663.75 |
|
|
X-ray elbow 2 views (both sides)
|
$147.52 |
$147.52 |
$232.50 |
|
|
X-ray elbow >= 3 views (both sides)
|
$188.80 |
$188.80 |
$277.50 |
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$182.08 |
$182.08 |
$458.25 |
|
|
X-ray exam entire spi 4/5 vw
|
$214.72 |
$214.72 |
$473.25 |
|
|
X-ray exam entire spi 6/> vw
|
$266.24 |
$266.24 |
$491.25 |
|
|
X-ray exam of arm infant
|
$139.52 |
$139.52 |
$298.50 |
|
|
X-ray exam of eye sockets
|
$203.52 |
$203.52 |
$298.50 |
|
|
X-ray exam of femur 1
|
$157.12 |
$157.12 |
$240.00 |
|
|
X-ray exam of jaw joint
|
$135.68 |
$135.68 |
$240.00 |
|
|
X-ray exam of jaw joint
|
$652.50 |
$652.50 |
$652.50 |
|
|
X-ray exam of mastoids
|
$296.25 |
$296.25 |
$296.25 |
|
|
X-ray exam of middle ear
|
$1,400.25 |
$1,400.25 |
$1,400.25 |
|
|
X-ray exam of penis
|
$296.25 |
$296.25 |
$296.25 |
|
|
X-ray exam of perineum
|
$652.50 |
$652.50 |
$652.50 |
|
|
X-ray exam of salivary gland
|
$135.68 |
$135.68 |
$240.00 |
|
|
X-ray exam of sinuses
|
$135.68 |
$135.68 |
$240.00 |
|
|
X-ray exam of tear duct
|
$652.50 |
$652.50 |
$652.50 |
|
|
X-ray exam of teeth
|
$240.00 |
$240.00 |
$240.00 |
|
|
X-ray exam of teeth
|
$652.50 |
$652.50 |
$652.50 |
|
|
X-ray exam si joints
|
$88.32 |
$88.32 |
$298.50 |
|
|
X-ray exam thorac spine4/>vw
|
$79.04 |
$79.04 |
$296.25 |
|
|
X-ray eye detection foreign body (both sides)
|
$135.68 |
$135.68 |
$240.00 |
|
|
X-ray facial bones complete > 3 views
|
$203.52 |
$203.52 |
$298.50 |
|
|
X-ray fallopian tube
|
$265.50 |
$265.50 |
$265.50 |
|
|
X-ray femur >=2 views (both sides)
|
$188.80 |
$188.80 |
$330.00 |
|
|
X-ray finger(s) >= 2 views (both sides)
|
$143.04 |
$143.04 |
$232.50 |
|
|
X-ray foot 2 views (both sides)
|
$152.32 |
$152.32 |
$255.75 |
|
|
X-ray forearm 2 views (both sides)
|
$160.32 |
$160.32 |
$248.25 |
|
|
X-ray hand 2 views (both sides)
|
$165.12 |
$165.12 |
$334.50 |
|
|
X-ray head for orthodontia
|
$240.00 |
$240.00 |
$240.00 |
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$147.52 |
$147.52 |
$232.50 |
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$169.60 |
$169.60 |
$314.25 |
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$111.36 |
$111.36 |
$421.50 |
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$139.52 |
$139.52 |
$633.75 |
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$266.24 |
$266.24 |
$645.75 |
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$111.68 |
$111.68 |
$240.00 |
|
|
X-ray humerus >= 2 views left
|
$160.32 |
$160.32 |
$232.50 |
|
|
X-ray joint survey 1 view
|
$296.25 |
$296.25 |
$296.25 |
|
|
X-ray knee 1-2 views (both sides)
|
$161.28 |
$161.28 |
$250.50 |
|
|
X-ray knee 3 views (both sides)
|
$192.00 |
$192.00 |
$342.75 |
|
|
X-ray knee ap standing bilateral
|
$118.08 |
$118.08 |
$240.00 |
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$139.52 |
$139.52 |
$240.00 |
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$157.44 |
$157.44 |
$298.50 |
|
|
X-ray lumbosacral spine >= 4 views
|
$202.24 |
$202.24 |
$436.50 |
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$224.00 |
$224.00 |
$318.00 |
|
|
X-ray male genital tract
|
$652.50 |
$652.50 |
$652.50 |
|
|
X-ray mandible complete > 4 views
|
$203.52 |
$203.52 |
$298.50 |
|
|
X-ray mandible ltd <4 views
|
$240.00 |
$240.00 |
$240.00 |
|
|
X-ray nasal bones complete > 3 views
|
$135.68 |
$135.68 |
$240.00 |
|
|
X-ray neck soft tissue
|
$135.68 |
$135.68 |
$240.00 |
|
|
X-ray nose to rectum for foreign body child
|
$101.76 |
$101.76 |
$240.00 |
|
|
X-ray of mammary ducts
|
$201.60 |
$201.60 |
$652.50 |
|
|
X-ray optic foramina
|
$203.52 |
$203.52 |
$240.00 |
|
|
X-ray pelvis 1-2 views
|
$111.36 |
$111.36 |
$276.75 |
|
|
X-ray pelvis complete > 3 views
|
$202.24 |
$202.24 |
$312.75 |
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$332.80 |
$332.80 |
$1,026.00 |
|
|
X-ray ribs 2 views left
|
$125.76 |
$125.76 |
$298.50 |
|
|
X-ray ribs 3 views bilateral
|
$189.12 |
$189.12 |
$400.50 |
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$146.24 |
$146.24 |
$299.25 |
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$217.28 |
$217.28 |
$473.25 |
|
|
X-ray sacroiliac joints >= 3 views
|
$159.04 |
$159.04 |
$296.25 |
|
|
X-ray sacrum/coccyx >= 2 views
|
$145.60 |
$145.60 |
$268.50 |
|
|
X-ray scapula complete (both sides)
|
$218.56 |
$218.56 |
$298.50 |
|
|
X-ray sella turcica
|
$240.00 |
$240.00 |
$240.00 |
|
|
X-ray shoulder 1 view (both sides)
|
$154.24 |
$154.24 |
$240.00 |
|
|
X-ray sinuses paranasal complete > 3 views
|
$155.84 |
$155.84 |
$240.00 |
|
|
X-ray sinus tract/fistula/abscess
|
$315.52 |
$315.52 |
$1,404.00 |
|
|
X-ray skull < 4 views
|
$203.52 |
$203.52 |
$298.50 |
|
|
X-ray skull > 4 views complete
|
$223.04 |
$223.04 |
$298.50 |
|
|
X-ray slg plne bdy sect without urogr
|
$171.20 |
$171.20 |
$296.25 |
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$264.32 |
$264.32 |
$509.25 |
|
|
X-ray small intestine follow-through study
|
$317.76 |
$317.76 |
$480.00 |
|
|
X-ray spine single view
|
$116.80 |
$116.80 |
$240.00 |
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$187.52 |
$187.52 |
$240.00 |
|
|
X-ray sternum > 2 views
|
$133.12 |
$133.12 |
$240.00 |
|
|
X-ray surgical specimen
|
$273.28 |
$273.28 |
$1,374.75 |
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$333.76 |
$333.76 |
$483.00 |
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$240.00 |
$240.00 |
$271.36 |
|
|
X-ray thoracic spine 2 views
|
$145.60 |
$145.60 |
$282.00 |
|
|
X-ray thoracic spine 3 views
|
$159.68 |
$159.68 |
$364.50 |
|
|
X-ray thoracolumbar spine >=2 views
|
$145.60 |
$145.60 |
$249.75 |
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$67.84 |
$67.84 |
$240.00 |
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$139.52 |
$139.52 |
$616.50 |
|
|
X-ray tibia/fibula 2 views (both sides)
|
$160.32 |
$160.32 |
$242.25 |
|
|
X-ray toe(s) > 2 views (both sides)
|
$142.08 |
$142.08 |
$232.50 |
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$227.20 |
$227.20 |
$458.25 |
|
