|
Wrist X-ray
|
$440.64 |
$440.64 |
$440.64 |
$342.80
|
|
X-ray abdomen 1 view
|
$403.92 |
$403.92 |
$403.92 |
$258.50
|
|
X-ray abdomen 2 views
|
$460.08 |
$460.08 |
$460.08 |
$316.47
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$678.96 |
$678.96 |
$678.96 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$352.08 |
$352.08 |
$352.08 |
$270.20
|
|
X-ray ankle 2 views (both sides)
|
$385.92 |
$385.92 |
$385.92 |
$282.50
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$1,136.16 |
$1,136.16 |
$1,136.16 |
$773.40
|
|
X-ray bone age studies
|
$343.44 |
$343.44 |
$343.44 |
$251.40
|
|
X-ray bone length studies
|
$485.28 |
$485.28 |
$485.28 |
$285.30
|
|
X-ray bone survey complete
|
$280.08 |
$280.08 |
$280.08 |
$660.00
|
|
X-ray bone survey infant
|
$229.68 |
$229.68 |
$229.68 |
$394.69
|
|
X-ray cervical spine 2-3 views
|
$439.92 |
$439.92 |
$439.92 |
$333.83
|
|
X-ray cervical spine 4-5 views
|
$648.00 |
$648.00 |
$648.00 |
$457.05
|
|
X-ray cervical spine >= 6 views
|
$648.00 |
$648.00 |
$648.00 |
$508.50
|
|
X-ray clavicle complete (both sides)
|
$360.72 |
$360.72 |
$360.72 |
$300.05
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$1,018.08 |
$1,018.08 |
$1,018.08 |
$657.03
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$1,274.40 |
$1,274.40 |
$1,274.40 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$252.72 |
$252.72 |
$252.72 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$390.24 |
$390.24 |
$390.24 |
$364.12
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$718.56 |
$718.56 |
$718.56 |
$483.50
|
|
X-ray exam of arm infant
|
$280.08 |
$280.08 |
$280.08 |
$248.44
|
|
X-ray exam of eye sockets
|
$280.08 |
$280.08 |
$280.08 |
$328.35
|
|
X-ray exam of femur 1
|
$190.08 |
$190.08 |
$190.08 |
$240.00
|
|
X-ray exam of sinuses
|
$208.08 |
$208.08 |
$208.08 |
$214.50
|
|
X-ray exam si joints
|
$352.08 |
$352.08 |
$352.08 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$465.12 |
$465.12 |
$465.12 |
$387.40
|
|
X-ray eye detection foreign body (both sides)
|
$403.92 |
$403.92 |
$403.92 |
$238.29
|
|
X-ray facial bones complete > 3 views
|
$485.28 |
$485.28 |
$485.28 |
$381.75
|
|
X-ray femur >=2 views (both sides)
|
$385.92 |
$385.92 |
$385.92 |
$317.25
|
|
X-ray finger(s) >= 2 views (both sides)
|
$352.08 |
$352.08 |
$352.08 |
$241.05
|
|
X-ray foot 2 views (both sides)
|
$379.44 |
$379.44 |
$379.44 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$379.44 |
$379.44 |
$379.44 |
$322.20
|
|
X-ray hand 2 views (both sides)
|
$379.44 |
$379.44 |
$379.44 |
$291.20
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$352.08 |
$352.08 |
$352.08 |
$274.95
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$406.80 |
$406.80 |
$406.80 |
$374.40
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$496.08 |
$496.08 |
$496.08 |
$424.05
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$496.80 |
$496.80 |
$496.80 |
$505.60
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$208.08 |
$208.08 |
$208.08 |
$231.00
|
|
X-ray humerus >= 2 views left
|
$385.92 |
$385.92 |
$385.92 |
$309.31
|
|
X-ray joint survey 1 view
|
$280.08 |
$280.08 |
$280.08 |
$232.00
|
|
X-ray knee 1-2 views (both sides)
|
$432.00 |
$432.00 |
$432.00 |
$285.00
|
|
X-ray knee 3 views (both sides)
|
$440.64 |
$440.64 |
$440.64 |
$363.20
|
|
X-ray knee ap standing bilateral
|
$208.08 |
$208.08 |
$208.08 |
$252.50
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$208.08 |
$208.08 |
$208.08 |
$254.12
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$409.68 |
$409.68 |
$409.68 |
$369.15
|
|
X-ray lumbosacral spine >= 4 views
|
$768.24 |
$768.24 |
$768.24 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$909.36 |
$909.36 |
$909.36 |
$535.91
|
|
X-ray mandible complete > 4 views
|
$385.92 |
$385.92 |
$385.92 |
$361.61
|
|
X-ray mandible ltd <4 views
|
$208.08 |
$208.08 |
$208.08 |
$235.30
|
|
X-ray nasal bones complete > 3 views
|
$385.92 |
$385.92 |
$385.92 |
$274.65
|
|
X-ray neck soft tissue
|
$403.92 |
$403.92 |
$403.92 |
$237.43
|
|
X-ray optic foramina
|
$208.08 |
$208.08 |
$208.08 |
$188.40
|
|
X-ray pelvis 1-2 views
|
$379.44 |
$379.44 |
$379.44 |
$280.80
|
|
X-ray pelvis complete > 3 views
|
$414.00 |
$414.00 |
$414.00 |
$348.19
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$946.08 |
$946.08 |
$946.08 |
$755.50
|
|
X-ray ribs 2 views left
|
$415.44 |
$415.44 |
$415.44 |
$292.80
|
|
X-ray ribs 3 views bilateral
|
$519.84 |
$519.84 |
$519.84 |
$395.76
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$498.96 |
$498.96 |
$498.96 |
$356.20
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$633.60 |
$633.60 |
$633.60 |
$491.70
|
|
X-ray sacroiliac joints >= 3 views
|
$419.76 |
$419.76 |
$419.76 |
$312.75
|
|
X-ray sacrum/coccyx >= 2 views
|
$431.28 |
$431.28 |
$431.28 |
$288.80
|
|
X-ray scapula complete (both sides)
|
$385.92 |
$385.92 |
$385.92 |
$285.00
|
|
X-ray shoulder 1 view (both sides)
|
$352.08 |
$352.08 |
$352.08 |
$260.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$485.28 |
$485.28 |
$485.28 |
$345.60
|
|
X-ray skull < 4 views
|
$415.44 |
$415.44 |
$415.44 |
$292.50
|
|
X-ray skull > 4 views complete
|
$648.00 |
$648.00 |
$648.00 |
$417.50
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$788.40 |
$788.40 |
$788.40 |
$557.70
|
|
X-ray small intestine follow-through study
|
$1,092.96 |
$1,092.96 |
$1,092.96 |
$499.50
|
|
X-ray spine single view
|
$208.08 |
$208.08 |
$208.08 |
$251.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$208.08 |
$208.08 |
$208.08 |
$264.48
|
|
X-ray sternum > 2 views
|
$385.92 |
$385.92 |
$385.92 |
$274.65
|
|
X-ray surgical specimen
|
$591.84 |
$591.84 |
$591.84 |
$504.00
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$718.56 |
$718.56 |
$718.56 |
$523.25
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$208.08 |
$208.08 |
$208.08 |
$327.80
|
|
X-ray thoracic spine 2 views
|
$385.92 |
$385.92 |
$385.92 |
$320.45
|
|
X-ray thoracic spine 3 views
|
$473.76 |
$473.76 |
$473.76 |
$381.60
|
|
X-ray thoracolumbar spine >=2 views
|
$321.12 |
$321.12 |
$321.12 |
$282.50
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$256.32 |
$256.32 |
$256.32 |
$257.04
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$589.68 |
$589.68 |
$589.68 |
$352.95
|
|
X-ray tibia/fibula 2 views (both sides)
|
$385.92 |
$385.92 |
$385.92 |
$332.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$489.00 |
$489.00 |
$489.00 |
$258.50
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$1,109.52 |
$1,109.52 |
$1,109.52 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$458.64 |
$458.64 |
$458.64 |
$603.20
|
|
X-ray wrist 2 views (both sides)
|
$379.44 |
$379.44 |
$379.44 |
$290.40
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$207.36 |
$207.36 |
$207.36 |
$452.69
|
