|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$320.40 |
$320.40 |
$562.20 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$246.00 |
$246.00 |
$520.80 |
$270.20
|
|
X-ray ankle 2 views (both sides)
|
$211.80 |
$211.80 |
$781.80 |
$282.50
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$689.40 |
$689.40 |
$1,021.20 |
$773.40
|
|
X-ray bone age studies
|
$520.80 |
$520.80 |
$520.80 |
$251.40
|
|
X-ray bone length studies
|
$520.80 |
$520.80 |
$520.80 |
$285.30
|
|
X-ray bone survey complete
|
$500.40 |
$500.40 |
$860.40 |
$660.00
|
|
X-ray bone survey infant
|
$659.40 |
$659.40 |
$659.40 |
$394.69
|
|
X-ray cervical spine 2-3 views
|
$486.00 |
$486.00 |
$486.00 |
$333.83
|
|
X-ray cervical spine 4-5 views
|
$599.40 |
$599.40 |
$599.40 |
$457.05
|
|
X-ray cervical spine >= 6 views
|
$659.40 |
$659.40 |
$659.40 |
$508.50
|
|
X-ray clavicle complete (both sides)
|
$195.00 |
$195.00 |
$679.20 |
$300.05
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$484.80 |
$484.80 |
$1,050.00 |
$657.03
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$607.20 |
$607.20 |
$1,050.00 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$173.40 |
$173.40 |
$781.80 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$213.00 |
$213.00 |
$851.40 |
$364.12
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$387.00 |
$387.00 |
$624.00 |
$483.50
|
|
X-ray exam entire spi 4/5 vw
|
$393.60 |
$393.60 |
$393.60 |
$441.48
|
|
X-ray exam entire spi 6/> vw
|
$453.00 |
$453.00 |
$453.00 |
$517.80
|
|
X-ray exam of arm infant
|
$968.40 |
$968.40 |
$968.40 |
$248.44
|
|
X-ray exam of eye sockets
|
$301.80 |
$301.80 |
$716.40 |
$328.35
|
|
X-ray exam of femur 1
|
$169.20 |
$169.20 |
$520.80 |
$240.00
|
|
X-ray exam of jaw joint
|
$171.60 |
$171.60 |
$486.60 |
$188.40
|
|
X-ray exam of mastoids
|
$484.20 |
$484.20 |
$484.20 |
$193.41
|
|
X-ray exam of penis
|
$1,950.00 |
$1,950.00 |
$1,950.00 |
$593.46
|
|
X-ray exam of salivary gland
|
$346.20 |
$346.20 |
$346.20 |
$162.60
|
|
X-ray exam of sinuses
|
$165.00 |
$165.00 |
$659.40 |
$214.50
|
|
X-ray exam of teeth
|
$276.00 |
$276.00 |
$276.00 |
$119.66
|
|
X-ray exam of teeth
|
$276.00 |
$276.00 |
$276.00 |
$328.08
|
|
X-ray exam si joints
|
$191.40 |
$191.40 |
$519.60 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$591.60 |
$591.60 |
$591.60 |
$387.40
|
|
X-ray eye detection foreign body (both sides)
|
$196.80 |
$196.80 |
$289.80 |
$238.29
|
|
X-ray facial bones complete > 3 views
|
$314.40 |
$314.40 |
$676.80 |
$381.75
|
|
X-ray fallopian tube
|
$778.20 |
$778.20 |
$778.20 |
$532.38
|
|
X-ray femur >=2 views (both sides)
|
$204.00 |
$204.00 |
$781.80 |
$317.25
|
|
X-ray finger(s) >= 2 views (both sides)
|
$178.80 |
$178.80 |
$610.20 |
$241.05
|
|
X-ray foot 2 views (both sides)
|
$181.20 |
$181.20 |
$781.80 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$194.40 |
$194.40 |
$781.80 |
$322.20
|
|
X-ray hand 2 views (both sides)
|
$187.20 |
$187.20 |
$781.80 |
$291.20
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$180.60 |
$180.60 |
$781.80 |
$274.95
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$345.00 |
$345.00 |
$921.60 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$295.20 |
$295.20 |
$921.60 |
$374.40
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$297.60 |
$297.60 |
$1,295.40 |
$424.05
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$444.00 |
$444.00 |
$1,454.40 |
$505.60
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$162.60 |
$162.60 |
$365.40 |
$231.00
|
|
X-ray humerus >= 2 views left
|
$204.00 |
$204.00 |
$781.80 |
$309.31
|
|
X-ray joint survey 1 view
|
$553.80 |
$553.80 |
$553.80 |
$232.00
|
|
X-ray knee 1-2 views (both sides)
|
$187.80 |
$187.80 |
$781.80 |
$285.00
|
|
X-ray knee 3 views (both sides)
|
$231.00 |
$231.00 |
$851.40 |
$363.20
|
|
X-ray knee ap standing bilateral
|
$213.00 |
$213.00 |
$406.80 |
$252.50
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$909.60 |
$909.60 |
$909.60 |
$254.12
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$489.60 |
$489.60 |
$489.60 |
$369.15
|
|
X-ray lumbosacral spine >= 4 views
|
$562.80 |
$562.80 |
$562.80 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$636.00 |
$636.00 |
$636.00 |
$535.91
|
|
X-ray mandible complete > 4 views
|
$299.40 |
$299.40 |
$804.00 |
$361.61
|
|
X-ray mandible ltd <4 views
|
$192.60 |
$192.60 |
$676.80 |
$235.30
|
|
X-ray nasal bones complete > 3 views
|
$231.00 |
$231.00 |
$676.80 |
$274.65
|
|
X-ray neck soft tissue
|
$204.00 |
$204.00 |
$519.60 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$405.60 |
$405.60 |
$405.60 |
$225.60
|
|
X-ray of mammary ducts
|
$1,041.00 |
$1,041.00 |
$1,041.00 |
$568.26
|
|
X-ray pelvis 1-2 views
|
$204.00 |
$204.00 |
$568.20 |
$280.80
|
|
X-ray pelvis complete > 3 views
|
$285.60 |
$285.60 |
$663.60 |
$348.19
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$618.60 |
$618.60 |
$912.60 |
$755.50
|
|
X-ray ribs 2 views left
|
$223.20 |
$223.20 |
$538.20 |
$292.80
|
|
X-ray ribs 3 views bilateral
|
$318.00 |
$318.00 |
$602.40 |
$395.76
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$281.40 |
$281.40 |
$624.60 |
$356.20
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$373.80 |
$373.80 |
$624.60 |
$491.70
|
|
X-ray sacroiliac joints >= 3 views
|
$246.00 |
$246.00 |
$545.40 |
$312.75
|
|
X-ray sacrum/coccyx >= 2 views
|
$228.60 |
$228.60 |
$519.60 |
$288.80
|
|
X-ray scapula complete (both sides)
|
$214.80 |
$214.80 |
$814.80 |
$285.00
|
|
X-ray shoulder 1 view (both sides)
|
$163.20 |
$163.20 |
$781.80 |
$260.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$294.60 |
$294.60 |
$676.80 |
$345.60
|
|
X-ray sinus tract/fistula/abscess
|
$609.60 |
$609.60 |
$1,540.20 |
$606.89
|
|
X-ray skull < 4 views
|
$219.60 |
$219.60 |
$659.40 |
$292.50
|
|
X-ray skull > 4 views complete
|
$323.40 |
$323.40 |
$716.40 |
$417.50
|
|
X-ray slg plne bdy sect without urogr
|
$537.00 |
$537.00 |
$2,482.20 |
$399.82
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$429.60 |
$429.60 |
$811.20 |
$557.70
|
|
X-ray small intestine follow-through study
|
$1,050.00 |
$1,050.00 |
$1,050.00 |
$499.50
|
|
X-ray spine single view
|
$381.60 |
$381.60 |
$381.60 |
$251.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$223.80 |
$223.80 |
$565.80 |
$264.48
|
|
X-ray sternum > 2 views
|
$224.40 |
$224.40 |
$565.80 |
$274.65
|
|
X-ray surgical specimen
|
$415.80 |
$415.80 |
$633.60 |
$504.00
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$352.20 |
$352.20 |
$624.00 |
$523.25
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$267.00 |
$267.00 |
$729.60 |
$327.80
|
|
X-ray thoracic spine 2 views
|
$476.40 |
$476.40 |
$476.40 |
$320.45
|
|
X-ray thoracic spine 3 views
|
$547.80 |
$547.80 |
$547.80 |
$381.60
|
|
X-ray thoracolumbar spine >=2 views
|
$232.20 |
$232.20 |
$232.20 |
$282.50
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$306.00 |
$306.00 |
$306.00 |
$257.04
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$354.60 |
$354.60 |
$354.60 |
$352.95
|
|
X-ray tibia/fibula 2 views (both sides)
|
$201.60 |
$201.60 |
$781.80 |
$332.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$166.20 |
$166.20 |
$610.20 |
$258.50
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$519.00 |
$519.00 |
$1,043.40 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$441.00 |
$441.00 |
$929.40 |
$603.20
|
|
X-ray wrist 2 views (both sides)
|
$178.80 |
$178.80 |
$781.80 |
$290.40
|
|
X-ray xm phrnx&/crv esoph c+
|
$624.00 |
$624.00 |
$624.00 |
$354.00
|
|
Xylose absorption test blood &/or urine
|
$285.60 |
$285.60 |
$285.60 |
$99.89
|
|
Zika virus dna/rna amp probe
|
$208.20 |
$208.20 |
$694.80 |
$185.00
|
|
Zika virus igm antibody
|
$448.80 |
$448.80 |
$448.80 |
$85.00
|
