|
Xpos opn fmrl eprst aor uni add-on
|
$5,359.12 |
$5,359.12 |
$5,359.12 |
$2,160.89
|
|
X-ray abdomen 1 view
|
$701.37 |
$701.37 |
$701.37 |
$255.00
|
|
X-ray abdomen 2 views
|
$863.22 |
$863.22 |
$863.22 |
$312.36
|
|
X-ray abdomen >=3 views
|
$1,025.07 |
$1,025.07 |
$1,025.07 |
$332.15
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$1,213.90 |
$1,213.90 |
$1,213.90 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$1,061.26 |
$1,061.26 |
$1,061.26 |
$271.44
|
|
X-ray ankle 2 views (both sides)
|
$374.88 |
$374.88 |
$374.88 |
$283.00
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$1,342.03 |
$1,342.03 |
$1,342.03 |
$768.30
|
|
X-ray bone age studies
|
$651.32 |
$651.32 |
$651.32 |
$246.75
|
|
X-ray bone survey complete
|
$2,532.06 |
$2,532.06 |
$2,532.06 |
$666.60
|
|
X-ray bone survey infant
|
$759.20 |
$759.20 |
$759.20 |
$410.73
|
|
X-ray cervical spine 2-3 views
|
$680.98 |
$680.98 |
$680.98 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$1,472.56 |
$1,472.56 |
$1,472.56 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$1,641.11 |
$1,641.11 |
$1,641.11 |
$515.35
|
|
X-ray clavicle complete (both sides)
|
$714.69 |
$714.69 |
$714.69 |
$299.65
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$2,456.97 |
$2,456.97 |
$2,456.97 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$2,999.21 |
$2,999.21 |
$2,999.21 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$791.14 |
$791.14 |
$791.14 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$916.37 |
$916.37 |
$916.37 |
$342.00
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$976.84 |
$976.84 |
$976.84 |
$486.24
|
|
X-ray exam entire spi 6/> vw
|
$611.40 |
$611.40 |
$611.40 |
$575.76
|
|
X-ray exam of arm infant
|
$465.23 |
$465.23 |
$465.23 |
$248.82
|
|
X-ray exam of eye sockets
|
$725.80 |
$725.80 |
$725.80 |
$349.05
|
|
X-ray exam of femur 1
|
$519.16 |
$519.16 |
$519.16 |
$232.36
|
|
X-ray exam of jaw joint
|
$585.25 |
$585.25 |
$585.25 |
$192.39
|
|
X-ray exam of sinuses
|
$838.76 |
$838.76 |
$838.76 |
$211.00
|
|
X-ray exam of tear duct
|
$2,651.15 |
$2,651.15 |
$2,651.15 |
$340.70
|
|
X-ray exam si joints
|
$508.54 |
$508.54 |
$508.54 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$1,387.59 |
$1,387.59 |
$1,387.59 |
$395.59
|
|
X-ray eye detection foreign body (both sides)
|
$980.63 |
$980.63 |
$980.63 |
$235.00
|
|
X-ray facial bones complete > 3 views
|
$1,243.30 |
$1,243.30 |
$1,243.30 |
$366.60
|
|
X-ray femur >=2 views (both sides)
|
$1,090.93 |
$1,090.93 |
$1,090.93 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$608.16 |
$608.16 |
$608.16 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$785.98 |
$785.98 |
$785.98 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$915.63 |
$915.63 |
$915.63 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$347.51 |
$347.51 |
$347.51 |
$316.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$729.53 |
$729.53 |
$729.53 |
$270.00
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$2,094.50 |
$2,094.50 |
$2,094.50 |
$370.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$993.42 |
$993.42 |
$993.42 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$1,303.86 |
$1,303.86 |
$1,303.86 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$1,396.99 |
$1,396.99 |
$1,396.99 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$652.67 |
$652.67 |
$652.67 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$486.72 |
$486.72 |
$486.72 |
$304.15
|
|
X-ray knee 1-2 views (both sides)
|
$928.35 |
$928.35 |
$928.35 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$966.52 |
$966.52 |
$966.52 |
$353.25
|
|
X-ray knee ap standing bilateral
|
$509.73 |
$509.73 |
$509.73 |
$276.25
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$539.39 |
$539.39 |
$539.39 |
$249.13
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$1,157.01 |
$1,157.01 |
$1,157.01 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$1,064.47 |
$1,064.47 |
$1,064.47 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$1,237.08 |
$1,237.08 |
$1,237.08 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$1,061.26 |
$1,061.26 |
$1,061.26 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$745.71 |
$745.71 |
$745.71 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$890.01 |
$890.01 |
$890.01 |
$277.70
|
|
X-ray neck soft tissue
|
$558.71 |
$558.71 |
$558.71 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$1,351.71 |
$1,351.71 |
$1,351.71 |
$225.96
|
|
X-ray pelvis 1-2 views
|
$663.45 |
$663.45 |
$663.45 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$663.45 |
$663.45 |
$663.45 |
$342.30
|
|
X-ray ribs 2 views left
|
$926.42 |
$926.42 |
$926.42 |
$296.32
|
|
X-ray ribs 3 views bilateral
|
$796.96 |
$796.96 |
$796.96 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$1,161.06 |
$1,161.06 |
$1,161.06 |
$359.47
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$1,548.07 |
$1,548.07 |
$1,548.07 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$678.06 |
$678.06 |
$678.06 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$790.22 |
$790.22 |
$790.22 |
$285.60
|
|
X-ray scapula complete (both sides)
|
$890.01 |
$890.01 |
$890.01 |
$292.50
|
|
X-ray shoulder 1 view (both sides)
|
$822.59 |
$822.59 |
$822.59 |
$264.48
|
|
X-ray sinuses paranasal complete > 3 views
|
$1,374.11 |
$1,374.11 |
$1,374.11 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$1,276.00 |
$1,276.00 |
$1,276.00 |
$601.30
|
|
X-ray skull < 4 views
|
$819.89 |
$819.89 |
$819.89 |
$291.78
|
|
X-ray skull > 4 views complete
|
$1,347.16 |
$1,347.16 |
$1,347.16 |
$414.60
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$1,079.57 |
$1,079.57 |
$1,079.57 |
$557.70
|
|
X-ray small intestine follow-through study
|
$1,079.57 |
$1,079.57 |
$1,079.57 |
$504.14
|
|
X-ray spine single view
|
$691.77 |
$691.77 |
$691.77 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$640.54 |
$640.54 |
$640.54 |
$263.49
|
|
X-ray sternum > 2 views
|
$888.65 |
$888.65 |
$888.65 |
$269.75
|
|
X-ray surgical specimen
|
$304.13 |
$304.13 |
$304.13 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$1,220.13 |
$1,220.13 |
$1,220.13 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$841.46 |
$841.46 |
$841.46 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$591.99 |
$591.99 |
$591.99 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$1,061.26 |
$1,061.26 |
$1,061.26 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$528.60 |
$528.60 |
$528.60 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$466.33 |
$466.33 |
$466.33 |
$385.80
|
|
X-ray tibia/fibula 2 views (both sides)
|
$885.39 |
$885.39 |
$885.39 |
$328.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$547.49 |
$547.49 |
$547.49 |
$264.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$2,649.32 |
$2,649.32 |
$2,649.32 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$1,731.89 |
$1,731.89 |
$1,731.89 |
$555.04
|
|
X-ray wrist 2 views (both sides)
|
$541.20 |
$541.20 |
$541.20 |
$290.40
|
|
X-ray xm phrnx&/crv esoph c+
|
$976.84 |
$976.84 |
$976.84 |
$324.20
|
|
Zika virus igm antibody
|
$206.67 |
$206.67 |
$206.67 |
$75.40
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$679.59 |
$679.59 |
$679.59 |
$405.10
|