|
X-ray abdomen >=3 views
|
$97.60 |
$97.60 |
$97.60 |
$342.50
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$93.20 |
$93.20 |
$93.20 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$73.80 |
$73.80 |
$73.80 |
$270.20
|
|
X-ray ankle 2 views (both sides)
|
$57.40 |
$57.40 |
$57.40 |
$282.50
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$250.60 |
$250.60 |
$250.60 |
$773.40
|
|
X-ray bone age studies
|
$56.60 |
$56.60 |
$56.60 |
$251.40
|
|
X-ray bone length studies
|
$71.40 |
$71.40 |
$71.40 |
$285.30
|
|
X-ray bone survey complete
|
$190.60 |
$190.60 |
$190.60 |
$660.00
|
|
X-ray bone survey infant
|
$74.00 |
$74.00 |
$74.00 |
$394.69
|
|
X-ray cervical spine 2-3 views
|
$71.40 |
$71.40 |
$71.40 |
$333.83
|
|
X-ray cervical spine 4-5 views
|
$124.80 |
$124.80 |
$124.80 |
$457.05
|
|
X-ray cervical spine >= 6 views
|
$138.60 |
$138.60 |
$138.60 |
$508.50
|
|
X-ray clavicle complete (both sides)
|
$77.00 |
$77.00 |
$77.00 |
$300.05
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$129.20 |
$129.20 |
$129.20 |
$657.03
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$246.20 |
$246.20 |
$246.20 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$56.60 |
$56.60 |
$56.60 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$74.00 |
$74.00 |
$74.00 |
$364.12
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$113.20 |
$113.20 |
$113.20 |
$483.50
|
|
X-ray exam entire spi 4/5 vw
|
$126.20 |
$126.20 |
$126.20 |
$441.48
|
|
X-ray exam entire spi 6/> vw
|
$145.60 |
$145.60 |
$145.60 |
$517.80
|
|
X-ray exam of arm infant
|
$56.60 |
$56.60 |
$56.60 |
$248.44
|
|
X-ray exam of eye sockets
|
$56.60 |
$56.60 |
$56.60 |
$328.35
|
|
X-ray exam of femur 1
|
$47.20 |
$47.20 |
$47.20 |
$240.00
|
|
X-ray exam of jaw joint
|
$34.60 |
$34.60 |
$34.60 |
$188.40
|
|
X-ray exam of sinuses
|
$56.60 |
$56.60 |
$56.60 |
$214.50
|
|
X-ray exam si joints
|
$38.20 |
$38.20 |
$38.20 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$111.60 |
$111.60 |
$111.60 |
$387.40
|
|
X-ray eye detection foreign body (both sides)
|
$109.40 |
$109.40 |
$109.40 |
$238.29
|
|
X-ray facial bones complete > 3 views
|
$83.40 |
$83.40 |
$83.40 |
$381.75
|
|
X-ray femur >=2 views (both sides)
|
$85.20 |
$85.20 |
$85.20 |
$317.25
|
|
X-ray finger(s) >= 2 views (both sides)
|
$50.80 |
$50.80 |
$50.80 |
$241.05
|
|
X-ray foot 2 views (both sides)
|
$53.60 |
$53.60 |
$53.60 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$56.60 |
$56.60 |
$56.60 |
$322.20
|
|
X-ray hand 2 views (both sides)
|
$56.60 |
$56.60 |
$56.60 |
$291.20
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$38.60 |
$38.60 |
$38.60 |
$274.95
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$113.80 |
$113.80 |
$113.80 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$99.60 |
$99.60 |
$99.60 |
$374.40
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$113.80 |
$113.80 |
$113.80 |
$424.05
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$131.80 |
$131.80 |
$131.80 |
$505.60
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$52.60 |
$52.60 |
$52.60 |
$231.00
|
|
X-ray humerus >= 2 views left
|
$56.60 |
$56.60 |
$56.60 |
$309.31
|
|
X-ray knee 1-2 views (both sides)
|
$74.00 |
$74.00 |
$74.00 |
$285.00
|
|
X-ray knee 3 views (both sides)
|
$71.40 |
$71.40 |
$71.40 |
$363.20
|
|
X-ray knee ap standing bilateral
|
$59.20 |
$59.20 |
$59.20 |
$252.50
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$61.20 |
$61.20 |
$61.20 |
$254.12
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$57.40 |
$57.40 |
$57.40 |
$369.15
|
|
X-ray lumbosacral spine >= 4 views
|
$138.60 |
$138.60 |
$138.60 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$162.20 |
$162.20 |
$162.20 |
$535.91
|
|
X-ray mandible complete > 4 views
|
$90.80 |
$90.80 |
$90.80 |
$361.61
|
|
X-ray mandible ltd <4 views
|
$52.60 |
$52.60 |
$52.60 |
$235.30
|
|
X-ray nasal bones complete > 3 views
|
$64.80 |
$64.80 |
$64.80 |
$274.65
|
|
X-ray neck soft tissue
|
$93.20 |
$93.20 |
$93.20 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$88.00 |
$88.00 |
$88.00 |
$225.60
|
|
X-ray pelvis 1-2 views
|
$76.60 |
$76.60 |
$76.60 |
$280.80
|
|
X-ray pelvis complete > 3 views
|
$77.20 |
$77.20 |
$77.20 |
$348.19
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$123.00 |
$123.00 |
$123.00 |
$755.50
|
|
X-ray ribs 2 views left
|
$66.00 |
$66.00 |
$66.00 |
$292.80
|
|
X-ray ribs 3 views bilateral
|
$74.40 |
$74.40 |
$74.40 |
$395.76
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$97.80 |
$97.80 |
$97.80 |
$356.20
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$102.80 |
$102.80 |
$102.80 |
$491.70
|
|
X-ray sacroiliac joints >= 3 views
|
$71.40 |
$71.40 |
$71.40 |
$312.75
|
|
X-ray sacrum/coccyx >= 2 views
|
$71.40 |
$71.40 |
$71.40 |
$288.80
|
|
X-ray scapula complete (both sides)
|
$77.00 |
$77.00 |
$77.00 |
$285.00
|
|
X-ray shoulder 1 view (both sides)
|
$39.80 |
$39.80 |
$39.80 |
$260.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$86.60 |
$86.60 |
$86.60 |
$345.60
|
|
X-ray sinus tract/fistula/abscess
|
$263.20 |
$263.20 |
$263.20 |
$606.89
|
|
X-ray skull < 4 views
|
$68.20 |
$68.20 |
$68.20 |
$292.50
|
|
X-ray skull > 4 views complete
|
$104.60 |
$104.60 |
$104.60 |
$417.50
|
|
X-ray slg plne bdy sect without urogr
|
$129.00 |
$129.00 |
$129.00 |
$399.82
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$118.80 |
$118.80 |
$118.80 |
$557.70
|
|
X-ray small intestine follow-through study
|
$139.60 |
$139.60 |
$139.60 |
$499.50
|
|
X-ray spine single view
|
$43.60 |
$43.60 |
$43.60 |
$251.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$74.40 |
$74.40 |
$74.40 |
$264.48
|
|
X-ray sternum > 2 views
|
$64.20 |
$64.20 |
$64.20 |
$274.65
|
|
X-ray surgical specimen
|
$303.00 |
$303.00 |
$303.00 |
$504.00
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$86.40 |
$86.40 |
$86.40 |
$523.25
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$81.00 |
$81.00 |
$81.00 |
$327.80
|
|
X-ray thoracic spine 2 views
|
$93.20 |
$93.20 |
$93.20 |
$320.45
|
|
X-ray thoracic spine 3 views
|
$139.80 |
$139.80 |
$139.80 |
$381.60
|
|
X-ray thoracolumbar spine >=2 views
|
$77.20 |
$77.20 |
$77.20 |
$282.50
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$79.40 |
$79.40 |
$79.40 |
$257.04
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$88.00 |
$88.00 |
$88.00 |
$352.95
|
|
X-ray tibia/fibula 2 views (both sides)
|
$87.80 |
$87.80 |
$87.80 |
$332.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$38.20 |
$38.20 |
$38.20 |
$258.50
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$269.40 |
$269.40 |
$269.40 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$235.00 |
$235.00 |
$235.00 |
$603.20
|
|
X-ray upper gi delay w/kub
|
$213.80 |
$213.80 |
$213.80 |
$247.02
|
|
X-ray upper gi&small intest
|
$303.20 |
$303.20 |
$303.20 |
$697.56
|
|
X-ray wrist 2 views (both sides)
|
$56.60 |
$56.60 |
$56.60 |
$290.40
|
|
Yersinia antibody
|
$55.20 |
$55.20 |
$55.20 |
$55.80
|
|
Zika virus dna/rna amp probe
|
$32.00 |
$32.00 |
$32.00 |
$185.00
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$17.41 |
$17.41 |
$17.41 |
$122.45
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$243.00 |
$243.00 |
$243.00 |
$452.69
|
