|
Wrist endoscopy/surgery
|
$754.40 |
$754.40 |
$754.40 |
|
|
Wrist X-ray
|
$202.40 |
$202.40 |
$239.20 |
|
|
Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/<
|
$1,142.40 |
$1,142.40 |
$2,488.00 |
|
|
Xfer tis s/a/l 10 sq cm/<
|
$1,056.80 |
$1,056.80 |
$2,381.60 |
|
|
Xpos opn axillary/sbclvn art w/cndt crtn
|
$737.60 |
$737.60 |
$737.60 |
|
|
Xpos opn fmrl eprst aor uni add-on
|
$1,379.20 |
$1,379.20 |
$1,379.20 |
|
|
X-ray abdomen 1 view
|
$180.00 |
$180.00 |
$236.00 |
|
|
X-ray abdomen 2 views
|
$188.80 |
$188.80 |
$267.20 |
|
|
X-ray abdomen >=3 views
|
$312.80 |
$312.80 |
$324.00 |
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$355.20 |
$355.20 |
$546.40 |
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$242.40 |
$242.40 |
$263.20 |
|
|
X-ray ankle 2 views (both sides)
|
$179.20 |
$179.20 |
$182.40 |
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$468.80 |
$468.80 |
$636.80 |
|
|
X-ray bone age studies
|
$252.80 |
$252.80 |
$293.60 |
|
|
X-ray bone length studies
|
$384.80 |
$384.80 |
$541.60 |
|
|
X-ray bone survey complete
|
$552.00 |
$552.00 |
$902.40 |
|
|
X-ray bone survey infant
|
$191.20 |
$191.20 |
$218.40 |
|
|
X-ray cervical spine 2-3 views
|
$182.40 |
$182.40 |
$241.60 |
|
|
X-ray cervical spine 4-5 views
|
$256.00 |
$256.00 |
$359.20 |
|
|
X-ray cervical spine >= 6 views
|
$394.40 |
$394.40 |
$423.20 |
|
|
X-ray clavicle complete (both sides)
|
$172.80 |
$172.80 |
$196.00 |
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$480.80 |
$480.80 |
$760.80 |
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$636.00 |
$636.00 |
$1,031.20 |
|
|
X-ray elbow 2 views (both sides)
|
$182.40 |
$182.40 |
$192.00 |
|
|
X-ray elbow >= 3 views (both sides)
|
$182.40 |
$182.40 |
$193.60 |
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$386.40 |
$386.40 |
$657.60 |
|
|
X-ray exam entire spi 4/5 vw
|
$436.80 |
$436.80 |
$558.40 |
|
|
X-ray exam entire spi 6/> vw
|
$436.80 |
$436.80 |
$558.40 |
|
|
X-ray exam of arm infant
|
$171.20 |
$171.20 |
$193.60 |
|
|
X-ray exam of eye sockets
|
$181.60 |
$181.60 |
$282.40 |
|
|
X-ray exam of femur 1
|
$139.20 |
$139.20 |
$178.40 |
|
|
X-ray exam of jaw joint
|
$133.60 |
$133.60 |
$137.60 |
|
|
X-ray exam of jaw joint
|
$619.20 |
$619.20 |
$619.20 |
|
|
X-ray exam of sinuses
|
$192.00 |
$192.00 |
$196.00 |
|
|
X-ray exam si joints
|
$141.60 |
$141.60 |
$204.80 |
|
|
X-ray exam thorac spine4/>vw
|
$268.80 |
$268.80 |
$304.80 |
|
|
X-ray eye detection foreign body (both sides)
|
$371.20 |
$371.20 |
$371.20 |
|
|
X-ray facial bones complete > 3 views
|
$318.40 |
$318.40 |
$455.20 |
|
|
X-ray femur >=2 views (both sides)
|
$178.40 |
$178.40 |
$182.40 |
|
|
X-ray finger(s) >= 2 views (both sides)
|
$182.40 |
$182.40 |
$236.00 |
|
|
X-ray foot 2 views (both sides)
|
$172.80 |
$172.80 |
$182.40 |
|
|
X-ray forearm 2 views (both sides)
|
$182.40 |
$182.40 |
$203.20 |
|
|
X-ray hand 2 views (both sides)
|
$169.60 |
$169.60 |
$256.00 |
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$179.20 |
$179.20 |
$192.00 |
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$249.60 |
$249.60 |
$294.40 |
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$230.40 |
$230.40 |
$294.40 |
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$230.40 |
$230.40 |
$294.40 |
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$436.80 |
$436.80 |
$558.40 |
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$160.80 |
$160.80 |
$202.40 |
|
|
X-ray humerus >= 2 views left
|
$182.40 |
$182.40 |
$193.60 |
|
|
X-ray joint survey 1 view
|
$121.60 |
$121.60 |
$256.00 |
|
|
X-ray knee 1-2 views (both sides)
|
$182.40 |
$182.40 |
$192.00 |
|
|
X-ray knee 3 views (both sides)
|
$182.40 |
$182.40 |
$193.60 |
|
|
X-ray knee ap standing bilateral
|
$153.60 |
$153.60 |
$155.20 |
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$171.20 |
$171.20 |
$193.60 |
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$256.00 |
$256.00 |
$309.60 |
|
|
X-ray lumbosacral spine >= 4 views
|
$256.00 |
$256.00 |
$330.40 |
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$473.60 |
$473.60 |
$492.80 |
|
|
X-ray mandible complete > 4 views
|
$345.60 |
$345.60 |
$458.40 |
|
|
X-ray mandible ltd <4 views
|
$176.80 |
$176.80 |
$278.40 |
|
|
X-ray nasal bones complete > 3 views
|
$208.80 |
$208.80 |
$210.40 |
|
|
X-ray neck soft tissue
|
$207.20 |
$207.20 |
$224.80 |
|
|
X-ray nose to rectum for foreign body child
|
$118.40 |
$118.40 |
$141.60 |
|
|
X-ray pelvis 1-2 views
|
$198.40 |
$198.40 |
$256.00 |
|
|
X-ray pelvis complete > 3 views
|
$223.20 |
$223.20 |
$277.60 |
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$512.00 |
$512.00 |
$621.60 |
|
|
X-ray ribs 2 views left
|
$216.00 |
$216.00 |
$308.80 |
|
|
X-ray ribs 3 views bilateral
|
$342.40 |
$342.40 |
$560.80 |
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$256.00 |
$256.00 |
$357.60 |
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$356.80 |
$356.80 |
$585.60 |
|
|
X-ray sacroiliac joints >= 3 views
|
$204.80 |
$204.80 |
$256.00 |
|
|
X-ray sacrum/coccyx >= 2 views
|
$237.60 |
$237.60 |
$251.20 |
|
|
X-ray scapula complete (both sides)
|
$198.40 |
$198.40 |
$252.80 |
|
|
X-ray shoulder 1 view (both sides)
|
$172.80 |
$172.80 |
$220.00 |
|
|
X-ray sinuses paranasal complete > 3 views
|
$219.20 |
$219.20 |
$290.40 |
|
|
X-ray sinus tract/fistula/abscess
|
$445.60 |
$445.60 |
$632.80 |
|
|
X-ray skull < 4 views
|
$212.80 |
$212.80 |
$225.60 |
|
|
X-ray skull > 4 views complete
|
$282.40 |
$282.40 |
$330.40 |
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$473.60 |
$473.60 |
$660.00 |
|
|
X-ray small intestine follow-through study
|
$517.60 |
$517.60 |
$628.00 |
|
|
X-ray spine single view
|
$165.60 |
$165.60 |
$182.40 |
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$174.40 |
$174.40 |
$250.40 |
|
|
X-ray sternum > 2 views
|
$234.40 |
$234.40 |
$276.80 |
|
|
X-ray surgical specimen
|
$224.80 |
$224.80 |
$770.40 |
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$432.80 |
$432.80 |
$475.20 |
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$333.60 |
$333.60 |
$336.80 |
|
|
X-ray thoracic spine 2 views
|
$165.60 |
$165.60 |
$256.00 |
|
|
X-ray thoracic spine 3 views
|
$239.20 |
$239.20 |
$256.00 |
|
|
X-ray thoracolumbar spine >=2 views
|
$223.20 |
$223.20 |
$228.80 |
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$139.20 |
$139.20 |
$178.40 |
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$230.40 |
$230.40 |
$294.40 |
|
|
X-ray tibia/fibula 2 views (both sides)
|
$182.40 |
$182.40 |
$192.00 |
|
|
X-ray toe(s) > 2 views (both sides)
|
$148.00 |
$148.00 |
$184.00 |
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$432.80 |
$432.80 |
$652.00 |
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$519.20 |
$519.20 |
$602.40 |
|
|
X-ray wrist 2 views (both sides)
|
$188.80 |
$188.80 |
$190.40 |
|
|
Xylose absorption test blood &/or urine
|
$193.60 |
$193.60 |
$193.60 |
|
|
Yersinia antibody
|
$55.20 |
$55.20 |
$55.20 |
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$168.40 |
$168.40 |
$168.40 |
|
|
Zika virus dna/rna amp probe
|
$366.40 |
$366.40 |
$366.40 |
|