|
X-ray clavicle complete (both sides)
|
$358.58 |
$358.58 |
$358.58 |
$299.65
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$828.03 |
$828.03 |
$828.03 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$828.03 |
$828.03 |
$828.03 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$304.92 |
$304.92 |
$304.92 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$334.64 |
$334.64 |
$334.64 |
$342.00
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$907.31 |
$907.31 |
$907.31 |
$486.24
|
|
X-ray exam entire spi 4/5 vw
|
$696.89 |
$696.89 |
$696.89 |
$486.01
|
|
X-ray exam entire spi 6/> vw
|
$880.00 |
$880.00 |
$880.00 |
$575.76
|
|
X-ray exam of eye sockets
|
$409.82 |
$409.82 |
$409.82 |
$349.05
|
|
X-ray exam of femur 1
|
$256.83 |
$256.83 |
$256.83 |
$232.36
|
|
X-ray exam si joints
|
$427.77 |
$427.77 |
$427.77 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$591.36 |
$591.36 |
$591.36 |
$395.59
|
|
X-ray eye detection foreign body (both sides)
|
$431.03 |
$431.03 |
$431.03 |
$235.00
|
|
X-ray facial bones complete > 3 views
|
$436.38 |
$436.38 |
$436.38 |
$366.60
|
|
X-ray femur >=2 views (both sides)
|
$330.75 |
$330.75 |
$330.75 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$236.04 |
$236.04 |
$236.04 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$308.49 |
$308.49 |
$308.49 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$290.85 |
$290.85 |
$290.85 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$274.26 |
$274.26 |
$274.26 |
$316.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$281.82 |
$281.82 |
$281.82 |
$270.00
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$707.18 |
$707.18 |
$707.18 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$807.98 |
$807.98 |
$807.98 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$377.37 |
$377.37 |
$377.37 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$279.20 |
$279.20 |
$279.20 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$334.64 |
$334.64 |
$334.64 |
$304.15
|
|
X-ray knee 1-2 views (both sides)
|
$307.34 |
$307.34 |
$307.34 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$358.58 |
$358.58 |
$358.58 |
$353.25
|
|
X-ray knee ap standing bilateral
|
$334.64 |
$334.64 |
$334.64 |
$276.25
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$288.02 |
$288.02 |
$288.02 |
$249.13
|
|
X-ray lumbosacral spine >= 4 views
|
$739.73 |
$739.73 |
$739.73 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$739.73 |
$739.73 |
$739.73 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$427.46 |
$427.46 |
$427.46 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$311.96 |
$311.96 |
$311.96 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$436.38 |
$436.38 |
$436.38 |
$277.70
|
|
X-ray neck soft tissue
|
$463.38 |
$463.38 |
$463.38 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$435.44 |
$435.44 |
$435.44 |
$225.96
|
|
X-ray pelvis 1-2 views
|
$440.48 |
$440.48 |
$440.48 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$576.14 |
$576.14 |
$576.14 |
$342.30
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$1,435.25 |
$1,435.25 |
$1,435.25 |
$742.00
|
|
X-ray ribs 2 views left
|
$378.00 |
$378.00 |
$378.00 |
$296.32
|
|
X-ray ribs 3 views bilateral
|
$551.57 |
$551.57 |
$551.57 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$606.59 |
$606.59 |
$606.59 |
$359.47
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$793.28 |
$793.28 |
$793.28 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$427.77 |
$427.77 |
$427.77 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$440.48 |
$440.48 |
$440.48 |
$285.60
|
|
X-ray scapula complete (both sides)
|
$440.48 |
$440.48 |
$440.48 |
$292.50
|
|
X-ray sinuses paranasal complete > 3 views
|
$497.81 |
$497.81 |
$497.81 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$2,030.28 |
$2,030.28 |
$2,030.28 |
$601.30
|
|
X-ray skull < 4 views
|
$426.41 |
$426.41 |
$426.41 |
$291.78
|
|
X-ray skull > 4 views complete
|
$696.89 |
$696.89 |
$696.89 |
$414.60
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$907.31 |
$907.31 |
$907.31 |
$557.70
|
|
X-ray spine single view
|
$275.31 |
$275.31 |
$275.31 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$427.46 |
$427.46 |
$427.46 |
$263.49
|
|
X-ray sternum > 2 views
|
$334.64 |
$334.64 |
$334.64 |
$269.75
|
|
X-ray surgical specimen
|
$429.87 |
$429.87 |
$429.87 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$1,080.03 |
$1,080.03 |
$1,080.03 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$620.97 |
$620.97 |
$620.97 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$468.51 |
$468.51 |
$468.51 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$550.31 |
$550.31 |
$550.31 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$593.67 |
$593.67 |
$593.67 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$246.50 |
$246.50 |
$246.50 |
$256.85
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$366.87 |
$366.87 |
$366.87 |
$385.80
|
|
X-ray tibia/fibula 2 views (both sides)
|
$440.48 |
$440.48 |
$440.48 |
$328.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$330.12 |
$330.12 |
$330.12 |
$264.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$1,080.03 |
$1,080.03 |
$1,080.03 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$880.43 |
$880.43 |
$880.43 |
$555.04
|
|
X-ray wrist 2 views (both sides)
|
$330.12 |
$330.12 |
$330.12 |
$290.40
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$220.37 |
$220.37 |
$220.37 |
$405.10
|