|
Wrist arthroscopy/surgery
|
$9,114.60 |
$9,114.60 |
$9,114.60 |
|
|
Wrist endoscopy/surgery
|
$4,942.18 |
$4,942.18 |
$4,942.18 |
|
|
Wrist X-ray
|
$61.00 |
$285.35 |
$681.00 |
|
|
Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/<
|
$2,004.20 |
$2,004.20 |
$2,004.20 |
|
|
Xm archive tissue molec anal
|
$29.00 |
$91.00 |
$7,367.33 |
|
|
Xpos opn fmrl eprst aor uni add-on
|
$386.00 |
$386.00 |
$386.00 |
|
|
X-ray abdomen 1 view
|
$90.35 |
$136.00 |
$382.20 |
|
|
X-ray abdomen 2 views
|
$136.50 |
$158.73 |
$518.05 |
|
|
X-ray abdomen >=3 views
|
$158.73 |
$177.45 |
$679.25 |
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$99.00 |
$199.80 |
$831.35 |
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$45.00 |
$117.94 |
$388.05 |
|
|
X-ray ankle 2 views (both sides)
|
$34.00 |
$230.51 |
$586.00 |
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$267.14 |
$267.14 |
$3,337.75 |
|
|
X-ray bone age studies
|
$29.00 |
$170.57 |
$359.45 |
|
|
X-ray bone length studies
|
$43.00 |
$150.41 |
$249.60 |
|
|
X-ray bone survey complete
|
$111.00 |
$614.25 |
$1,372.00 |
|
|
X-ray bone survey infant
|
$112.00 |
$318.50 |
$490.00 |
|
|
X-ray cervical spine 2-3 views
|
$41.00 |
$193.70 |
$442.00 |
|
|
X-ray cervical spine 4-5 views
|
$96.00 |
$241.80 |
$585.65 |
|
|
X-ray cervical spine >= 6 views
|
$67.00 |
$445.25 |
$685.00 |
|
|
X-ray clavicle complete (both sides)
|
$50.00 |
$263.25 |
$629.85 |
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$287.68 |
$287.68 |
$1,275.30 |
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$340.40 |
$340.40 |
$1,409.00 |
|
|
X-ray elbow 2 views (both sides)
|
$66.00 |
$233.35 |
$582.40 |
|
|
X-ray elbow >= 3 views (both sides)
|
$58.00 |
$292.50 |
$707.00 |
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$221.54 |
$525.85 |
$876.00 |
|
|
X-ray exam entire spi 4/5 vw
|
$195.36 |
$195.36 |
$1,079.65 |
|
|
X-ray exam entire spi 6/> vw
|
$662.35 |
$692.90 |
$1,066.00 |
|
|
X-ray exam of arm infant
|
$33.00 |
$167.06 |
$439.00 |
|
|
X-ray exam of eye sockets
|
$49.00 |
$74.93 |
$520.00 |
|
|
X-ray exam of femur 1
|
$110.54 |
$174.85 |
$372.00 |
|
|
X-ray exam of jaw joint
|
$37.00 |
$57.44 |
$278.00 |
|
|
X-ray exam of jaw joint
|
$88.00 |
$1,257.00 |
$2,065.70 |
|
|
X-ray exam of mastoids
|
$41.00 |
$48.01 |
$335.40 |
|
|
X-ray exam of middle ear
|
$61.00 |
$61.00 |
$61.00 |
|
|
X-ray exam of penis
|
$66.00 |
$533.65 |
$613.60 |
|
|
X-ray exam of perineum
|
$38.00 |
$160.95 |
$160.95 |
|
|
X-ray exam of salivary gland
|
$43.00 |
$53.47 |
$53.47 |
|
|
X-ray exam of sinuses
|
$36.00 |
$70.67 |
$289.25 |
|
|
X-ray exam of tear duct
|
$22.00 |
$22.00 |
$22.00 |
|
|
X-ray exam of teeth
|
$20.00 |
$20.00 |
$20.00 |
|
|
X-ray exam of teeth
|
$43.00 |
$43.00 |
$43.00 |
|
|
X-ray exam si joints
|
$35.00 |
$120.71 |
$618.80 |
|
|
X-ray exam thorac spine4/>vw
|
$75.00 |
$175.01 |
$429.00 |
|
|
X-ray eye detection foreign body (both sides)
|
$34.00 |
$45.70 |
$242.45 |
|
|
X-ray facial bones complete > 3 views
|
$48.00 |
$224.90 |
$410.00 |
|
|
X-ray fallopian tube
|
$38.00 |
$38.00 |
$750.75 |
|
|
X-ray femur >=2 views (both sides)
|
$232.18 |
$411.45 |
$633.00 |
|
|
X-ray finger(s) >= 2 views (both sides)
|
$54.00 |
$240.32 |
$520.00 |
|
|
X-ray foot 2 views (both sides)
|
$32.00 |
$287.95 |
$638.95 |
|
|
X-ray forearm 2 views (both sides)
|
$69.00 |
$430.30 |
$662.00 |
|
|
X-ray hand 2 views (both sides)
|
$33.00 |
$284.70 |
$555.10 |
|
|
X-ray head for orthodontia
|
$27.00 |
$27.00 |
$27.00 |
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$52.00 |
$220.15 |
$590.00 |
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$161.69 |
$219.05 |
$576.55 |
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$107.67 |
$222.00 |
$539.00 |
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$159.19 |
$310.05 |
$685.00 |
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$384.80 |
$577.85 |
$1,155.70 |
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$43.00 |
$120.90 |
$276.00 |
|
|
X-ray humerus >= 2 views left
|
$45.00 |
$193.70 |
$624.65 |
|
|
X-ray joint survey 1 view
|
$284.16 |
$284.16 |
$284.16 |
|
|
X-ray knee 1-2 views (both sides)
|
$36.00 |
$207.20 |
$597.00 |
|
|
X-ray knee 3 views (both sides)
|
$210.00 |
$243.65 |
$726.00 |
|
|
X-ray knee ap standing bilateral
|
$89.82 |
$155.00 |
$343.00 |
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$33.00 |
$227.92 |
$506.00 |
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$46.00 |
$192.03 |
$512.20 |
|
|
X-ray lumbosacral spine >= 4 views
|
$100.00 |
$288.60 |
$778.00 |
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$69.00 |
$266.22 |
$861.00 |
|
|
X-ray male genital tract
|
$87.00 |
$87.00 |
$87.00 |
|
|
X-ray mandible complete > 4 views
|
$45.00 |
$229.45 |
$568.00 |
|
|
X-ray mandible ltd <4 views
|
$40.00 |
$81.12 |
$274.30 |
|
|
X-ray nasal bones complete > 3 views
|
$39.00 |
$208.65 |
$321.00 |
|
|
X-ray neck soft tissue
|
$34.00 |
$109.15 |
$508.30 |
|
|
X-ray nose to rectum for foreign body child
|
$32.00 |
$200.20 |
$345.00 |
|
|
X-ray of mammary ducts
|
$85.00 |
$233.56 |
$1,032.20 |
|
|
X-ray optic foramina
|
$41.00 |
$41.00 |
$41.00 |
|
|
X-ray pelvis 1-2 views
|
$105.30 |
$154.70 |
$365.00 |
|
|
X-ray pelvis complete > 3 views
|
$74.00 |
$152.10 |
$411.00 |
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$289.25 |
$289.25 |
$1,593.80 |
|
|
X-ray ribs 2 views left
|
$75.00 |
$172.88 |
$450.45 |
|
|
X-ray ribs 3 views bilateral
|
$46.00 |
$386.10 |
$675.35 |
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$66.00 |
$206.74 |
$476.45 |
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$59.00 |
$351.65 |
$608.00 |
|
|
X-ray sacroiliac joints >= 3 views
|
$55.00 |
$266.50 |
$471.00 |
|
|
X-ray sacrum/coccyx >= 2 views
|
$40.00 |
$174.85 |
$397.00 |
|
|
X-ray scapula complete (both sides)
|
$45.00 |
$259.56 |
$642.20 |
|
|
X-ray sella turcica
|
$36.00 |
$126.10 |
$205.40 |
|
|
X-ray shoulder 1 view (both sides)
|
$29.00 |
$224.04 |
$490.75 |
|
|
X-ray sinuses paranasal complete > 3 views
|
$90.00 |
$211.25 |
$508.00 |
|
|
X-ray sinus tract/fistula/abscess
|
$66.00 |
$245.22 |
$895.70 |
|
|
X-ray skull < 4 views
|
$43.00 |
$189.80 |
$325.00 |
|
|
X-ray skull > 4 views complete
|
$78.00 |
$286.00 |
$552.50 |
|
|
X-ray slg plne bdy sect without urogr
|
$105.00 |
$240.59 |
$902.85 |
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$113.00 |
$172.14 |
$1,150.00 |
|
|
X-ray small intestine follow-through study
|
$90.37 |
$90.37 |
$1,071.85 |
|
|
X-ray spine single view
|
$28.00 |
$213.85 |
$329.00 |
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$43.00 |
$125.80 |
$332.00 |
|
|
X-ray sternum > 2 views
|
$41.00 |
$122.85 |
$412.00 |
|
|
X-ray surgical specimen
|
$24.00 |
$209.61 |
$697.45 |
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$240.41 |
$297.70 |
$582.40 |
|
