|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$2,860.50 |
$2,860.50 |
$2,860.50 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$543.00 |
$543.00 |
$543.00 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$773.50 |
$773.50 |
$773.50 |
$364.12
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$1,249.00 |
$1,249.00 |
$1,249.00 |
$483.50
|
|
X-ray exam entire spi 4/5 vw
|
$1,226.00 |
$1,226.00 |
$1,226.00 |
$441.48
|
|
X-ray exam entire spi 6/> vw
|
$1,487.00 |
$1,487.00 |
$1,487.00 |
$517.80
|
|
X-ray exam of arm infant
|
$461.50 |
$461.50 |
$461.50 |
$248.44
|
|
X-ray exam of eye sockets
|
$789.00 |
$789.00 |
$789.00 |
$328.35
|
|
X-ray exam of femur 1
|
$495.00 |
$495.00 |
$495.00 |
$240.00
|
|
X-ray exam of perineum
|
$907.50 |
$907.50 |
$907.50 |
$577.85
|
|
X-ray exam of sinuses
|
$442.50 |
$442.50 |
$442.50 |
$214.50
|
|
X-ray exam thorac spine4/>vw
|
$858.00 |
$858.00 |
$858.00 |
$387.40
|
|
X-ray eye detection foreign body (both sides)
|
$429.50 |
$429.50 |
$429.50 |
$238.29
|
|
X-ray facial bones complete > 3 views
|
$858.00 |
$858.00 |
$858.00 |
$381.75
|
|
X-ray femur >=2 views (both sides)
|
$612.00 |
$612.00 |
$612.00 |
$317.25
|
|
X-ray finger(s) >= 2 views (both sides)
|
$497.50 |
$497.50 |
$497.50 |
$241.05
|
|
X-ray foot 2 views (both sides)
|
$636.00 |
$636.00 |
$636.00 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$631.00 |
$631.00 |
$631.00 |
$322.20
|
|
X-ray hand 2 views (both sides)
|
$477.00 |
$477.00 |
$477.00 |
$291.20
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$615.50 |
$615.50 |
$615.50 |
$274.95
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$602.50 |
$602.50 |
$602.50 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$902.50 |
$902.50 |
$902.50 |
$374.40
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$1,187.50 |
$1,187.50 |
$1,187.50 |
$424.05
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$1,374.50 |
$1,374.50 |
$1,374.50 |
$505.60
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$435.50 |
$435.50 |
$435.50 |
$231.00
|
|
X-ray humerus >= 2 views left
|
$632.50 |
$632.50 |
$632.50 |
$309.31
|
|
X-ray knee 1-2 views (both sides)
|
$598.00 |
$598.00 |
$598.00 |
$285.00
|
|
X-ray knee 3 views (both sides)
|
$732.00 |
$732.00 |
$732.00 |
$363.20
|
|
X-ray knee ap standing bilateral
|
$708.50 |
$708.50 |
$708.50 |
$252.50
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$338.00 |
$338.00 |
$338.00 |
$254.12
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$497.00 |
$497.00 |
$497.00 |
$369.15
|
|
X-ray lumbosacral spine >= 4 views
|
$1,152.00 |
$1,152.00 |
$1,152.00 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$1,180.00 |
$1,180.00 |
$1,180.00 |
$535.91
|
|
X-ray mandible complete > 4 views
|
$855.50 |
$855.50 |
$855.50 |
$361.61
|
|
X-ray mandible ltd <4 views
|
$673.50 |
$673.50 |
$673.50 |
$235.30
|
|
X-ray nasal bones complete > 3 views
|
$522.50 |
$522.50 |
$522.50 |
$274.65
|
|
X-ray neck soft tissue
|
$594.50 |
$594.50 |
$594.50 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$532.00 |
$532.00 |
$532.00 |
$225.60
|
|
X-ray of mammary ducts
|
$1,200.00 |
$1,200.00 |
$1,200.00 |
$568.26
|
|
X-ray pelvis 1-2 views
|
$596.00 |
$596.00 |
$596.00 |
$280.80
|
|
X-ray pelvis complete > 3 views
|
$733.50 |
$733.50 |
$733.50 |
$348.19
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$1,952.50 |
$1,952.50 |
$1,952.50 |
$755.50
|
|
X-ray ribs 2 views left
|
$651.50 |
$651.50 |
$651.50 |
$292.80
|
|
X-ray ribs 3 views bilateral
|
$939.50 |
$939.50 |
$939.50 |
$395.76
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$770.50 |
$770.50 |
$770.50 |
$356.20
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$894.00 |
$894.00 |
$894.00 |
$491.70
|
|
X-ray sacroiliac joints >= 3 views
|
$657.50 |
$657.50 |
$657.50 |
$312.75
|
|
X-ray sacrum/coccyx >= 2 views
|
$583.50 |
$583.50 |
$583.50 |
$288.80
|
|
X-ray scapula complete (both sides)
|
$671.00 |
$671.00 |
$671.00 |
$285.00
|
|
X-ray shoulder 1 view (both sides)
|
$492.50 |
$492.50 |
$492.50 |
$260.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$761.50 |
$761.50 |
$761.50 |
$345.60
|
|
X-ray sinus tract/fistula/abscess
|
$1,200.50 |
$1,200.50 |
$1,200.50 |
$606.89
|
|
X-ray skull < 4 views
|
$729.50 |
$729.50 |
$729.50 |
$292.50
|
|
X-ray skull > 4 views complete
|
$1,153.50 |
$1,153.50 |
$1,153.50 |
$417.50
|
|
X-ray slg plne bdy sect without urogr
|
$641.00 |
$641.00 |
$641.00 |
$399.82
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$1,522.00 |
$1,522.00 |
$1,522.00 |
$557.70
|
|
X-ray small intestine follow-through study
|
$2,596.00 |
$2,596.00 |
$2,596.00 |
$499.50
|
|
X-ray spine single view
|
$535.50 |
$535.50 |
$535.50 |
$251.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$370.00 |
$370.00 |
$370.00 |
$264.48
|
|
X-ray sternum > 2 views
|
$572.50 |
$572.50 |
$572.50 |
$274.65
|
|
X-ray surgical specimen
|
$1,450.00 |
$1,450.00 |
$1,450.00 |
$504.00
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$1,176.00 |
$1,176.00 |
$1,176.00 |
$523.25
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$839.50 |
$839.50 |
$839.50 |
$327.80
|
|
X-ray thoracic spine 2 views
|
$726.50 |
$726.50 |
$726.50 |
$320.45
|
|
X-ray thoracic spine 3 views
|
$899.50 |
$899.50 |
$899.50 |
$381.60
|
|
X-ray thoracolumbar spine >=2 views
|
$615.50 |
$615.50 |
$615.50 |
$282.50
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$695.00 |
$695.00 |
$695.00 |
$257.04
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$927.50 |
$927.50 |
$927.50 |
$352.95
|
|
X-ray tibia/fibula 2 views (both sides)
|
$782.50 |
$782.50 |
$782.50 |
$332.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$468.00 |
$468.00 |
$468.00 |
$258.50
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$1,732.00 |
$1,732.00 |
$1,732.00 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$1,502.50 |
$1,502.50 |
$1,502.50 |
$603.20
|
|
X-ray upper gi delay w/kub
|
$668.50 |
$668.50 |
$668.50 |
$247.02
|
|
X-ray upper gi&small intest
|
$1,502.00 |
$1,502.00 |
$1,502.00 |
$697.56
|
|
X-ray wrist 2 views (both sides)
|
$484.00 |
$484.00 |
$484.00 |
$290.40
|
|
Xylose absorption test blood &/or urine
|
$183.50 |
$183.50 |
$183.50 |
$99.89
|
|
Zika virus dna/rna amp probe
|
$342.50 |
$342.50 |
$342.50 |
$185.00
|
|
Zika virus igm antibody
|
$85.00 |
$85.00 |
$85.00 |
$85.00
|