|
X-ray abdomen 2 views
|
$850.70 |
$850.70 |
$850.70 |
$312.36
|
|
X-ray abdomen >=3 views
|
$646.31 |
$646.31 |
$646.31 |
$332.15
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$920.90 |
$920.90 |
$920.90 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$570.08 |
$570.08 |
$570.08 |
$271.44
|
|
X-ray ankle 2 views (both sides)
|
$479.22 |
$479.22 |
$479.22 |
$283.00
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$781.55 |
$781.55 |
$781.55 |
$768.30
|
|
X-ray bone age studies
|
$417.90 |
$417.90 |
$417.90 |
$246.75
|
|
X-ray bone length studies
|
$679.13 |
$679.13 |
$679.13 |
$287.25
|
|
X-ray bone survey complete
|
$1,533.13 |
$1,533.13 |
$1,533.13 |
$666.60
|
|
X-ray bone survey infant
|
$1,137.92 |
$1,137.92 |
$1,137.92 |
$410.73
|
|
X-ray cervical spine 2-3 views
|
$735.88 |
$735.88 |
$735.88 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$942.59 |
$942.59 |
$942.59 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$1,087.95 |
$1,087.95 |
$1,087.95 |
$515.35
|
|
X-ray clavicle complete (both sides)
|
$392.91 |
$392.91 |
$392.91 |
$299.65
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$1,110.87 |
$1,110.87 |
$1,110.87 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$1,577.52 |
$1,577.52 |
$1,577.52 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$575.95 |
$575.95 |
$575.95 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$613.26 |
$613.26 |
$613.26 |
$342.00
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$838.31 |
$838.31 |
$838.31 |
$486.24
|
|
X-ray exam of arm infant
|
$415.64 |
$415.64 |
$415.64 |
$248.82
|
|
X-ray exam of eye sockets
|
$813.13 |
$813.13 |
$813.13 |
$349.05
|
|
X-ray exam of femur 1
|
$383.85 |
$383.85 |
$383.85 |
$232.36
|
|
X-ray exam of jaw joint
|
$1,036.04 |
$1,036.04 |
$1,036.04 |
$192.39
|
|
X-ray exam of sinuses
|
$830.26 |
$830.26 |
$830.26 |
$211.00
|
|
X-ray exam si joints
|
$627.75 |
$627.75 |
$627.75 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$872.16 |
$872.16 |
$872.16 |
$395.59
|
|
X-ray facial bones complete > 3 views
|
$583.72 |
$583.72 |
$583.72 |
$366.60
|
|
X-ray femur >=2 views (both sides)
|
$590.52 |
$590.52 |
$590.52 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$463.32 |
$463.32 |
$463.32 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$440.62 |
$440.62 |
$440.62 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$522.39 |
$522.39 |
$522.39 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$495.15 |
$495.15 |
$495.15 |
$316.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$461.06 |
$461.06 |
$461.06 |
$270.00
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$2,314.98 |
$2,314.98 |
$2,314.98 |
$370.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$842.65 |
$842.65 |
$842.65 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$353.83 |
$353.83 |
$353.83 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$1,412.06 |
$1,412.06 |
$1,412.06 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$383.85 |
$383.85 |
$383.85 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$536.20 |
$536.20 |
$536.20 |
$304.15
|
|
X-ray knee 1-2 views (both sides)
|
$558.73 |
$558.73 |
$558.73 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$570.08 |
$570.08 |
$570.08 |
$353.25
|
|
X-ray knee ap standing bilateral
|
$922.15 |
$922.15 |
$922.15 |
$276.25
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$440.62 |
$440.62 |
$440.62 |
$249.13
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$814.45 |
$814.45 |
$814.45 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$872.16 |
$872.16 |
$872.16 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$1,049.33 |
$1,049.33 |
$1,049.33 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$654.13 |
$654.13 |
$654.13 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$426.98 |
$426.98 |
$426.98 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$642.77 |
$642.77 |
$642.77 |
$277.70
|
|
X-ray neck soft tissue
|
$520.32 |
$520.32 |
$520.32 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$415.03 |
$415.03 |
$415.03 |
$225.96
|
|
X-ray pelvis 1-2 views
|
$465.62 |
$465.62 |
$465.62 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$622.03 |
$622.03 |
$622.03 |
$342.30
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$1,081.96 |
$1,081.96 |
$1,081.96 |
$742.00
|
|
X-ray ribs 2 views left
|
$452.21 |
$452.21 |
$452.21 |
$296.32
|
|
X-ray ribs 3 views bilateral
|
$721.35 |
$721.35 |
$721.35 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$788.15 |
$788.15 |
$788.15 |
$359.47
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$988.01 |
$988.01 |
$988.01 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$601.90 |
$601.90 |
$601.90 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$683.63 |
$683.63 |
$683.63 |
$285.60
|
|
X-ray scapula complete (both sides)
|
$540.58 |
$540.58 |
$540.58 |
$292.50
|
|
X-ray shoulder 1 view (both sides)
|
$440.62 |
$440.62 |
$440.62 |
$264.48
|
|
X-ray sinuses paranasal complete > 3 views
|
$888.07 |
$888.07 |
$888.07 |
$339.00
|
|
X-ray skull < 4 views
|
$615.53 |
$615.53 |
$615.53 |
$291.78
|
|
X-ray skull > 4 views complete
|
$1,008.44 |
$1,008.44 |
$1,008.44 |
$414.60
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$712.36 |
$712.36 |
$712.36 |
$557.70
|
|
X-ray small intestine follow-through study
|
$868.28 |
$868.28 |
$868.28 |
$504.14
|
|
X-ray spine single view
|
$358.87 |
$358.87 |
$358.87 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$256.50 |
$256.50 |
$256.50 |
$263.49
|
|
X-ray sternum > 2 views
|
$513.31 |
$513.31 |
$513.31 |
$269.75
|
|
X-ray surgical specimen
|
$465.10 |
$465.10 |
$465.10 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$1,152.15 |
$1,152.15 |
$1,152.15 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$706.38 |
$706.38 |
$706.38 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$670.05 |
$670.05 |
$670.05 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$822.20 |
$822.20 |
$822.20 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$779.05 |
$779.05 |
$779.05 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$1,022.07 |
$1,022.07 |
$1,022.07 |
$385.80
|
|
X-ray tibia/fibula 2 views (both sides)
|
$565.55 |
$565.55 |
$565.55 |
$328.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$540.58 |
$540.58 |
$540.58 |
$264.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$1,185.20 |
$1,185.20 |
$1,185.20 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$1,331.34 |
$1,331.34 |
$1,331.34 |
$555.04
|
|
X-ray wrist 2 views (both sides)
|
$470.16 |
$470.16 |
$470.16 |
$290.40
|
|
X-ray xm phrnx&/crv esoph c+
|
$1,199.13 |
$1,199.13 |
$1,199.13 |
$324.20
|
|
Yersinia antibody
|
$161.78 |
$161.78 |
$161.78 |
$66.95
|
|
Zika virus igm antibody
|
$206.67 |
$206.67 |
$206.67 |
$75.40
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$606.83 |
$606.83 |
$606.83 |
$346.14
|