|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$120.50 |
$299.50 |
$556.20 |
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$16.80 |
$183.50 |
$323.50 |
|
|
X-ray ankle 2 views (both sides)
|
$104.00 |
$201.60 |
$444.60 |
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$411.60 |
$875.00 |
$2,101.00 |
|
|
X-ray bone age studies
|
$116.50 |
$213.50 |
$355.00 |
|
|
X-ray bone length studies
|
$70.50 |
$190.50 |
$543.00 |
|
|
X-ray bone survey complete
|
$65.50 |
$344.00 |
$1,270.20 |
|
|
X-ray bone survey infant
|
$117.00 |
$328.50 |
$598.00 |
|
|
X-ray cervical spine 2-3 views
|
$121.00 |
$195.50 |
$639.00 |
|
|
X-ray cervical spine 4-5 views
|
$220.50 |
$288.00 |
$402.50 |
|
|
X-ray cervical spine >= 6 views
|
$70.50 |
$299.50 |
$643.00 |
|
|
X-ray clavicle complete (both sides)
|
$108.00 |
$305.00 |
$486.60 |
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$352.00 |
$439.50 |
$877.80 |
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$295.20 |
$603.00 |
$954.00 |
|
|
X-ray consultation
|
$42.50 |
$42.50 |
$42.50 |
|
|
X-ray elbow 2 views (both sides)
|
$120.00 |
$208.50 |
$385.00 |
|
|
X-ray elbow >= 3 views (both sides)
|
$133.00 |
$201.60 |
$545.40 |
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$221.00 |
$381.00 |
$625.00 |
|
|
X-ray exam entire spi 4/5 vw
|
$194.50 |
$231.50 |
$1,041.00 |
|
|
X-ray exam entire spi 6/> vw
|
$22.00 |
$221.50 |
$390.00 |
|
|
X-ray exam of arm infant
|
$153.50 |
$217.50 |
$678.00 |
|
|
X-ray exam of eye sockets
|
$133.00 |
$241.50 |
$404.40 |
|
|
X-ray exam of femur 1
|
$84.00 |
$184.50 |
$412.50 |
|
|
X-ray exam of jaw joint
|
$117.00 |
$220.50 |
$223.80 |
|
|
X-ray exam of mastoids
|
$234.50 |
$234.50 |
$334.50 |
|
|
X-ray exam of middle ear
|
$263.50 |
$283.00 |
$556.50 |
|
|
X-ray exam of penis
|
$155.00 |
$155.00 |
$155.00 |
|
|
X-ray exam of perineum
|
$403.50 |
$537.00 |
$545.50 |
|
|
X-ray exam of salivary gland
|
$128.00 |
$128.00 |
$128.00 |
|
|
X-ray exam of sinuses
|
$59.50 |
$194.00 |
$243.00 |
|
|
X-ray exam of tear duct
|
$460.00 |
$460.00 |
$546.00 |
|
|
X-ray exam of teeth
|
$117.00 |
$117.00 |
$117.00 |
|
|
X-ray exam si joints
|
$161.40 |
$201.00 |
$267.00 |
|
|
X-ray exam thorac spine4/>vw
|
$160.00 |
$236.00 |
$464.40 |
|
|
X-ray eye detection foreign body (both sides)
|
$34.00 |
$197.50 |
$584.00 |
|
|
X-ray facial bones complete > 3 views
|
$121.00 |
$241.50 |
$380.00 |
|
|
X-ray femur >=2 views (both sides)
|
$49.00 |
$202.00 |
$486.60 |
|
|
X-ray finger(s) >= 2 views (both sides)
|
$83.50 |
$194.00 |
$397.00 |
|
|
X-ray foot 2 views (both sides)
|
$104.00 |
$194.00 |
$441.60 |
|
|
X-ray forearm 2 views (both sides)
|
$121.00 |
$213.50 |
$463.80 |
|
|
X-ray hand 2 views (both sides)
|
$104.00 |
$261.00 |
$528.00 |
|
|
X-ray head for orthodontia
|
$117.00 |
$117.00 |
$117.00 |
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$58.50 |
$184.00 |
$463.80 |
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$154.00 |
$219.50 |
$427.00 |
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$151.00 |
$219.50 |
$475.20 |
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$133.00 |
$271.50 |
$469.80 |
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$34.80 |
$225.50 |
$383.00 |
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$58.50 |
$186.00 |
$244.50 |
|
|
X-ray humerus >= 2 views left
|
$131.00 |
$201.60 |
$486.60 |
|
|
X-ray joint survey 1 view
|
$159.00 |
$159.00 |
$159.00 |
|
|
X-ray knee 1-2 views (both sides)
|
$120.50 |
$354.00 |
$458.40 |
|
|
X-ray knee 3 views (both sides)
|
$139.50 |
$403.00 |
$584.00 |
|
|
X-ray knee ap standing bilateral
|
$58.50 |
$199.50 |
$418.20 |
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$153.50 |
$319.00 |
$1,481.00 |
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$164.80 |
$300.50 |
$637.50 |
|
|
X-ray lumbosacral spine >= 4 views
|
$173.60 |
$299.50 |
$466.20 |
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$164.80 |
$338.00 |
$679.80 |
|
|
X-ray mandible complete > 4 views
|
$70.50 |
$220.00 |
$393.60 |
|
|
X-ray mandible ltd <4 views
|
$124.20 |
$208.50 |
$339.50 |
|
|
X-ray nasal bones complete > 3 views
|
$58.50 |
$173.00 |
$243.00 |
|
|
X-ray neck soft tissue
|
$58.50 |
$171.50 |
$231.00 |
|
|
X-ray nose to rectum for foreign body child
|
$9.00 |
$195.50 |
$865.50 |
|
|
X-ray of mammary ducts
|
$288.50 |
$345.50 |
$790.50 |
|
|
X-ray optic foramina
|
$193.50 |
$196.00 |
$234.50 |
|
|
X-ray pelvis 1-2 views
|
$100.50 |
$217.50 |
$378.00 |
|
|
X-ray pelvis complete > 3 views
|
$14.00 |
$224.50 |
$339.50 |
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$27.50 |
$755.50 |
$1,331.50 |
|
|
X-ray ribs 2 views left
|
$129.50 |
$194.00 |
$477.60 |
|
|
X-ray ribs 3 views bilateral
|
$15.00 |
$253.00 |
$477.60 |
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$111.50 |
$227.00 |
$384.50 |
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$70.50 |
$290.50 |
$542.40 |
|
|
X-ray sacroiliac joints >= 3 views
|
$121.00 |
$205.50 |
$438.50 |
|
|
X-ray sacrum/coccyx >= 2 views
|
$126.00 |
$192.50 |
$281.50 |
|
|
X-ray scapula complete (both sides)
|
$90.00 |
$200.50 |
$486.60 |
|
|
X-ray sella turcica
|
$130.50 |
$191.00 |
$217.50 |
|
|
X-ray shoulder 1 view (both sides)
|
$113.50 |
$196.00 |
$418.20 |
|
|
X-ray sinuses paranasal complete > 3 views
|
$58.50 |
$220.00 |
$393.00 |
|
|
X-ray sinus tract/fistula/abscess
|
$242.50 |
$628.00 |
$1,332.00 |
|
|
X-ray skull < 4 views
|
$91.50 |
$208.00 |
$643.00 |
|
|
X-ray skull > 4 views complete
|
$70.50 |
$289.00 |
$393.60 |
|
|
X-ray slg plne bdy sect without urogr
|
$334.50 |
$363.50 |
$385.00 |
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$237.00 |
$400.50 |
$489.00 |
|
|
X-ray small intestine follow-through study
|
$58.00 |
$158.50 |
$625.00 |
|
|
X-ray spine single view
|
$8.50 |
$160.50 |
$243.00 |
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$132.50 |
$194.00 |
$269.00 |
|
|
X-ray sternum > 2 views
|
$113.50 |
$201.00 |
$243.00 |
|
|
X-ray surgical specimen
|
$197.50 |
$644.50 |
$1,210.50 |
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$255.50 |
$394.00 |
$579.60 |
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$58.50 |
$203.00 |
$436.00 |
|
|
X-ray thoracic spine 2 views
|
$11.00 |
$217.50 |
$341.50 |
|
|
X-ray thoracic spine 3 views
|
$121.00 |
$232.00 |
$370.80 |
|
|
X-ray thoracolumbar spine >=2 views
|
$108.00 |
$192.50 |
$220.50 |
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$54.50 |
$194.00 |
$283.50 |
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$99.00 |
$184.00 |
$569.00 |
|
|
X-ray tibia/fibula 2 views (both sides)
|
$123.50 |
$323.00 |
$501.60 |
|
|
X-ray toe(s) > 2 views (both sides)
|
$92.00 |
$183.00 |
$233.00 |
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$276.00 |
$416.80 |
$1,670.50 |
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$280.80 |
$381.00 |
$1,149.00 |
|
|
X-ray wrist 2 views (both sides)
|
$58.50 |
$201.60 |
$441.60 |
|
|
X-ray xm phrnx&/crv esoph c+
|
$259.50 |
$259.50 |
$259.50 |
|
