|
X-ray cervical spine 2-3 views
|
$178.75 |
$206.70 |
$286.00 |
|
|
X-ray cervical spine 4-5 views
|
$289.25 |
$365.30 |
$382.85 |
|
|
X-ray cervical spine >= 6 views
|
$433.55 |
$433.55 |
$464.75 |
|
|
X-ray clavicle complete (both sides)
|
$257.40 |
$371.15 |
$388.70 |
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$456.30 |
$456.30 |
$603.85 |
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$559.65 |
$559.65 |
$743.60 |
|
|
X-ray elbow 2 views (both sides)
|
$297.70 |
$423.15 |
$425.75 |
|
|
X-ray elbow >= 3 views (both sides)
|
$274.95 |
$326.95 |
$458.25 |
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$203.45 |
$245.05 |
$392.60 |
|
|
X-ray exam entire spi 4/5 vw
|
$464.75 |
$464.75 |
$537.55 |
|
|
X-ray exam entire spi 6/> vw
|
$562.90 |
$562.90 |
$650.65 |
|
|
X-ray exam of arm infant
|
$66.95 |
$171.60 |
$200.20 |
|
|
X-ray exam of eye sockets
|
$254.15 |
$320.45 |
$322.40 |
|
|
X-ray exam of femur 1
|
$153.40 |
$193.70 |
$329.55 |
|
|
X-ray exam of jaw joint
|
$112.45 |
$113.10 |
$180.05 |
|
|
X-ray exam of jaw joint
|
$286.00 |
$286.00 |
$286.00 |
|
|
X-ray exam of mastoids
|
$123.50 |
$155.35 |
$155.35 |
|
|
X-ray exam of middle ear
|
$302.25 |
$302.25 |
$324.35 |
|
|
X-ray exam of salivary gland
|
$126.75 |
$126.75 |
$137.80 |
|
|
X-ray exam of sinuses
|
$150.15 |
$189.80 |
$190.45 |
|
|
X-ray exam of tear duct
|
$290.55 |
$290.55 |
$349.70 |
|
|
X-ray exam of teeth
|
$48.75 |
$48.75 |
$48.75 |
|
|
X-ray exam of teeth
|
$98.15 |
$98.15 |
$98.15 |
|
|
X-ray exam si joints
|
$131.95 |
$141.70 |
$238.55 |
|
|
X-ray exam thorac spine4/>vw
|
$269.10 |
$305.50 |
$336.70 |
|
|
X-ray eye detection foreign body (both sides)
|
$231.40 |
$254.80 |
$263.90 |
|
|
X-ray facial bones complete > 3 views
|
$205.40 |
$260.00 |
$289.25 |
|
|
X-ray fallopian tube
|
$337.35 |
$337.35 |
$337.35 |
|
|
X-ray femur >=2 views (both sides)
|
$404.30 |
$420.55 |
$426.40 |
|
|
X-ray finger(s) >= 2 views (both sides)
|
$191.10 |
$226.20 |
$367.25 |
|
|
X-ray foot 2 views (both sides)
|
$204.10 |
$348.40 |
$375.70 |
|
|
X-ray forearm 2 views (both sides)
|
$257.40 |
$364.65 |
$398.45 |
|
|
X-ray hand 2 views (both sides)
|
$211.90 |
$342.55 |
$362.05 |
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$211.25 |
$321.75 |
$331.50 |
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$243.10 |
$243.10 |
$279.50 |
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$170.95 |
$215.80 |
$302.90 |
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$204.75 |
$258.70 |
$386.75 |
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$310.70 |
$310.70 |
$498.55 |
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$131.95 |
$166.40 |
$168.35 |
|
|
X-ray humerus >= 2 views left
|
$228.80 |
$429.00 |
$445.25 |
|
|
X-ray joint survey 1 view
|
$241.15 |
$241.15 |
$241.15 |
|
|
X-ray knee 1-2 views (both sides)
|
$271.70 |
$384.15 |
$386.10 |
|
|
X-ray knee 3 views (both sides)
|
$357.50 |
$461.50 |
$463.45 |
|
|
X-ray knee ap standing bilateral
|
$169.00 |
$213.20 |
$215.80 |
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$181.35 |
$187.85 |
$309.40 |
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$117.65 |
$148.85 |
$342.55 |
|
|
X-ray lumbosacral spine >= 4 views
|
$336.05 |
$423.80 |
$425.75 |
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$393.90 |
$496.60 |
$498.55 |
|
|
X-ray male genital tract
|
$197.60 |
$197.60 |
$197.60 |
|
|
X-ray mandible complete > 4 views
|
$215.80 |
$273.00 |
$334.75 |
|
|
X-ray mandible ltd <4 views
|
$159.25 |
$200.85 |
$235.30 |
|
|
X-ray nasal bones complete > 3 views
|
$211.25 |
$266.50 |
$268.45 |
|
|
X-ray neck soft tissue
|
$192.40 |
$217.10 |
$219.05 |
|
|
X-ray nose to rectum for foreign body child
|
$135.20 |
$152.10 |
$226.20 |
|
|
X-ray of mammary ducts
|
$351.65 |
$351.65 |
$351.65 |
|
|
X-ray optic foramina
|
$118.95 |
$118.95 |
$128.05 |
|
|
X-ray pelvis 1-2 views
|
$198.25 |
$225.55 |
$241.15 |
|
|
X-ray pelvis complete > 3 views
|
$236.60 |
$237.90 |
$295.75 |
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$317.20 |
$317.20 |
$658.45 |
|
|
X-ray ribs 2 views left
|
$189.80 |
$239.85 |
$242.45 |
|
|
X-ray ribs 3 views bilateral
|
$239.20 |
$302.25 |
$364.00 |
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$213.85 |
$270.40 |
$272.35 |
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$265.85 |
$335.40 |
$386.10 |
|
|
X-ray sacroiliac joints >= 3 views
|
$167.05 |
$210.60 |
$254.80 |
|
|
X-ray sacrum/coccyx >= 2 views
|
$213.85 |
$258.05 |
$260.65 |
|
|
X-ray scapula complete (both sides)
|
$197.60 |
$343.85 |
$442.00 |
|
|
X-ray sella turcica
|
$115.70 |
$115.70 |
$124.15 |
|
|
X-ray shoulder 1 view (both sides)
|
$257.40 |
$274.30 |
$365.30 |
|
|
X-ray sinuses paranasal complete > 3 views
|
$189.80 |
$239.20 |
$337.35 |
|
|
X-ray sinus tract/fistula/abscess
|
$371.80 |
$389.35 |
$401.70 |
|
|
X-ray skull < 4 views
|
$177.45 |
$224.25 |
$226.20 |
|
|
X-ray skull > 4 views complete
|
$321.10 |
$404.30 |
$406.25 |
|
|
X-ray slg plne bdy sect without urogr
|
$339.95 |
$339.95 |
$491.40 |
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$337.35 |
$337.35 |
$618.80 |
|
|
X-ray small intestine follow-through study
|
$411.45 |
$411.45 |
$411.45 |
|
|
X-ray spine single view
|
$145.60 |
$183.95 |
$183.95 |
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$177.45 |
$190.45 |
$236.60 |
|
|
X-ray sternum > 2 views
|
$130.65 |
$165.75 |
$239.20 |
|
|
X-ray surgical specimen
|
$308.75 |
$308.75 |
$420.55 |
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$396.50 |
$396.50 |
$398.45 |
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$168.35 |
$212.55 |
$299.00 |
|
|
X-ray thoracic spine 2 views
|
$202.15 |
$218.40 |
$243.75 |
|
|
X-ray thoracic spine 3 views
|
$218.40 |
$248.30 |
$307.45 |
|
|
X-ray thoracolumbar spine >=2 views
|
$175.50 |
$176.80 |
$246.35 |
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$153.40 |
$154.05 |
$258.05 |
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$334.75 |
$336.70 |
$362.70 |
|
|
X-ray tibia/fibula 2 views (both sides)
|
$300.30 |
$424.45 |
$470.60 |
|
|
X-ray toe(s) > 2 views (both sides)
|
$174.20 |
$281.45 |
$312.65 |
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$471.25 |
$471.25 |
$597.35 |
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$593.45 |
$593.45 |
$612.30 |
|
|
X-ray wrist 2 views (both sides)
|
$326.95 |
$375.70 |
$403.00 |
|
|
X-ray xm phrnx&/crv esoph c+
|
$193.70 |
$193.70 |
$233.35 |
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$88.26 |
$88.26 |
$90.15 |
|
|
Zidovudine, oral, 100 mg
|
$76.05 |
$76.05 |
$76.05 |
|
|
Zika virus dna/rna amp probe
|
$277.55 |
$280.80 |
$587.60 |
|
|
Zika virus igm antibody
|
$196.95 |
$211.25 |
$240.50 |
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$101.24 |
$145.11 |
$145.11 |
|
|
Ziv-aflibercept 25 mg/ml intravenous solution (wrapper)
|
$7,286.50 |
$7,286.50 |
$7,286.50 |
|
|
Zolbetuximab-clzb 100 mg intravenous solution
|
$3,682.90 |
$3,682.90 |
$3,682.90 |
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$195.65 |
$362.70 |
$604.50 |
|
