|
X-ray abdomen >=3 views
|
$480.90 |
$480.90 |
$480.90 |
$332.15
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$530.60 |
$530.60 |
$530.60 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$427.70 |
$427.70 |
$427.70 |
$271.44
|
|
X-ray ankle 2 views (both sides)
|
$384.65 |
$384.65 |
$384.65 |
$283.00
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$613.20 |
$613.20 |
$613.20 |
$768.30
|
|
X-ray bone age studies
|
$329.35 |
$329.35 |
$329.35 |
$246.75
|
|
X-ray bone length studies
|
$517.30 |
$517.30 |
$517.30 |
$287.25
|
|
X-ray bone survey complete
|
$1,153.60 |
$1,153.60 |
$1,153.60 |
$666.60
|
|
X-ray bone survey infant
|
$492.80 |
$492.80 |
$492.80 |
$410.73
|
|
X-ray cervical spine 2-3 views
|
$613.55 |
$613.55 |
$613.55 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$711.20 |
$711.20 |
$711.20 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$841.75 |
$841.75 |
$841.75 |
$515.35
|
|
X-ray clavicle complete (both sides)
|
$392.00 |
$392.00 |
$392.00 |
$299.65
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$1,403.50 |
$1,403.50 |
$1,403.50 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$1,403.50 |
$1,403.50 |
$1,403.50 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$384.65 |
$384.65 |
$384.65 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$439.60 |
$439.60 |
$439.60 |
$342.00
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$565.25 |
$565.25 |
$565.25 |
$486.24
|
|
X-ray exam entire spi 4/5 vw
|
$503.30 |
$503.30 |
$503.30 |
$486.01
|
|
X-ray exam entire spi 6/> vw
|
$668.15 |
$668.15 |
$668.15 |
$575.76
|
|
X-ray exam of arm infant
|
$427.00 |
$427.00 |
$427.00 |
$248.82
|
|
X-ray exam of eye sockets
|
$633.85 |
$633.85 |
$633.85 |
$349.05
|
|
X-ray exam of femur 1
|
$344.05 |
$344.05 |
$344.05 |
$232.36
|
|
X-ray exam of sinuses
|
$730.10 |
$730.10 |
$730.10 |
$211.00
|
|
X-ray exam si joints
|
$201.95 |
$201.95 |
$201.95 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$718.20 |
$718.20 |
$718.20 |
$395.59
|
|
X-ray facial bones complete > 3 views
|
$489.30 |
$489.30 |
$489.30 |
$366.60
|
|
X-ray femur >=2 views (both sides)
|
$459.20 |
$459.20 |
$459.20 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$329.35 |
$329.35 |
$329.35 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$405.30 |
$405.30 |
$405.30 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$384.65 |
$384.65 |
$384.65 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$384.65 |
$384.65 |
$384.65 |
$316.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$372.05 |
$372.05 |
$372.05 |
$270.00
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$580.30 |
$580.30 |
$580.30 |
$370.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$921.20 |
$921.20 |
$921.20 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$1,013.60 |
$1,013.60 |
$1,013.60 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$1,283.10 |
$1,283.10 |
$1,283.10 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$315.35 |
$315.35 |
$315.35 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$372.05 |
$372.05 |
$372.05 |
$304.15
|
|
X-ray joint survey 1 view
|
$517.30 |
$517.30 |
$517.30 |
$211.00
|
|
X-ray knee 1-2 views (both sides)
|
$405.30 |
$405.30 |
$405.30 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$439.60 |
$439.60 |
$439.60 |
$353.25
|
|
X-ray knee ap standing bilateral
|
$197.40 |
$197.40 |
$197.40 |
$276.25
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$427.00 |
$427.00 |
$427.00 |
$249.13
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$201.95 |
$201.95 |
$201.95 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$1,007.65 |
$1,007.65 |
$1,007.65 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$1,007.65 |
$1,007.65 |
$1,007.65 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$532.00 |
$532.00 |
$532.00 |
$352.83
|
|
X-ray nasal bones complete > 3 views
|
$501.55 |
$501.55 |
$501.55 |
$277.70
|
|
X-ray neck soft tissue
|
$327.25 |
$327.25 |
$327.25 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$491.05 |
$491.05 |
$491.05 |
$225.96
|
|
X-ray of mammary ducts
|
$1,185.80 |
$1,185.80 |
$1,185.80 |
$473.55
|
|
X-ray pelvis 1-2 views
|
$372.05 |
$372.05 |
$372.05 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$554.75 |
$554.75 |
$554.75 |
$342.30
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$967.40 |
$967.40 |
$967.40 |
$742.00
|
|
X-ray ribs 2 views left
|
$474.95 |
$474.95 |
$474.95 |
$296.32
|
|
X-ray ribs 3 views bilateral
|
$609.35 |
$609.35 |
$609.35 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$554.75 |
$554.75 |
$554.75 |
$359.47
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$610.75 |
$610.75 |
$610.75 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$474.95 |
$474.95 |
$474.95 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$506.10 |
$506.10 |
$506.10 |
$285.60
|
|
X-ray scapula complete (both sides)
|
$384.65 |
$384.65 |
$384.65 |
$292.50
|
|
X-ray shoulder 1 view (both sides)
|
$329.35 |
$329.35 |
$329.35 |
$264.48
|
|
X-ray sinuses paranasal complete > 3 views
|
$823.90 |
$823.90 |
$823.90 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$590.45 |
$590.45 |
$590.45 |
$601.30
|
|
X-ray skull < 4 views
|
$501.55 |
$501.55 |
$501.55 |
$291.78
|
|
X-ray skull > 4 views complete
|
$858.55 |
$858.55 |
$858.55 |
$414.60
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$746.20 |
$746.20 |
$746.20 |
$557.70
|
|
X-ray small intestine follow-through study
|
$212.80 |
$212.80 |
$212.80 |
$504.14
|
|
X-ray spine single view
|
$392.00 |
$392.00 |
$392.00 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$459.20 |
$459.20 |
$459.20 |
$263.49
|
|
X-ray sternum > 2 views
|
$503.65 |
$503.65 |
$503.65 |
$269.75
|
|
X-ray surgical specimen
|
$723.80 |
$723.80 |
$723.80 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$565.25 |
$565.25 |
$565.25 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$744.80 |
$744.80 |
$744.80 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$644.70 |
$644.70 |
$644.70 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$718.20 |
$718.20 |
$718.20 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$644.70 |
$644.70 |
$644.70 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$260.75 |
$260.75 |
$260.75 |
$256.85
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$336.35 |
$336.35 |
$336.35 |
$385.80
|
|
X-ray tibia/fibula 2 views (both sides)
|
$459.20 |
$459.20 |
$459.20 |
$328.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$329.35 |
$329.35 |
$329.35 |
$264.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$1,012.90 |
$1,012.90 |
$1,012.90 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$964.25 |
$964.25 |
$964.25 |
$555.04
|
|
X-ray wrist 2 views (both sides)
|
$384.65 |
$384.65 |
$384.65 |
$290.40
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$106.94 |
$106.94 |
$106.94 |
$106.94
|
|
Ziv-aflibercept 25 mg/ml intravenous solution (wrapper)
|
$2,905.51 |
$2,905.51 |
$2,905.51 |
$4,764.60
|
|
Zolbetuximab-clzb 100 mg intravenous solution
|
$5,775.09 |
$5,775.09 |
$5,775.09 |
$4,848.00
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$175.80 |
$175.80 |
$175.80 |
$405.10
|
