|
X-ray bone age studies
|
$750.21 |
$750.21 |
$750.21 |
$246.75
|
|
X-ray bone survey complete
|
$1,347.93 |
$1,347.93 |
$1,347.93 |
$666.60
|
|
X-ray bone survey infant
|
$886.89 |
$886.89 |
$886.89 |
$410.73
|
|
X-ray cervical spine 2-3 views
|
$971.04 |
$971.04 |
$971.04 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$1,561.62 |
$1,561.62 |
$1,561.62 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$1,561.62 |
$1,561.62 |
$1,561.62 |
$515.35
|
|
X-ray clavicle complete (both sides)
|
$669.12 |
$669.12 |
$669.12 |
$299.65
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$1,077.63 |
$1,077.63 |
$1,077.63 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$1,077.63 |
$1,077.63 |
$1,077.63 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$750.21 |
$750.21 |
$750.21 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$894.03 |
$894.03 |
$894.03 |
$342.00
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$912.90 |
$912.90 |
$912.90 |
$486.24
|
|
X-ray exam entire spi 6/> vw
|
$2,044.59 |
$2,044.59 |
$2,044.59 |
$575.76
|
|
X-ray exam of arm infant
|
$610.47 |
$610.47 |
$610.47 |
$248.82
|
|
X-ray exam of eye sockets
|
$983.79 |
$983.79 |
$983.79 |
$349.05
|
|
X-ray exam of femur 1
|
$672.18 |
$672.18 |
$672.18 |
$232.36
|
|
X-ray exam of jaw joint
|
$621.18 |
$621.18 |
$621.18 |
$192.39
|
|
X-ray exam of sinuses
|
$90.27 |
$90.27 |
$90.27 |
$211.00
|
|
X-ray exam si joints
|
$932.28 |
$932.28 |
$932.28 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$1,324.98 |
$1,324.98 |
$1,324.98 |
$395.59
|
|
X-ray eye detection foreign body (both sides)
|
$297.84 |
$297.84 |
$297.84 |
$235.00
|
|
X-ray facial bones complete > 3 views
|
$1,403.52 |
$1,403.52 |
$1,403.52 |
$366.60
|
|
X-ray femur >=2 views (both sides)
|
$859.35 |
$859.35 |
$859.35 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$584.97 |
$584.97 |
$584.97 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$608.43 |
$608.43 |
$608.43 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$776.73 |
$776.73 |
$776.73 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$513.06 |
$513.06 |
$513.06 |
$316.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$562.53 |
$562.53 |
$562.53 |
$270.00
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$1,073.04 |
$1,073.04 |
$1,073.04 |
$370.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$1,073.04 |
$1,073.04 |
$1,073.04 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$1,073.04 |
$1,073.04 |
$1,073.04 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$2,044.59 |
$2,044.59 |
$2,044.59 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$616.59 |
$616.59 |
$616.59 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$772.65 |
$772.65 |
$772.65 |
$304.15
|
|
X-ray knee 1-2 views (both sides)
|
$599.25 |
$599.25 |
$599.25 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$784.89 |
$784.89 |
$784.89 |
$353.25
|
|
X-ray knee ap standing bilateral
|
$550.29 |
$550.29 |
$550.29 |
$276.25
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$450.84 |
$450.84 |
$450.84 |
$249.13
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$933.81 |
$933.81 |
$933.81 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$1,935.45 |
$1,935.45 |
$1,935.45 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$1,994.10 |
$1,994.10 |
$1,994.10 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$1,329.06 |
$1,329.06 |
$1,329.06 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$615.57 |
$615.57 |
$615.57 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$896.58 |
$896.58 |
$896.58 |
$277.70
|
|
X-ray neck soft tissue
|
$574.77 |
$574.77 |
$574.77 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$311.61 |
$311.61 |
$311.61 |
$225.96
|
|
X-ray pelvis 1-2 views
|
$369.75 |
$369.75 |
$369.75 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$383.01 |
$383.01 |
$383.01 |
$342.30
|
|
X-ray ribs 2 views left
|
$700.23 |
$700.23 |
$700.23 |
$296.32
|
|
X-ray ribs 3 views bilateral
|
$753.78 |
$753.78 |
$753.78 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$753.78 |
$753.78 |
$753.78 |
$359.47
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$926.16 |
$926.16 |
$926.16 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$951.66 |
$951.66 |
$951.66 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$928.71 |
$928.71 |
$928.71 |
$285.60
|
|
X-ray scapula complete (both sides)
|
$835.38 |
$835.38 |
$835.38 |
$292.50
|
|
X-ray shoulder 1 view (both sides)
|
$585.48 |
$585.48 |
$585.48 |
$264.48
|
|
X-ray sinuses paranasal complete > 3 views
|
$1,082.73 |
$1,082.73 |
$1,082.73 |
$339.00
|
|
X-ray skull < 4 views
|
$393.21 |
$393.21 |
$393.21 |
$291.78
|
|
X-ray skull > 4 views complete
|
$587.01 |
$587.01 |
$587.01 |
$414.60
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$659.43 |
$659.43 |
$659.43 |
$557.70
|
|
X-ray small intestine follow-through study
|
$367.20 |
$367.20 |
$367.20 |
$504.14
|
|
X-ray spine single view
|
$570.18 |
$570.18 |
$570.18 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$559.98 |
$559.98 |
$559.98 |
$263.49
|
|
X-ray sternum > 2 views
|
$521.73 |
$521.73 |
$521.73 |
$269.75
|
|
X-ray surgical specimen
|
$804.27 |
$804.27 |
$804.27 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$972.57 |
$972.57 |
$972.57 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$955.23 |
$955.23 |
$955.23 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$815.49 |
$815.49 |
$815.49 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$1,161.27 |
$1,161.27 |
$1,161.27 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$815.49 |
$815.49 |
$815.49 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$1,073.04 |
$1,073.04 |
$1,073.04 |
$385.80
|
|
X-ray tibia/fibula 2 views (both sides)
|
$702.78 |
$702.78 |
$702.78 |
$328.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$511.53 |
$511.53 |
$511.53 |
$264.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$594.15 |
$594.15 |
$594.15 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$182.07 |
$182.07 |
$182.07 |
$555.04
|
|
X-ray wrist 2 views (both sides)
|
$649.74 |
$649.74 |
$649.74 |
$290.40
|
|
Zika virus dna/rna amp probe
|
$255.00 |
$255.00 |
$255.00 |
$175.00
|
|
Zika virus igm antibody
|
$140.25 |
$140.25 |
$140.25 |
$75.40
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$100.77 |
$100.77 |
$100.77 |
$121.56
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$168.62 |
$168.62 |
$168.62 |
$405.10
|
|
Zoster vaccine-live inj
|
$127.50 |
$127.50 |
$127.50 |
$235.20
|