|
X-ray exam si joints
|
$464.16 |
$464.16 |
$464.16 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$709.92 |
$709.92 |
$709.92 |
$395.59
|
|
X-ray eye detection foreign body (both sides)
|
$125.76 |
$125.76 |
$125.76 |
$235.00
|
|
X-ray facial bones complete > 3 views
|
$687.36 |
$687.36 |
$687.36 |
$366.60
|
|
X-ray femur >=2 views (both sides)
|
$360.48 |
$360.48 |
$360.48 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$318.24 |
$318.24 |
$318.24 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$335.04 |
$335.04 |
$335.04 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$404.16 |
$404.16 |
$404.16 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$335.04 |
$335.04 |
$335.04 |
$316.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$338.88 |
$338.88 |
$338.88 |
$270.00
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$709.92 |
$709.92 |
$709.92 |
$370.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$462.24 |
$462.24 |
$462.24 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$490.56 |
$490.56 |
$490.56 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$763.68 |
$763.68 |
$763.68 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$235.20 |
$235.20 |
$235.20 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$367.20 |
$367.20 |
$367.20 |
$304.15
|
|
X-ray joint survey 1 view
|
$685.44 |
$685.44 |
$685.44 |
$211.00
|
|
X-ray knee 1-2 views (both sides)
|
$243.84 |
$243.84 |
$243.84 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$517.44 |
$517.44 |
$517.44 |
$353.25
|
|
X-ray knee ap standing bilateral
|
$243.84 |
$243.84 |
$243.84 |
$276.25
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$328.32 |
$328.32 |
$328.32 |
$249.13
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$915.36 |
$915.36 |
$915.36 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$816.48 |
$816.48 |
$816.48 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$852.96 |
$852.96 |
$852.96 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$662.88 |
$662.88 |
$662.88 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$396.48 |
$396.48 |
$396.48 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$439.68 |
$439.68 |
$439.68 |
$277.70
|
|
X-ray neck soft tissue
|
$286.56 |
$286.56 |
$286.56 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$292.80 |
$292.80 |
$292.80 |
$225.96
|
|
X-ray pelvis 1-2 views
|
$270.24 |
$270.24 |
$270.24 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$543.84 |
$543.84 |
$543.84 |
$342.30
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$668.64 |
$668.64 |
$668.64 |
$742.00
|
|
X-ray ribs 2 views left
|
$426.72 |
$426.72 |
$426.72 |
$296.32
|
|
X-ray ribs 3 views bilateral
|
$482.40 |
$482.40 |
$482.40 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$454.08 |
$454.08 |
$454.08 |
$359.47
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$571.20 |
$571.20 |
$571.20 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$464.16 |
$464.16 |
$464.16 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$478.08 |
$478.08 |
$478.08 |
$285.60
|
|
X-ray scapula complete (both sides)
|
$360.48 |
$360.48 |
$360.48 |
$292.50
|
|
X-ray shoulder 1 view (both sides)
|
$288.96 |
$288.96 |
$288.96 |
$264.48
|
|
X-ray sinuses paranasal complete > 3 views
|
$638.88 |
$638.88 |
$638.88 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$274.56 |
$274.56 |
$274.56 |
$601.30
|
|
X-ray skull < 4 views
|
$388.32 |
$388.32 |
$388.32 |
$291.78
|
|
X-ray skull > 4 views complete
|
$665.28 |
$665.28 |
$665.28 |
$414.60
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$784.32 |
$784.32 |
$784.32 |
$557.70
|
|
X-ray small intestine follow-through study
|
$236.64 |
$236.64 |
$236.64 |
$504.14
|
|
X-ray spine single view
|
$314.88 |
$314.88 |
$314.88 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$249.60 |
$249.60 |
$249.60 |
$263.49
|
|
X-ray sternum > 2 views
|
$355.20 |
$355.20 |
$355.20 |
$269.75
|
|
X-ray surgical specimen
|
$665.76 |
$665.76 |
$665.76 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$598.56 |
$598.56 |
$598.56 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$444.96 |
$444.96 |
$444.96 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$424.80 |
$424.80 |
$424.80 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$614.88 |
$614.88 |
$614.88 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$373.44 |
$373.44 |
$373.44 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$450.72 |
$450.72 |
$450.72 |
$256.85
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$627.36 |
$627.36 |
$627.36 |
$385.80
|
|
X-ray tibia/fibula 2 views (both sides)
|
$395.52 |
$395.52 |
$395.52 |
$328.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$318.24 |
$318.24 |
$318.24 |
$264.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$710.40 |
$710.40 |
$710.40 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$710.40 |
$710.40 |
$710.40 |
$555.04
|
|
X-ray wrist 2 views (both sides)
|
$335.04 |
$335.04 |
$335.04 |
$290.40
|
|
X-ray xm phrnx&/crv esoph c+
|
$312.96 |
$312.96 |
$312.96 |
$324.20
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$110.40 |
$110.40 |
$110.40 |
$106.94
|
|
Zika virus dna/rna amp probe
|
$240.00 |
$240.00 |
$240.00 |
$175.00
|
|
Zika virus igm antibody
|
$132.00 |
$132.00 |
$132.00 |
$75.40
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$241.08 |
$241.08 |
$241.08 |
$121.56
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$83.48 |
$83.48 |
$83.48 |
$405.10
|
