|
X-ray elbow 2 views (both sides)
|
$200.88 |
$200.88 |
$200.88 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$244.62 |
$244.62 |
$244.62 |
$364.12
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$225.99 |
$225.99 |
$225.99 |
$483.50
|
|
X-ray exam entire spi 4/5 vw
|
$18.36 |
$18.36 |
$18.36 |
$441.48
|
|
X-ray exam entire spi 6/> vw
|
$21.33 |
$21.33 |
$21.33 |
$517.80
|
|
X-ray exam of arm infant
|
$120.15 |
$120.15 |
$120.15 |
$248.44
|
|
X-ray exam of eye sockets
|
$258.12 |
$258.12 |
$258.12 |
$328.35
|
|
X-ray exam of femur 1
|
$12.69 |
$12.69 |
$12.69 |
$240.00
|
|
X-ray exam of jaw joint
|
$109.89 |
$109.89 |
$109.89 |
$188.40
|
|
X-ray exam of mastoids
|
$93.42 |
$93.42 |
$93.42 |
$193.41
|
|
X-ray exam of salivary gland
|
$8.64 |
$8.64 |
$8.64 |
$162.60
|
|
X-ray exam of sinuses
|
$91.26 |
$91.26 |
$91.26 |
$214.50
|
|
X-ray exam si joints
|
$124.74 |
$124.74 |
$124.74 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$216.00 |
$216.00 |
$216.00 |
$387.40
|
|
X-ray eye detection foreign body (both sides)
|
$9.18 |
$9.18 |
$9.18 |
$238.29
|
|
X-ray facial bones complete > 3 views
|
$209.79 |
$209.79 |
$209.79 |
$381.75
|
|
X-ray femur >=2 views (both sides)
|
$194.94 |
$194.94 |
$194.94 |
$317.25
|
|
X-ray finger(s) >= 2 views (both sides)
|
$180.63 |
$180.63 |
$180.63 |
$241.05
|
|
X-ray foot 2 views (both sides)
|
$227.34 |
$227.34 |
$227.34 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$214.65 |
$214.65 |
$214.65 |
$322.20
|
|
X-ray hand 2 views (both sides)
|
$212.76 |
$212.76 |
$212.76 |
$291.20
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$177.93 |
$177.93 |
$177.93 |
$274.95
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$121.23 |
$121.23 |
$121.23 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$186.57 |
$186.57 |
$186.57 |
$374.40
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$239.49 |
$239.49 |
$239.49 |
$424.05
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$15.93 |
$15.93 |
$15.93 |
$505.60
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$128.79 |
$128.79 |
$128.79 |
$231.00
|
|
X-ray humerus >= 2 views left
|
$218.70 |
$218.70 |
$218.70 |
$309.31
|
|
X-ray joint survey 1 view
|
$17.55 |
$17.55 |
$17.55 |
$232.00
|
|
X-ray knee 1-2 views (both sides)
|
$216.81 |
$216.81 |
$216.81 |
$285.00
|
|
X-ray knee 3 views (both sides)
|
$261.36 |
$261.36 |
$261.36 |
$363.20
|
|
X-ray knee ap standing bilateral
|
$146.88 |
$146.88 |
$146.88 |
$252.50
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$176.31 |
$176.31 |
$176.31 |
$254.12
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$214.38 |
$214.38 |
$214.38 |
$369.15
|
|
X-ray lumbosacral spine >= 4 views
|
$268.38 |
$268.38 |
$268.38 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$215.46 |
$215.46 |
$215.46 |
$535.91
|
|
X-ray mandible complete > 4 views
|
$182.52 |
$182.52 |
$182.52 |
$361.61
|
|
X-ray mandible ltd <4 views
|
$160.92 |
$160.92 |
$160.92 |
$235.30
|
|
X-ray nasal bones complete > 3 views
|
$119.88 |
$119.88 |
$119.88 |
$274.65
|
|
X-ray neck soft tissue
|
$139.32 |
$139.32 |
$139.32 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$58.59 |
$58.59 |
$58.59 |
$225.60
|
|
X-ray of mammary ducts
|
$343.44 |
$343.44 |
$343.44 |
$568.26
|
|
X-ray optic foramina
|
$135.00 |
$135.00 |
$135.00 |
$188.40
|
|
X-ray pelvis 1-2 views
|
$158.22 |
$158.22 |
$158.22 |
$280.80
|
|
X-ray pelvis complete > 3 views
|
$12.96 |
$12.96 |
$12.96 |
$348.19
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$477.09 |
$477.09 |
$477.09 |
$755.50
|
|
X-ray ribs 2 views left
|
$189.00 |
$189.00 |
$189.00 |
$292.80
|
|
X-ray ribs 3 views bilateral
|
$196.83 |
$196.83 |
$196.83 |
$395.76
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$244.62 |
$244.62 |
$244.62 |
$356.20
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$290.52 |
$290.52 |
$290.52 |
$491.70
|
|
X-ray sacroiliac joints >= 3 views
|
$180.63 |
$180.63 |
$180.63 |
$312.75
|
|
X-ray sacrum/coccyx >= 2 views
|
$165.24 |
$165.24 |
$165.24 |
$288.80
|
|
X-ray scapula complete (both sides)
|
$231.66 |
$231.66 |
$231.66 |
$285.00
|
|
X-ray sella turcica
|
$122.58 |
$122.58 |
$122.58 |
$162.50
|
|
X-ray shoulder 1 view (both sides)
|
$203.04 |
$203.04 |
$203.04 |
$260.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$196.56 |
$196.56 |
$196.56 |
$345.60
|
|
X-ray sinus tract/fistula/abscess
|
$25.92 |
$25.92 |
$25.92 |
$606.89
|
|
X-ray skull < 4 views
|
$172.26 |
$172.26 |
$172.26 |
$292.50
|
|
X-ray skull > 4 views complete
|
$247.32 |
$247.32 |
$247.32 |
$417.50
|
|
X-ray slg plne bdy sect without urogr
|
$29.16 |
$29.16 |
$29.16 |
$399.82
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$295.92 |
$295.92 |
$295.92 |
$557.70
|
|
X-ray small intestine follow-through study
|
$219.78 |
$219.78 |
$219.78 |
$499.50
|
|
X-ray spine single view
|
$118.80 |
$118.80 |
$118.80 |
$251.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$94.50 |
$94.50 |
$94.50 |
$264.48
|
|
X-ray sternum > 2 views
|
$126.90 |
$126.90 |
$126.90 |
$274.65
|
|
X-ray surgical specimen
|
$373.95 |
$373.95 |
$373.95 |
$504.00
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$257.58 |
$257.58 |
$257.58 |
$523.25
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$198.99 |
$198.99 |
$198.99 |
$327.80
|
|
X-ray thoracic spine 2 views
|
$183.06 |
$183.06 |
$183.06 |
$320.45
|
|
X-ray thoracic spine 3 views
|
$201.15 |
$201.15 |
$201.15 |
$381.60
|
|
X-ray thoracolumbar spine >=2 views
|
$151.20 |
$151.20 |
$151.20 |
$282.50
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$76.68 |
$76.68 |
$76.68 |
$257.04
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$128.25 |
$128.25 |
$128.25 |
$352.95
|
|
X-ray tibia/fibula 2 views (both sides)
|
$217.08 |
$217.08 |
$217.08 |
$332.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$161.19 |
$161.19 |
$161.19 |
$258.50
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$44.82 |
$44.82 |
$44.82 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$252.45 |
$252.45 |
$252.45 |
$603.20
|
|
X-ray wrist 2 views (both sides)
|
$220.32 |
$220.32 |
$220.32 |
$290.40
|
|
X-ray xm phrnx&/crv esoph c+
|
$186.57 |
$186.57 |
$186.57 |
$354.00
|
|
Xtrnl ecg rec>48hr<7d
|
$190.35 |
$190.35 |
$190.35 |
$789.60
|
|
Xtrnl ecg rec up to 48 hrs
|
$95.31 |
$95.31 |
$95.31 |
$253.60
|
|
Yersinia antibody
|
$3.16 |
$3.16 |
$3.16 |
$55.80
|
|
Zika virus dna/rna amp probe
|
$12.31 |
$12.31 |
$12.31 |
$185.00
|
|
Zika virus igm antibody
|
$4.04 |
$4.04 |
$4.04 |
$85.00
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$145.94 |
$145.94 |
$145.94 |
$122.45
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$626.94 |
$626.94 |
$626.94 |
$452.69
|
|
Zoster vaccine-live inj
|
$171.99 |
$171.99 |
$171.99 |
$361.50
|
