|
X-ray exam entire spi 6/> vw
|
$1,467.07 |
$1,467.07 |
$5,824.00 |
$575.76
|
|
X-ray exam of arm infant
|
$939.50 |
$939.50 |
$939.50 |
$248.82
|
|
X-ray exam of eye sockets
|
$1,877.07 |
$1,877.07 |
$2,825.00 |
$349.05
|
|
X-ray exam of femur 1
|
$363.00 |
$363.00 |
$683.56 |
$232.36
|
|
X-ray exam of jaw joint
|
$1,076.40 |
$1,076.40 |
$1,076.40 |
$192.39
|
|
X-ray exam of sinuses
|
$1,385.38 |
$1,385.38 |
$1,845.00 |
$211.00
|
|
X-ray exam si joints
|
$881.89 |
$881.89 |
$2,431.00 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$2,120.40 |
$2,120.40 |
$2,120.40 |
$395.59
|
|
X-ray eye detection foreign body (both sides)
|
$1,076.40 |
$1,076.40 |
$1,076.40 |
$235.00
|
|
X-ray facial bones complete > 3 views
|
$2,096.01 |
$2,096.01 |
$3,412.00 |
$366.60
|
|
X-ray femur >=2 views (both sides)
|
$1,363.86 |
$1,363.86 |
$1,363.86 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$793.67 |
$793.67 |
$793.67 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$1,017.23 |
$1,017.23 |
$1,017.23 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$1,383.28 |
$1,383.28 |
$1,383.28 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$1,062.59 |
$1,062.59 |
$1,062.59 |
$316.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$1,227.82 |
$1,227.82 |
$1,227.82 |
$270.00
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$2,375.74 |
$2,375.74 |
$2,803.00 |
$370.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$1,041.29 |
$1,041.29 |
$4,656.00 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$1,366.69 |
$1,366.69 |
$3,475.00 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$1,464.31 |
$1,464.31 |
$9,310.00 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$870.00 |
$870.00 |
$1,840.09 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$1,506.44 |
$1,506.44 |
$1,506.44 |
$304.15
|
|
X-ray knee 1-2 views (both sides)
|
$1,444.89 |
$1,444.89 |
$1,444.89 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$1,626.27 |
$1,626.27 |
$1,626.27 |
$353.25
|
|
X-ray knee ap standing bilateral
|
$1,201.00 |
$1,201.00 |
$3,187.78 |
$276.25
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$1,013.54 |
$1,013.54 |
$1,013.54 |
$249.13
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$1,376.12 |
$1,376.12 |
$1,376.12 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$2,070.00 |
$2,070.00 |
$2,452.38 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$2,617.61 |
$2,617.61 |
$2,617.61 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$1,502.89 |
$1,502.89 |
$3,095.00 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$1,076.40 |
$1,076.40 |
$1,719.00 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$1,373.59 |
$1,373.59 |
$2,231.00 |
$277.70
|
|
X-ray neck soft tissue
|
$831.40 |
$831.40 |
$1,420.00 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$760.95 |
$760.95 |
$1,146.00 |
$225.96
|
|
X-ray pelvis 1-2 views
|
$1,146.83 |
$1,146.83 |
$1,507.00 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$1,467.07 |
$1,467.07 |
$1,984.00 |
$342.30
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$3,315.00 |
$3,315.00 |
$4,185.14 |
$742.00
|
|
X-ray ribs 2 views left
|
$1,542.02 |
$1,542.02 |
$1,542.02 |
$296.32
|
|
X-ray ribs 3 views bilateral
|
$2,290.42 |
$2,290.42 |
$2,372.00 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$1,785.03 |
$1,785.03 |
$1,785.03 |
$359.47
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$2,501.00 |
$2,501.00 |
$3,683.00 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$1,175.85 |
$1,175.85 |
$2,902.00 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$1,532.33 |
$1,532.33 |
$2,345.00 |
$285.60
|
|
X-ray scapula complete (both sides)
|
$1,308.84 |
$1,308.84 |
$1,308.84 |
$292.50
|
|
X-ray shoulder 1 view (both sides)
|
$1,153.30 |
$1,153.30 |
$1,153.30 |
$264.48
|
|
X-ray sinuses paranasal complete > 3 views
|
$1,629.52 |
$1,629.52 |
$2,770.00 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$2,764.88 |
$2,764.88 |
$2,764.88 |
$601.30
|
|
X-ray skull < 4 views
|
$1,152.00 |
$1,152.00 |
$1,529.09 |
$291.78
|
|
X-ray skull > 4 views complete
|
$1,731.00 |
$1,731.00 |
$2,212.65 |
$414.60
|
|
X-ray slg plne bdy sect without urogr
|
$4,245.00 |
$4,245.00 |
$4,245.00 |
$387.00
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$2,106.67 |
$2,106.67 |
$4,913.00 |
$557.70
|
|
X-ray small intestine follow-through study
|
$2,070.19 |
$2,070.19 |
$4,913.00 |
$504.14
|
|
X-ray spine single view
|
$971.90 |
$971.90 |
$1,242.00 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$1,286.43 |
$1,286.43 |
$2,847.00 |
$263.49
|
|
X-ray sternum > 2 views
|
$1,386.55 |
$1,386.55 |
$2,458.00 |
$269.75
|
|
X-ray surgical specimen
|
$4,361.00 |
$4,361.00 |
$7,437.45 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$1,752.03 |
$1,752.03 |
$3,772.00 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$1,898.68 |
$1,898.68 |
$4,987.00 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$1,756.90 |
$1,756.90 |
$2,597.00 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$1,938.65 |
$1,938.65 |
$3,336.00 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$1,357.40 |
$1,357.40 |
$2,913.00 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$295.77 |
$295.77 |
$8,735.00 |
$256.85
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$1,467.07 |
$1,467.07 |
$2,913.00 |
$385.80
|
|
X-ray tibia/fibula 2 views (both sides)
|
$1,383.28 |
$1,383.28 |
$1,383.28 |
$328.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$764.56 |
$764.56 |
$764.56 |
$264.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$2,524.00 |
$2,524.00 |
$4,423.35 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$2,659.00 |
$2,659.00 |
$3,966.97 |
$555.04
|
|
X-ray wrist 2 views (both sides)
|
$1,062.59 |
$1,062.59 |
$1,062.59 |
$290.40
|
|
X-ray xm phrnx&/crv esoph c+
|
$1,795.97 |
$1,795.97 |
$1,795.97 |
$324.20
|
|
Xylose absorption test blood &/or urine
|
$14.07 |
$14.07 |
$14.07 |
$64.28
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$367.00 |
$367.00 |
$367.00 |
$106.94
|
|
Zika virus dna/rna amp probe
|
$375.00 |
$375.00 |
$375.00 |
$175.00
|
|
Zika virus igm antibody
|
$185.78 |
$185.78 |
$185.78 |
$75.40
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$537.00 |
$537.00 |
$537.00 |
$128.10
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$946.72 |
$946.72 |
$13,375.00 |
$346.14
|