|
X-ray bone age studies
|
$462.00 |
$462.00 |
$462.00 |
$251.40
|
|
X-ray bone length studies
|
$770.70 |
$770.70 |
$770.70 |
$285.30
|
|
X-ray bone survey complete
|
$1,484.00 |
$1,484.00 |
$1,484.00 |
$660.00
|
|
X-ray bone survey infant
|
$1,250.20 |
$1,250.20 |
$1,250.20 |
$394.69
|
|
X-ray cervical spine 2-3 views
|
$665.70 |
$665.70 |
$665.70 |
$333.83
|
|
X-ray cervical spine 4-5 views
|
$943.60 |
$943.60 |
$943.60 |
$457.05
|
|
X-ray cervical spine >= 6 views
|
$985.60 |
$985.60 |
$985.60 |
$508.50
|
|
X-ray clavicle complete (both sides)
|
$547.40 |
$547.40 |
$547.40 |
$300.05
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$1,225.70 |
$1,225.70 |
$1,225.70 |
$657.03
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$1,260.00 |
$1,260.00 |
$1,260.00 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$367.50 |
$367.50 |
$367.50 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$577.50 |
$577.50 |
$577.50 |
$364.12
|
|
Xray endovasc thor ao repr
|
$3,993.50 |
$3,993.50 |
$3,993.50 |
$1,622.18
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$828.10 |
$828.10 |
$828.10 |
$483.50
|
|
X-ray exam entire spi 4/5 vw
|
$823.20 |
$823.20 |
$823.20 |
$441.48
|
|
X-ray exam entire spi 6/> vw
|
$2,067.10 |
$2,067.10 |
$2,067.10 |
$517.80
|
|
X-ray exam of arm infant
|
$451.50 |
$451.50 |
$451.50 |
$248.44
|
|
X-ray exam of eye sockets
|
$828.10 |
$828.10 |
$828.10 |
$328.35
|
|
X-ray exam of femur 1
|
$426.30 |
$426.30 |
$426.30 |
$240.00
|
|
X-ray exam of sinuses
|
$266.70 |
$266.70 |
$266.70 |
$214.50
|
|
X-ray eye detection foreign body (both sides)
|
$379.40 |
$379.40 |
$379.40 |
$238.29
|
|
X-ray facial bones complete > 3 views
|
$897.40 |
$897.40 |
$897.40 |
$381.75
|
|
X-ray femur >=2 views (both sides)
|
$566.30 |
$566.30 |
$566.30 |
$317.25
|
|
X-ray finger(s) >= 2 views (both sides)
|
$458.50 |
$458.50 |
$458.50 |
$241.05
|
|
X-ray foot 2 views (both sides)
|
$324.10 |
$324.10 |
$324.10 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$515.90 |
$515.90 |
$515.90 |
$322.20
|
|
X-ray hand 2 views (both sides)
|
$521.50 |
$521.50 |
$521.50 |
$291.20
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$468.30 |
$468.30 |
$468.30 |
$274.95
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$1,071.00 |
$1,071.00 |
$1,071.00 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$896.00 |
$896.00 |
$896.00 |
$374.40
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$940.80 |
$940.80 |
$940.80 |
$424.05
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$987.70 |
$987.70 |
$987.70 |
$505.60
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$497.00 |
$497.00 |
$497.00 |
$231.00
|
|
X-ray humerus >= 2 views left
|
$619.50 |
$619.50 |
$619.50 |
$309.31
|
|
X-ray joint survey 1 view
|
$485.10 |
$485.10 |
$485.10 |
$232.00
|
|
X-ray knee 1-2 views (both sides)
|
$556.50 |
$556.50 |
$556.50 |
$285.00
|
|
X-ray knee 3 views (both sides)
|
$598.50 |
$598.50 |
$598.50 |
$363.20
|
|
X-ray knee ap standing bilateral
|
$481.60 |
$481.60 |
$481.60 |
$252.50
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$478.80 |
$478.80 |
$478.80 |
$254.12
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$637.00 |
$637.00 |
$637.00 |
$369.15
|
|
X-ray lumbosacral spine >= 4 views
|
$909.30 |
$909.30 |
$909.30 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$1,169.00 |
$1,169.00 |
$1,169.00 |
$535.91
|
|
X-ray mandible complete > 4 views
|
$719.60 |
$719.60 |
$719.60 |
$361.61
|
|
X-ray mandible ltd <4 views
|
$524.30 |
$524.30 |
$524.30 |
$235.30
|
|
X-ray nasal bones complete > 3 views
|
$716.10 |
$716.10 |
$716.10 |
$274.65
|
|
X-ray neck soft tissue
|
$378.00 |
$378.00 |
$378.00 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$406.00 |
$406.00 |
$406.00 |
$225.60
|
|
X-ray pelvis 1-2 views
|
$576.10 |
$576.10 |
$576.10 |
$280.80
|
|
X-ray pelvis complete > 3 views
|
$687.40 |
$687.40 |
$687.40 |
$348.19
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$1,158.50 |
$1,158.50 |
$1,158.50 |
$755.50
|
|
X-ray ribs 2 views left
|
$659.40 |
$659.40 |
$659.40 |
$292.80
|
|
X-ray ribs 3 views bilateral
|
$787.50 |
$787.50 |
$787.50 |
$395.76
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$782.60 |
$782.60 |
$782.60 |
$356.20
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$988.40 |
$988.40 |
$988.40 |
$491.70
|
|
X-ray sacroiliac joints >= 3 views
|
$690.90 |
$690.90 |
$690.90 |
$312.75
|
|
X-ray sacrum/coccyx >= 2 views
|
$744.10 |
$744.10 |
$744.10 |
$288.80
|
|
X-ray scapula complete (both sides)
|
$500.50 |
$500.50 |
$500.50 |
$285.00
|
|
X-ray shoulder 1 view (both sides)
|
$415.10 |
$415.10 |
$415.10 |
$260.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$840.70 |
$840.70 |
$840.70 |
$345.60
|
|
X-ray sinus tract/fistula/abscess
|
$1,332.10 |
$1,332.10 |
$1,332.10 |
$606.89
|
|
X-ray skull < 4 views
|
$484.40 |
$484.40 |
$484.40 |
$292.50
|
|
X-ray skull > 4 views complete
|
$812.00 |
$812.00 |
$812.00 |
$417.50
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$790.30 |
$790.30 |
$790.30 |
$557.70
|
|
X-ray small intestine follow-through study
|
$781.90 |
$781.90 |
$781.90 |
$499.50
|
|
X-ray spine single view
|
$450.10 |
$450.10 |
$450.10 |
$251.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$706.30 |
$706.30 |
$706.30 |
$264.48
|
|
X-ray sternum > 2 views
|
$538.30 |
$538.30 |
$538.30 |
$274.65
|
|
X-ray surgical specimen
|
$790.30 |
$790.30 |
$790.30 |
$504.00
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$666.40 |
$666.40 |
$666.40 |
$523.25
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$803.60 |
$803.60 |
$803.60 |
$327.80
|
|
X-ray thoracic spine 2 views
|
$697.90 |
$697.90 |
$697.90 |
$320.45
|
|
X-ray thoracic spine 3 views
|
$778.40 |
$778.40 |
$778.40 |
$381.60
|
|
X-ray thoracolumbar spine >=2 views
|
$649.60 |
$649.60 |
$649.60 |
$282.50
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$613.20 |
$613.20 |
$613.20 |
$257.04
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$746.90 |
$746.90 |
$746.90 |
$352.95
|
|
X-ray tibia/fibula 2 views (both sides)
|
$536.90 |
$536.90 |
$536.90 |
$332.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$436.10 |
$436.10 |
$436.10 |
$258.50
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$1,048.60 |
$1,048.60 |
$1,048.60 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$822.50 |
$822.50 |
$822.50 |
$603.20
|
|
X-ray wrist 2 views (both sides)
|
$399.70 |
$399.70 |
$399.70 |
$290.40
|
|
Xylose absorption test blood &/or urine
|
$179.90 |
$179.90 |
$179.90 |
$99.89
|
|
Yersinia antibody
|
$144.20 |
$144.20 |
$144.20 |
$55.80
|
|
Yttrium y-90 ibritumomab ther
|
$65,419.20 |
$65,419.20 |
$65,419.20 |
$55,035.00
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$132.30 |
$132.30 |
$132.30 |
$93.06
|
|
Zika virus dna/rna amp probe
|
$858.20 |
$858.20 |
$858.20 |
$185.00
|
|
Zika virus igm antibody
|
$462.70 |
$462.70 |
$462.70 |
$85.00
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$114.97 |
$114.97 |
$114.97 |
$122.45
|
|
Ziv-aflibercept 25 mg/ml intravenous solution (wrapper)
|
$15,124.20 |
$15,124.20 |
$15,124.20 |
$5,215.08
|
|
Zolbetuximab-clzb 100 mg intravenous solution
|
$22,686.30 |
$22,686.30 |
$22,686.30 |
$7,810.92
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$1,313.72 |
$1,313.72 |
$1,313.72 |
$452.69
|
