|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$484.80 |
$484.80 |
$484.80 |
$434.76
|
|
X-ray exam entire spi 4/5 vw
|
$397.80 |
$397.80 |
$397.80 |
$441.48
|
|
X-ray exam entire spi 6/> vw
|
$517.80 |
$517.80 |
$517.80 |
$562.90
|
|
X-ray exam of arm infant
|
$200.40 |
$200.40 |
$200.40 |
$238.26
|
|
X-ray exam of eye sockets
|
$247.80 |
$247.80 |
$247.80 |
$321.48
|
|
X-ray exam of femur 1
|
$194.40 |
$194.40 |
$194.40 |
$194.40
|
|
X-ray exam of mastoids
|
$310.80 |
$310.80 |
$310.80 |
$187.60
|
|
X-ray exam of salivary gland
|
$162.60 |
$162.60 |
$162.60 |
$124.24
|
|
X-ray exam of sinuses
|
$192.00 |
$192.00 |
$192.00 |
$192.00
|
|
X-ray exam si joints
|
$265.80 |
$265.80 |
$265.80 |
$198.38
|
|
X-ray exam thorac spine4/>vw
|
$258.00 |
$258.00 |
$258.00 |
$365.00
|
|
X-ray eye detection foreign body (both sides)
|
$516.00 |
$516.00 |
$516.00 |
$227.80
|
|
X-ray facial bones complete > 3 views
|
$273.00 |
$273.00 |
$273.00 |
$336.00
|
|
X-ray femur >=2 views (both sides)
|
$390.00 |
$390.00 |
$390.00 |
$288.00
|
|
X-ray finger(s) >= 2 views (both sides)
|
$303.60 |
$303.60 |
$303.60 |
$233.55
|
|
X-ray foot 2 views (both sides)
|
$290.40 |
$290.40 |
$290.40 |
$270.40
|
|
X-ray forearm 2 views (both sides)
|
$367.20 |
$367.20 |
$367.20 |
$317.62
|
|
X-ray hand 2 views (both sides)
|
$343.20 |
$343.20 |
$343.20 |
$267.20
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$516.00 |
$516.00 |
$516.00 |
$243.10
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$376.80 |
$376.80 |
$376.80 |
$300.00
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$274.80 |
$274.80 |
$274.80 |
$313.45
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$376.80 |
$376.80 |
$376.80 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$478.80 |
$478.80 |
$478.80 |
$477.10
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$172.80 |
$172.80 |
$172.80 |
$186.60
|
|
X-ray humerus >= 2 views left
|
$362.40 |
$362.40 |
$362.40 |
$285.00
|
|
X-ray knee 1-2 views (both sides)
|
$417.60 |
$417.60 |
$417.60 |
$271.70
|
|
X-ray knee 3 views (both sides)
|
$458.40 |
$458.40 |
$458.40 |
$319.24
|
|
X-ray knee ap standing bilateral
|
$208.80 |
$208.80 |
$208.80 |
$238.80
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$271.20 |
$271.20 |
$271.20 |
$227.92
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$258.00 |
$258.00 |
$258.00 |
$342.55
|
|
X-ray lumbosacral spine >= 4 views
|
$346.80 |
$346.80 |
$346.80 |
$475.04
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$362.40 |
$362.40 |
$362.40 |
$513.63
|
|
X-ray mandible complete > 4 views
|
$259.20 |
$259.20 |
$259.20 |
$320.90
|
|
X-ray mandible ltd <4 views
|
$162.60 |
$162.60 |
$162.60 |
$200.20
|
|
X-ray nasal bones complete > 3 views
|
$193.20 |
$193.20 |
$193.20 |
$260.52
|
|
X-ray neck soft tissue
|
$172.80 |
$172.80 |
$172.80 |
$221.10
|
|
X-ray nose to rectum for foreign body child
|
$258.00 |
$258.00 |
$258.00 |
$201.00
|
|
X-ray of mammary ducts
|
$258.00 |
$258.00 |
$258.00 |
$437.00
|
|
X-ray optic foramina
|
$303.60 |
$303.60 |
$303.60 |
$165.09
|
|
X-ray pelvis 1-2 views
|
$186.00 |
$186.00 |
$186.00 |
$242.58
|
|
X-ray pelvis complete > 3 views
|
$226.20 |
$226.20 |
$226.20 |
$295.75
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$258.00 |
$258.00 |
$258.00 |
$663.18
|
|
X-ray ribs 2 views left
|
$204.60 |
$204.60 |
$204.60 |
$281.45
|
|
X-ray ribs 3 views bilateral
|
$292.20 |
$292.20 |
$292.20 |
$361.20
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$226.80 |
$226.80 |
$226.80 |
$327.21
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$309.60 |
$309.60 |
$309.60 |
$463.45
|
|
X-ray sacroiliac joints >= 3 views
|
$236.40 |
$236.40 |
$236.40 |
$270.40
|
|
X-ray sacrum/coccyx >= 2 views
|
$219.00 |
$219.00 |
$219.00 |
$260.00
|
|
X-ray scapula complete (both sides)
|
$444.00 |
$444.00 |
$444.00 |
$264.80
|
|
X-ray shoulder 1 view (both sides)
|
$325.20 |
$325.20 |
$325.20 |
$242.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$283.80 |
$283.80 |
$283.80 |
$324.53
|
|
X-ray sinus tract/fistula/abscess
|
$263.40 |
$263.40 |
$263.40 |
$529.75
|
|
X-ray skull < 4 views
|
$232.80 |
$232.80 |
$232.80 |
$277.54
|
|
X-ray skull > 4 views complete
|
$306.60 |
$306.60 |
$306.60 |
$404.30
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$258.00 |
$258.00 |
$258.00 |
$511.38
|
|
X-ray small intestine follow-through study
|
$193.80 |
$193.80 |
$193.80 |
$470.16
|
|
X-ray spine single view
|
$171.60 |
$171.60 |
$171.60 |
$225.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$223.80 |
$223.80 |
$223.80 |
$236.88
|
|
X-ray sternum > 2 views
|
$195.00 |
$195.00 |
$195.00 |
$230.00
|
|
X-ray surgical specimen
|
$258.00 |
$258.00 |
$258.00 |
$457.47
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$258.00 |
$258.00 |
$258.00 |
$463.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$262.20 |
$262.20 |
$262.20 |
$276.00
|
|
X-ray thoracic spine 2 views
|
$238.20 |
$238.20 |
$238.20 |
$286.65
|
|
X-ray thoracic spine 3 views
|
$283.80 |
$283.80 |
$283.80 |
$343.00
|
|
X-ray thoracolumbar spine >=2 views
|
$234.60 |
$234.60 |
$234.60 |
$269.10
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$244.20 |
$244.20 |
$244.20 |
$211.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$386.40 |
$386.40 |
$386.40 |
$346.50
|
|
X-ray tibia/fibula 2 views (both sides)
|
$397.20 |
$397.20 |
$397.20 |
$306.47
|
|
X-ray toe(s) > 2 views (both sides)
|
$296.40 |
$296.40 |
$296.40 |
$225.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$704.40 |
$704.40 |
$704.40 |
$590.20
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$659.40 |
$659.40 |
$659.40 |
$497.93
|
|
X-ray wrist 2 views (both sides)
|
$290.40 |
$290.40 |
$290.40 |
$268.49
|
|
Xylose absorption test blood &/or urine
|
$172.80 |
$172.80 |
$172.80 |
$91.44
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$119.24 |
$119.24 |
$119.24 |
$90.15
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$130.33 |
$130.33 |
$130.33 |
$83.13
|
|
Ziv-aflibercept 25 mg/ml intravenous solution (wrapper)
|
$31.69 |
$31.69 |
$31.69 |
$31.69
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$69.19 |
$69.19 |
$69.19 |
$195.65
|