|
X-ray abdomen >=3 views
|
$1,093.61 |
$1,093.61 |
$1,093.61 |
$342.50
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$1,377.16 |
$1,377.16 |
$1,377.16 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$972.74 |
$972.74 |
$972.74 |
$270.20
|
|
X-ray ankle 2 views (both sides)
|
$1,767.26 |
$1,767.26 |
$1,767.26 |
$282.50
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$4,219.01 |
$4,219.01 |
$4,219.01 |
$773.40
|
|
X-ray bone age studies
|
$972.74 |
$972.74 |
$972.74 |
$251.40
|
|
X-ray bone length studies
|
$673.67 |
$673.67 |
$673.67 |
$285.30
|
|
X-ray bone survey complete
|
$2,201.63 |
$2,201.63 |
$2,201.63 |
$660.00
|
|
X-ray bone survey infant
|
$1,080.49 |
$1,080.49 |
$1,080.49 |
$394.69
|
|
X-ray cervical spine 2-3 views
|
$1,163.00 |
$1,163.00 |
$1,163.00 |
$333.83
|
|
X-ray cervical spine 4-5 views
|
$1,500.41 |
$1,500.41 |
$1,500.41 |
$457.05
|
|
X-ray cervical spine >= 6 views
|
$2,306.96 |
$2,306.96 |
$2,306.96 |
$508.50
|
|
X-ray clavicle complete (both sides)
|
$2,036.49 |
$2,036.49 |
$2,036.49 |
$300.05
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$2,279.42 |
$2,279.42 |
$2,279.42 |
$657.03
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$3,449.61 |
$3,449.61 |
$3,449.61 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$1,773.27 |
$1,773.27 |
$1,773.27 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$1,897.73 |
$1,897.73 |
$1,897.73 |
$364.12
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$1,555.49 |
$1,555.49 |
$1,555.49 |
$483.50
|
|
X-ray exam entire spi 4/5 vw
|
$6,301.94 |
$6,301.94 |
$6,301.94 |
$441.48
|
|
X-ray exam entire spi 6/> vw
|
$7,000.85 |
$7,000.85 |
$7,000.85 |
$517.80
|
|
X-ray exam of arm infant
|
$1,665.53 |
$1,665.53 |
$1,665.53 |
$248.44
|
|
X-ray exam of eye sockets
|
$1,149.87 |
$1,149.87 |
$1,149.87 |
$328.35
|
|
X-ray exam of femur 1
|
$614.99 |
$614.99 |
$614.99 |
$240.00
|
|
X-ray exam of jaw joint
|
$151.31 |
$151.31 |
$151.31 |
$188.40
|
|
X-ray exam of sinuses
|
$917.77 |
$917.77 |
$917.77 |
$214.50
|
|
X-ray exam si joints
|
$612.59 |
$612.59 |
$612.59 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$1,347.33 |
$1,347.33 |
$1,347.33 |
$387.40
|
|
X-ray eye detection foreign body (both sides)
|
$966.84 |
$966.84 |
$966.84 |
$238.29
|
|
X-ray facial bones complete > 3 views
|
$939.31 |
$939.31 |
$939.31 |
$381.75
|
|
X-ray femur >=2 views (both sides)
|
$1,767.26 |
$1,767.26 |
$1,767.26 |
$317.25
|
|
X-ray finger(s) >= 2 views (both sides)
|
$1,505.34 |
$1,505.34 |
$1,505.34 |
$241.05
|
|
X-ray foot 2 views (both sides)
|
$1,929.97 |
$1,929.97 |
$1,929.97 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$2,012.57 |
$2,012.57 |
$2,012.57 |
$322.20
|
|
X-ray hand 2 views (both sides)
|
$1,873.81 |
$1,873.81 |
$1,873.81 |
$291.20
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$1,879.69 |
$1,879.69 |
$1,879.69 |
$274.95
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$954.82 |
$954.82 |
$954.82 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$1,591.43 |
$1,591.43 |
$1,591.43 |
$374.40
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$1,934.77 |
$1,934.77 |
$1,934.77 |
$424.05
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$2,920.74 |
$2,920.74 |
$2,920.74 |
$505.60
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$674.87 |
$674.87 |
$674.87 |
$231.00
|
|
X-ray humerus >= 2 views left
|
$2,046.12 |
$2,046.12 |
$2,046.12 |
$309.31
|
|
X-ray joint survey 1 view
|
$819.65 |
$819.65 |
$819.65 |
$232.00
|
|
X-ray knee 1-2 views (both sides)
|
$1,749.35 |
$1,749.35 |
$1,749.35 |
$285.00
|
|
X-ray knee 3 views (both sides)
|
$1,974.34 |
$1,974.34 |
$1,974.34 |
$363.20
|
|
X-ray knee ap standing bilateral
|
$1,061.36 |
$1,061.36 |
$1,061.36 |
$252.50
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$2,235.16 |
$2,235.16 |
$2,235.16 |
$254.12
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$936.89 |
$936.89 |
$936.89 |
$369.15
|
|
X-ray lumbosacral spine >= 4 views
|
$1,836.65 |
$1,836.65 |
$1,836.65 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$2,047.22 |
$2,047.22 |
$2,047.22 |
$535.91
|
|
X-ray mandible complete > 4 views
|
$966.84 |
$966.84 |
$966.84 |
$361.61
|
|
X-ray mandible ltd <4 views
|
$966.84 |
$966.84 |
$966.84 |
$235.30
|
|
X-ray nasal bones complete > 3 views
|
$1,210.85 |
$1,210.85 |
$1,210.85 |
$274.65
|
|
X-ray neck soft tissue
|
$968.04 |
$968.04 |
$968.04 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$335.03 |
$335.03 |
$335.03 |
$225.60
|
|
X-ray of mammary ducts
|
$1,245.60 |
$1,245.60 |
$1,245.60 |
$568.26
|
|
X-ray pelvis 1-2 views
|
$869.92 |
$869.92 |
$869.92 |
$280.80
|
|
X-ray pelvis complete > 3 views
|
$1,429.82 |
$1,429.82 |
$1,429.82 |
$348.19
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$5,142.78 |
$5,142.78 |
$5,142.78 |
$755.50
|
|
X-ray ribs 2 views left
|
$2,537.84 |
$2,537.84 |
$2,537.84 |
$292.80
|
|
X-ray ribs 3 views bilateral
|
$1,420.31 |
$1,420.31 |
$1,420.31 |
$395.76
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$2,647.88 |
$2,647.88 |
$2,647.88 |
$356.20
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$1,742.14 |
$1,742.14 |
$1,742.14 |
$491.70
|
|
X-ray sacroiliac joints >= 3 views
|
$1,079.29 |
$1,079.29 |
$1,079.29 |
$312.75
|
|
X-ray sacrum/coccyx >= 2 views
|
$1,020.60 |
$1,020.60 |
$1,020.60 |
$288.80
|
|
X-ray scapula complete (both sides)
|
$2,127.42 |
$2,127.42 |
$2,127.42 |
$285.00
|
|
X-ray sella turcica
|
$436.76 |
$436.76 |
$436.76 |
$162.50
|
|
X-ray shoulder 1 view (both sides)
|
$1,301.88 |
$1,301.88 |
$1,301.88 |
$260.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$994.27 |
$994.27 |
$994.27 |
$345.60
|
|
X-ray sinus tract/fistula/abscess
|
$1,226.47 |
$1,226.47 |
$1,226.47 |
$606.89
|
|
X-ray skull < 4 views
|
$1,259.91 |
$1,259.91 |
$1,259.91 |
$292.50
|
|
X-ray skull > 4 views complete
|
$1,817.52 |
$1,817.52 |
$1,817.52 |
$417.50
|
|
X-ray slg plne bdy sect without urogr
|
$3,301.50 |
$3,301.50 |
$3,301.50 |
$399.82
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$1,677.54 |
$1,677.54 |
$1,677.54 |
$557.70
|
|
X-ray small intestine follow-through study
|
$2,833.43 |
$2,833.43 |
$2,833.43 |
$499.50
|
|
X-ray spine single view
|
$599.46 |
$599.46 |
$599.46 |
$251.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$387.70 |
$387.70 |
$387.70 |
$264.48
|
|
X-ray sternum > 2 views
|
$987.16 |
$987.16 |
$987.16 |
$274.65
|
|
X-ray surgical specimen
|
$2,078.35 |
$2,078.35 |
$2,078.35 |
$504.00
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$1,252.79 |
$1,252.79 |
$1,252.79 |
$523.25
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$1,103.21 |
$1,103.21 |
$1,103.21 |
$327.80
|
|
X-ray thoracic spine 2 views
|
$1,164.19 |
$1,164.19 |
$1,164.19 |
$320.45
|
|
X-ray thoracic spine 3 views
|
$1,231.28 |
$1,231.28 |
$1,231.28 |
$381.60
|
|
X-ray thoracolumbar spine >=2 views
|
$1,007.48 |
$1,007.48 |
$1,007.48 |
$282.50
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$1,799.61 |
$1,799.61 |
$1,799.61 |
$257.04
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$3,501.08 |
$3,501.08 |
$3,501.08 |
$352.95
|
|
X-ray tibia/fibula 2 views (both sides)
|
$1,867.78 |
$1,867.78 |
$1,867.78 |
$332.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$1,859.38 |
$1,859.38 |
$1,859.38 |
$258.50
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$1,134.36 |
$1,134.36 |
$1,134.36 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$2,474.78 |
$2,474.78 |
$2,474.78 |
$603.20
|
|
X-ray wrist 2 views (both sides)
|
$2,079.56 |
$2,079.56 |
$2,079.56 |
$290.40
|
|
X-ray xm phrnx&/crv esoph c+
|
$844.89 |
$844.89 |
$844.89 |
$354.00
|
|
Xylose absorption test blood &/or urine
|
$431.23 |
$431.23 |
$431.23 |
$99.89
|
|
Xyntha inj
|
$8.82 |
$8.82 |
$8.82 |
$6.65
|
|
Yersinia antibody
|
$157.10 |
$157.10 |
$157.10 |
$55.80
|
|
Yttrium y-90 ibritumomab ther
|
$43,032.62 |
$43,032.62 |
$43,032.62 |
$55,035.00
|
|
Ziconotide injection
|
$61,854.94 |
$61,854.94 |
$61,854.94 |
$7,216.02
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$295.42 |
$295.42 |
$295.42 |
$93.06
|
|
Zika virus dna/rna amp probe
|
$689.09 |
$689.09 |
$689.09 |
$185.00
|
|
Zika virus igm antibody
|
$260.74 |
$260.74 |
$260.74 |
$85.00
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$641.02 |
$641.02 |
$641.02 |
$122.45
|