|
Whole blood/red blood cells leukocytes reduced cmv negative each unit
|
$342.72 |
$342.72 |
$342.72 |
$432.00
|
|
Wrist X-ray
|
$91.84 |
$91.84 |
$91.84 |
$311.20
|
|
Xm archive tissue molec anal
|
$25.76 |
$25.76 |
$25.76 |
$48.00
|
|
X-ray abdomen 1 view
|
$53.76 |
$53.76 |
$53.76 |
$243.00
|
|
X-ray abdomen 2 views
|
$68.32 |
$68.32 |
$68.32 |
$281.50
|
|
X-ray abdomen >=3 views
|
$142.24 |
$142.24 |
$142.24 |
$309.38
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$86.24 |
$86.24 |
$86.24 |
$359.84
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$58.80 |
$58.80 |
$58.80 |
$246.42
|
|
X-ray ankle 2 views (both sides)
|
$80.08 |
$80.08 |
$80.08 |
$240.00
|
|
X-ray bone age studies
|
$80.08 |
$80.08 |
$80.08 |
$227.08
|
|
X-ray bone length studies
|
$60.48 |
$60.48 |
$60.48 |
$258.70
|
|
X-ray bone survey complete
|
$157.36 |
$157.36 |
$157.36 |
$569.03
|
|
X-ray cervical spine 2-3 views
|
$53.76 |
$53.76 |
$53.76 |
$308.40
|
|
X-ray cervical spine 4-5 views
|
$68.32 |
$68.32 |
$68.32 |
$439.14
|
|
X-ray cervical spine >= 6 views
|
$83.44 |
$83.44 |
$83.44 |
$479.05
|
|
X-ray clavicle complete (both sides)
|
$70.00 |
$70.00 |
$70.00 |
$277.00
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$157.36 |
$157.36 |
$157.36 |
$594.68
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$199.36 |
$199.36 |
$199.36 |
$785.86
|
|
X-ray elbow 2 views (both sides)
|
$53.76 |
$53.76 |
$53.76 |
$281.40
|
|
X-ray elbow >= 3 views (both sides)
|
$91.84 |
$91.84 |
$91.84 |
$325.88
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$90.16 |
$90.16 |
$90.16 |
$434.76
|
|
X-ray exam of arm infant
|
$45.36 |
$45.36 |
$45.36 |
$238.26
|
|
X-ray exam of eye sockets
|
$64.96 |
$64.96 |
$64.96 |
$321.48
|
|
X-ray exam of femur 1
|
$61.60 |
$61.60 |
$61.60 |
$194.40
|
|
X-ray exam of sinuses
|
$41.44 |
$41.44 |
$41.44 |
$192.00
|
|
X-ray exam si joints
|
$62.72 |
$62.72 |
$62.72 |
$198.38
|
|
X-ray exam thorac spine4/>vw
|
$96.32 |
$96.32 |
$96.32 |
$365.00
|
|
X-ray facial bones complete > 3 views
|
$68.32 |
$68.32 |
$68.32 |
$337.95
|
|
X-ray femur >=2 views (both sides)
|
$160.72 |
$160.72 |
$160.72 |
$290.44
|
|
X-ray finger(s) >= 2 views (both sides)
|
$54.88 |
$54.88 |
$54.88 |
$233.55
|
|
X-ray foot 2 views (both sides)
|
$80.08 |
$80.08 |
$80.08 |
$270.40
|
|
X-ray forearm 2 views (both sides)
|
$80.08 |
$80.08 |
$80.08 |
$317.62
|
|
X-ray hand 2 views (both sides)
|
$80.08 |
$80.08 |
$80.08 |
$270.00
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$72.80 |
$72.80 |
$72.80 |
$243.10
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$131.04 |
$131.04 |
$131.04 |
$300.00
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$102.48 |
$102.48 |
$102.48 |
$313.45
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$127.68 |
$127.68 |
$127.68 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$192.64 |
$192.64 |
$192.64 |
$477.10
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$100.80 |
$100.80 |
$100.80 |
$187.20
|
|
X-ray humerus >= 2 views left
|
$72.80 |
$72.80 |
$72.80 |
$285.00
|
|
X-ray knee 1-2 views (both sides)
|
$91.84 |
$91.84 |
$91.84 |
$271.70
|
|
X-ray knee 3 views (both sides)
|
$106.40 |
$106.40 |
$106.40 |
$319.24
|
|
X-ray knee ap standing bilateral
|
$50.40 |
$50.40 |
$50.40 |
$243.09
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$79.52 |
$79.52 |
$79.52 |
$227.92
|
|
X-ray lumbosacral spine >= 4 views
|
$83.44 |
$83.44 |
$83.44 |
$475.04
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$119.28 |
$119.28 |
$119.28 |
$513.63
|
|
X-ray mandible complete > 4 views
|
$60.48 |
$60.48 |
$60.48 |
$323.70
|
|
X-ray nasal bones complete > 3 views
|
$57.12 |
$57.12 |
$57.12 |
$260.52
|
|
X-ray neck soft tissue
|
$48.72 |
$48.72 |
$48.72 |
$221.10
|
|
X-ray nose to rectum for foreign body child
|
$42.56 |
$42.56 |
$42.56 |
$201.00
|
|
X-ray pelvis 1-2 views
|
$47.60 |
$47.60 |
$47.60 |
$242.58
|
|
X-ray pelvis complete > 3 views
|
$59.36 |
$59.36 |
$59.36 |
$299.46
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$300.72 |
$300.72 |
$300.72 |
$663.18
|
|
X-ray ribs 2 views left
|
$54.88 |
$54.88 |
$54.88 |
$281.45
|
|
X-ray ribs 3 views bilateral
|
$90.16 |
$90.16 |
$90.16 |
$361.20
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$82.32 |
$82.32 |
$82.32 |
$327.21
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$104.16 |
$104.16 |
$104.16 |
$466.80
|
|
X-ray sacroiliac joints >= 3 views
|
$54.88 |
$54.88 |
$54.88 |
$270.40
|
|
X-ray sacrum/coccyx >= 2 views
|
$54.88 |
$54.88 |
$54.88 |
$260.65
|
|
X-ray scapula complete (both sides)
|
$70.00 |
$70.00 |
$70.00 |
$264.80
|
|
X-ray shoulder 1 view (both sides)
|
$47.60 |
$47.60 |
$47.60 |
$242.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$68.32 |
$68.32 |
$68.32 |
$324.53
|
|
X-ray skull < 4 views
|
$57.12 |
$57.12 |
$57.12 |
$277.54
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$106.40 |
$106.40 |
$106.40 |
$511.38
|
|
X-ray spine single view
|
$47.60 |
$47.60 |
$47.60 |
$225.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$64.96 |
$64.96 |
$64.96 |
$236.88
|
|
X-ray sternum > 2 views
|
$53.76 |
$53.76 |
$53.76 |
$230.00
|
|
X-ray surgical specimen
|
$237.44 |
$237.44 |
$237.44 |
$457.47
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$196.56 |
$196.56 |
$196.56 |
$463.00
|
|
X-ray thoracic spine 2 views
|
$54.88 |
$54.88 |
$54.88 |
$286.65
|
|
X-ray thoracic spine 3 views
|
$75.04 |
$75.04 |
$75.04 |
$343.00
|
|
X-ray thoracolumbar spine >=2 views
|
$54.88 |
$54.88 |
$54.88 |
$269.10
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$110.32 |
$110.32 |
$110.32 |
$346.50
|
|
X-ray tibia/fibula 2 views (both sides)
|
$80.08 |
$80.08 |
$80.08 |
$306.47
|
|
X-ray toe(s) > 2 views (both sides)
|
$54.88 |
$54.88 |
$54.88 |
$225.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$168.00 |
$168.00 |
$168.00 |
$590.20
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$168.00 |
$168.00 |
$168.00 |
$497.93
|
|
X-ray wrist 2 views (both sides)
|
$80.08 |
$80.08 |
$80.08 |
$268.49
|
|
Xylose absorption test blood &/or urine
|
$69.68 |
$69.68 |
$69.68 |
$91.44
|
|
Zika virus dna/rna amp probe
|
$84.00 |
$84.00 |
$84.00 |
$197.25
|