|
X-ray bone survey complete
|
$540.80 |
$686.40 |
$1,164.80 |
|
|
X-ray bone survey infant
|
$163.80 |
$399.75 |
$499.85 |
|
|
X-ray cervical spine 2-3 views
|
$118.50 |
$309.40 |
$447.20 |
|
|
X-ray cervical spine 4-5 views
|
$160.50 |
$414.70 |
$592.15 |
|
|
X-ray cervical spine >= 6 views
|
$427.05 |
$491.40 |
$582.40 |
|
|
X-ray clavicle complete (both sides)
|
$81.75 |
$368.55 |
$601.90 |
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$525.20 |
$622.05 |
$771.55 |
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$633.75 |
$773.50 |
$1,075.75 |
|
|
X-ray elbow 2 views (both sides)
|
$99.00 |
$331.50 |
$533.00 |
|
|
X-ray elbow >= 3 views (both sides)
|
$105.75 |
$478.40 |
$598.00 |
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$365.30 |
$436.15 |
$611.00 |
|
|
X-ray exam entire spi 4/5 vw
|
$447.85 |
$482.95 |
$648.05 |
|
|
X-ray exam entire spi 6/> vw
|
$507.00 |
$644.80 |
$731.90 |
|
|
X-ray exam of arm infant
|
$166.40 |
$220.35 |
$635.05 |
|
|
X-ray exam of eye sockets
|
$288.60 |
$349.05 |
$547.95 |
|
|
X-ray exam of femur 1
|
$196.95 |
$209.30 |
$424.45 |
|
|
X-ray exam of jaw joint
|
$65.25 |
$153.40 |
$249.60 |
|
|
X-ray exam of jaw joint
|
$1,274.65 |
$1,274.65 |
$2,522.65 |
|
|
X-ray exam of mastoids
|
$149.50 |
$201.50 |
$350.35 |
|
|
X-ray exam of perineum
|
$496.60 |
$496.60 |
$496.60 |
|
|
X-ray exam of salivary gland
|
$217.10 |
$217.10 |
$217.10 |
|
|
X-ray exam of sinuses
|
$94.50 |
$195.65 |
$287.95 |
|
|
X-ray exam si joints
|
$90.75 |
$189.80 |
$291.20 |
|
|
X-ray exam thorac spine4/>vw
|
$296.40 |
$378.95 |
$451.75 |
|
|
X-ray eye detection foreign body (both sides)
|
$230.10 |
$317.85 |
$444.60 |
|
|
X-ray facial bones complete > 3 views
|
$130.50 |
$297.70 |
$508.30 |
|
|
X-ray fallopian tube
|
$707.20 |
$707.20 |
$707.20 |
|
|
X-ray femur >=2 views (both sides)
|
$9.00 |
$452.40 |
$517.40 |
|
|
X-ray finger(s) >= 2 views (both sides)
|
$57.00 |
$313.95 |
$466.70 |
|
|
X-ray foot 2 views (both sides)
|
$73.50 |
$331.50 |
$522.60 |
|
|
X-ray forearm 2 views (both sides)
|
$89.25 |
$360.75 |
$515.45 |
|
|
X-ray hand 2 views (both sides)
|
$65.25 |
$336.70 |
$554.45 |
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$85.50 |
$332.15 |
$522.60 |
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$271.05 |
$306.80 |
$365.95 |
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$10.50 |
$328.90 |
$529.10 |
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$419.90 |
$435.50 |
$681.85 |
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$452.40 |
$533.00 |
$871.65 |
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$149.50 |
$226.85 |
$273.00 |
|
|
X-ray humerus >= 2 views left
|
$89.25 |
$384.15 |
$544.05 |
|
|
X-ray joint survey 1 view
|
$193.70 |
$193.70 |
$261.95 |
|
|
X-ray knee 1-2 views (both sides)
|
$73.50 |
$397.15 |
$595.40 |
|
|
X-ray knee 3 views (both sides)
|
$96.75 |
$405.60 |
$608.40 |
|
|
X-ray knee ap standing bilateral
|
$15.00 |
$191.75 |
$263.25 |
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$245.05 |
$304.20 |
$546.65 |
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$286.00 |
$350.35 |
$405.60 |
|
|
X-ray lumbosacral spine >= 4 views
|
$14.25 |
$438.75 |
$566.15 |
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$384.80 |
$581.10 |
$586.95 |
|
|
X-ray mandible complete > 4 views
|
$119.25 |
$334.10 |
$367.25 |
|
|
X-ray mandible ltd <4 views
|
$69.75 |
$248.30 |
$273.00 |
|
|
X-ray nasal bones complete > 3 views
|
$101.25 |
$259.35 |
$377.00 |
|
|
X-ray neck soft tissue
|
$136.50 |
$228.15 |
$290.55 |
|
|
X-ray nose to rectum for foreign body child
|
$155.35 |
$226.85 |
$287.95 |
|
|
X-ray of mammary ducts
|
$1,066.65 |
$1,066.65 |
$1,066.65 |
|
|
X-ray optic foramina
|
$232.05 |
$232.05 |
$397.80 |
|
|
X-ray pelvis 1-2 views
|
$82.50 |
$214.50 |
$348.40 |
|
|
X-ray pelvis complete > 3 views
|
$217.75 |
$306.80 |
$342.55 |
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$634.40 |
$702.00 |
$793.65 |
|
|
X-ray ribs 2 views left
|
$96.75 |
$235.95 |
$450.45 |
|
|
X-ray ribs 3 views bilateral
|
$12.75 |
$317.20 |
$560.30 |
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$89.25 |
$280.80 |
$583.70 |
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$90.75 |
$417.95 |
$545.35 |
|
|
X-ray sacroiliac joints >= 3 views
|
$16.50 |
$272.35 |
$379.60 |
|
|
X-ray sacrum/coccyx >= 2 views
|
$89.25 |
$280.15 |
$338.00 |
|
|
X-ray scapula complete (both sides)
|
$93.00 |
$417.95 |
$503.75 |
|
|
X-ray sella turcica
|
$224.25 |
$224.25 |
$249.60 |
|
|
X-ray shoulder 1 view (both sides)
|
$36.00 |
$334.10 |
$499.85 |
|
|
X-ray sinuses paranasal complete > 3 views
|
$117.00 |
$330.85 |
$515.45 |
|
|
X-ray sinus tract/fistula/abscess
|
$529.10 |
$539.50 |
$859.30 |
|
|
X-ray skull < 4 views
|
$111.75 |
$277.55 |
$360.75 |
|
|
X-ray skull > 4 views complete
|
$141.00 |
$337.35 |
$436.15 |
|
|
X-ray slg plne bdy sect without urogr
|
$702.65 |
$702.65 |
$702.65 |
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$396.50 |
$517.40 |
$850.20 |
|
|
X-ray small intestine follow-through study
|
$882.70 |
$882.70 |
$910.00 |
|
|
X-ray spine single view
|
$134.55 |
$183.30 |
$312.65 |
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$183.30 |
$258.05 |
$338.65 |
|
|
X-ray sternum > 2 views
|
$118.50 |
$232.05 |
$348.40 |
|
|
X-ray surgical specimen
|
$217.10 |
$380.25 |
$1,941.55 |
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$286.65 |
$431.60 |
$523.25 |
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$79.50 |
$281.45 |
$364.65 |
|
|
X-ray thoracic spine 2 views
|
$102.00 |
$262.60 |
$415.35 |
|
|
X-ray thoracic spine 3 views
|
$10.50 |
$332.15 |
$469.30 |
|
|
X-ray thoracolumbar spine >=2 views
|
$166.40 |
$302.90 |
$415.35 |
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$108.55 |
$235.95 |
$287.95 |
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$304.20 |
$328.25 |
$447.85 |
|
|
X-ray tibia/fibula 2 views (both sides)
|
$99.00 |
$359.45 |
$613.60 |
|
|
X-ray toe(s) > 2 views (both sides)
|
$63.75 |
$328.90 |
$472.55 |
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$458.90 |
$590.20 |
$1,525.55 |
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$384.80 |
$601.90 |
$1,540.50 |
|
|
X-ray wrist 2 views (both sides)
|
$94.50 |
$347.75 |
$552.50 |
|
|
Xyntha inj
|
$7,669.48 |
$7,669.48 |
$7,669.48 |
|
|
Yttrium y-90 ibritumomab ther
|
$62,955.10 |
$62,955.10 |
$62,955.10 |
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$88.26 |
$88.26 |
$88.26 |
|
|
Zidovudine, oral, 100 mg
|
$40.95 |
$40.95 |
$75.35 |
|
|
Zika virus dna/rna amp probe
|
$269.10 |
$291.20 |
$422.50 |
|
|
Zika virus igm antibody
|
$163.15 |
$183.30 |
$198.25 |
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$99.11 |
$142.06 |
$152.75 |
|
|
Ziv-aflibercept 25 mg/ml intravenous solution (wrapper)
|
$6,975.80 |
$6,975.80 |
$6,975.80 |
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$252.52 |
$458.25 |
$853.12 |
|
|
Zoster vaccine-live inj
|
$214.50 |
$214.50 |
$214.50 |
|
