|
X-ray cervical spine 4-5 views
|
$485.56 |
$485.56 |
$485.56 |
$457.05
|
|
X-ray cervical spine >= 6 views
|
$665.51 |
$665.51 |
$665.51 |
$508.50
|
|
X-ray clavicle complete (both sides)
|
$290.36 |
$290.36 |
$290.36 |
$300.05
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$900.36 |
$900.36 |
$900.36 |
$657.03
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$1,154.73 |
$1,154.73 |
$1,154.73 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$276.94 |
$276.94 |
$276.94 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$352.58 |
$352.58 |
$352.58 |
$364.12
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$630.74 |
$630.74 |
$630.74 |
$483.50
|
|
X-ray exam entire spi 4/5 vw
|
$230.58 |
$230.58 |
$230.58 |
$441.48
|
|
X-ray exam entire spi 6/> vw
|
$233.63 |
$233.63 |
$233.63 |
$517.80
|
|
X-ray exam of arm infant
|
$203.74 |
$203.74 |
$203.74 |
$248.44
|
|
X-ray exam of eye sockets
|
$418.46 |
$418.46 |
$418.46 |
$328.35
|
|
X-ray exam of femur 1
|
$133.59 |
$133.59 |
$133.59 |
$240.00
|
|
X-ray exam of sinuses
|
$264.74 |
$264.74 |
$264.74 |
$214.50
|
|
X-ray exam of teeth
|
$117.12 |
$117.12 |
$117.12 |
$328.08
|
|
X-ray exam si joints
|
$258.64 |
$258.64 |
$258.64 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$331.84 |
$331.84 |
$331.84 |
$387.40
|
|
X-ray facial bones complete > 3 views
|
$410.53 |
$410.53 |
$410.53 |
$381.75
|
|
X-ray femur >=2 views (both sides)
|
$278.16 |
$278.16 |
$278.16 |
$317.25
|
|
X-ray finger(s) >= 2 views (both sides)
|
$222.04 |
$222.04 |
$222.04 |
$241.05
|
|
X-ray foot 2 views (both sides)
|
$203.13 |
$203.13 |
$203.13 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$264.74 |
$264.74 |
$264.74 |
$322.20
|
|
X-ray hand 2 views (both sides)
|
$297.68 |
$297.68 |
$297.68 |
$291.20
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$174.46 |
$174.46 |
$174.46 |
$274.95
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$197.64 |
$197.64 |
$197.64 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$455.67 |
$455.67 |
$455.67 |
$374.40
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$459.94 |
$459.94 |
$459.94 |
$424.05
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$399.55 |
$399.55 |
$399.55 |
$505.60
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$132.37 |
$132.37 |
$132.37 |
$231.00
|
|
X-ray humerus >= 2 views left
|
$284.87 |
$284.87 |
$284.87 |
$309.31
|
|
X-ray knee 1-2 views (both sides)
|
$364.17 |
$364.17 |
$364.17 |
$285.00
|
|
X-ray knee 3 views (both sides)
|
$387.35 |
$387.35 |
$387.35 |
$363.20
|
|
X-ray knee ap standing bilateral
|
$195.81 |
$195.81 |
$195.81 |
$252.50
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$142.74 |
$142.74 |
$142.74 |
$254.12
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$527.04 |
$527.04 |
$527.04 |
$369.15
|
|
X-ray lumbosacral spine >= 4 views
|
$536.19 |
$536.19 |
$536.19 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$573.40 |
$573.40 |
$573.40 |
$535.91
|
|
X-ray mandible complete > 4 views
|
$395.89 |
$395.89 |
$395.89 |
$361.61
|
|
X-ray mandible ltd <4 views
|
$190.32 |
$190.32 |
$190.32 |
$235.30
|
|
X-ray nasal bones complete > 3 views
|
$292.80 |
$292.80 |
$292.80 |
$274.65
|
|
X-ray neck soft tissue
|
$268.40 |
$268.40 |
$268.40 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$235.46 |
$235.46 |
$235.46 |
$225.60
|
|
X-ray pelvis 1-2 views
|
$281.82 |
$281.82 |
$281.82 |
$280.80
|
|
X-ray pelvis complete > 3 views
|
$315.37 |
$315.37 |
$315.37 |
$348.19
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$762.50 |
$762.50 |
$762.50 |
$755.50
|
|
X-ray ribs 2 views left
|
$267.18 |
$267.18 |
$267.18 |
$292.80
|
|
X-ray ribs 3 views bilateral
|
$412.97 |
$412.97 |
$412.97 |
$395.76
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$366.00 |
$366.00 |
$366.00 |
$356.20
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$480.07 |
$480.07 |
$480.07 |
$491.70
|
|
X-ray sacroiliac joints >= 3 views
|
$435.54 |
$435.54 |
$435.54 |
$312.75
|
|
X-ray sacrum/coccyx >= 2 views
|
$261.08 |
$261.08 |
$261.08 |
$288.80
|
|
X-ray scapula complete (both sides)
|
$353.19 |
$353.19 |
$353.19 |
$285.00
|
|
X-ray shoulder 1 view (both sides)
|
$218.38 |
$218.38 |
$218.38 |
$260.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$358.07 |
$358.07 |
$358.07 |
$345.60
|
|
X-ray sinus tract/fistula/abscess
|
$1,055.30 |
$1,055.30 |
$1,055.30 |
$606.89
|
|
X-ray skull < 4 views
|
$311.71 |
$311.71 |
$311.71 |
$292.50
|
|
X-ray skull > 4 views complete
|
$442.25 |
$442.25 |
$442.25 |
$417.50
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$661.85 |
$661.85 |
$661.85 |
$557.70
|
|
X-ray small intestine follow-through study
|
$490.44 |
$490.44 |
$490.44 |
$499.50
|
|
X-ray spine single view
|
$283.04 |
$283.04 |
$283.04 |
$251.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$220.21 |
$220.21 |
$220.21 |
$264.48
|
|
X-ray sternum > 2 views
|
$121.39 |
$121.39 |
$121.39 |
$274.65
|
|
X-ray surgical specimen
|
$386.74 |
$386.74 |
$386.74 |
$504.00
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$498.37 |
$498.37 |
$498.37 |
$523.25
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$217.77 |
$217.77 |
$217.77 |
$327.80
|
|
X-ray thoracic spine 2 views
|
$277.55 |
$277.55 |
$277.55 |
$320.45
|
|
X-ray thoracic spine 3 views
|
$416.63 |
$416.63 |
$416.63 |
$381.60
|
|
X-ray thoracolumbar spine >=2 views
|
$265.96 |
$265.96 |
$265.96 |
$282.50
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$261.08 |
$261.08 |
$261.08 |
$257.04
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$606.95 |
$606.95 |
$606.95 |
$352.95
|
|
X-ray tibia/fibula 2 views (both sides)
|
$301.95 |
$301.95 |
$301.95 |
$332.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$247.05 |
$247.05 |
$247.05 |
$258.50
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$708.21 |
$708.21 |
$708.21 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$649.04 |
$649.04 |
$649.04 |
$603.20
|
|
X-ray upper gi&small intest
|
$940.01 |
$940.01 |
$940.01 |
$697.56
|
|
X-ray wrist 2 views (both sides)
|
$216.55 |
$216.55 |
$216.55 |
$290.40
|
|
Xyntha inj
|
$0.70 |
$0.70 |
$0.70 |
$6.65
|
|
Yttrium y-90 ibritumomab ther
|
$47,601.35 |
$47,601.35 |
$47,601.35 |
$55,035.00
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$0.82 |
$0.82 |
$0.82 |
$93.06
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$23.37 |
$23.37 |
$23.37 |
$122.45
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$20.90 |
$20.90 |
$20.90 |
$452.69
|