|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$194.55 |
$194.55 |
$194.55 |
$486.24
|
|
X-ray exam entire spi 4/5 vw
|
$116.22 |
$116.22 |
$116.22 |
$486.01
|
|
X-ray exam entire spi 6/> vw
|
$116.22 |
$116.22 |
$116.22 |
$575.76
|
|
X-ray exam of arm infant
|
$116.22 |
$116.22 |
$116.22 |
$248.82
|
|
X-ray exam of eye sockets
|
$116.22 |
$116.22 |
$116.22 |
$349.05
|
|
X-ray exam of femur 1
|
$96.23 |
$96.23 |
$96.23 |
$232.36
|
|
X-ray exam of jaw joint
|
$96.23 |
$96.23 |
$96.23 |
$192.39
|
|
X-ray exam of jaw joint
|
$264.17 |
$264.17 |
$264.17 |
$354.79
|
|
X-ray exam of mastoids
|
$116.22 |
$116.22 |
$116.22 |
$191.91
|
|
X-ray exam of middle ear
|
$599.23 |
$599.23 |
$599.23 |
$341.25
|
|
X-ray exam of penis
|
$116.22 |
$116.22 |
$116.22 |
$565.20
|
|
X-ray exam of perineum
|
$264.17 |
$264.17 |
$264.17 |
$420.93
|
|
X-ray exam of salivary gland
|
$96.23 |
$96.23 |
$96.23 |
$124.24
|
|
X-ray exam of sinuses
|
$96.23 |
$96.23 |
$96.23 |
$211.00
|
|
X-ray exam of tear duct
|
$264.17 |
$264.17 |
$264.17 |
$340.70
|
|
X-ray exam of teeth
|
$96.23 |
$96.23 |
$96.23 |
$104.19
|
|
X-ray exam of teeth
|
$264.17 |
$264.17 |
$264.17 |
$286.04
|
|
X-ray exam si joints
|
$116.22 |
$116.22 |
$116.22 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$116.22 |
$116.22 |
$116.22 |
$395.59
|
|
X-ray eye detection foreign body (both sides)
|
$96.23 |
$96.23 |
$96.23 |
$235.00
|
|
X-ray facial bones complete > 3 views
|
$116.22 |
$116.22 |
$116.22 |
$366.60
|
|
X-ray femur >=2 views (both sides)
|
$96.23 |
$96.23 |
$96.23 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$96.23 |
$96.23 |
$96.23 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$96.23 |
$96.23 |
$96.23 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$96.23 |
$96.23 |
$96.23 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$116.22 |
$116.22 |
$116.22 |
$316.50
|
|
X-ray head for orthodontia
|
$96.23 |
$96.23 |
$96.23 |
$104.19
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$96.23 |
$96.23 |
$96.23 |
$270.00
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$116.22 |
$116.22 |
$116.22 |
$370.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$116.22 |
$116.22 |
$116.22 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$116.22 |
$116.22 |
$116.22 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$116.22 |
$116.22 |
$116.22 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$96.23 |
$96.23 |
$96.23 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$96.23 |
$96.23 |
$96.23 |
$304.15
|
|
X-ray joint survey 1 view
|
$116.22 |
$116.22 |
$116.22 |
$211.00
|
|
X-ray knee 1-2 views (both sides)
|
$96.23 |
$96.23 |
$96.23 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$96.23 |
$96.23 |
$96.23 |
$353.25
|
|
X-ray knee ap standing bilateral
|
$96.23 |
$96.23 |
$96.23 |
$276.25
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$96.23 |
$96.23 |
$96.23 |
$249.13
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$116.22 |
$116.22 |
$116.22 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$116.22 |
$116.22 |
$116.22 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$116.22 |
$116.22 |
$116.22 |
$559.65
|
|
X-ray male genital tract
|
$264.17 |
$264.17 |
$264.17 |
$286.04
|
|
X-ray mandible complete > 4 views
|
$116.22 |
$116.22 |
$116.22 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$96.23 |
$96.23 |
$96.23 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$96.23 |
$96.23 |
$96.23 |
$277.70
|
|
X-ray neck soft tissue
|
$96.23 |
$96.23 |
$96.23 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$96.23 |
$96.23 |
$96.23 |
$225.96
|
|
X-ray of mammary ducts
|
$264.17 |
$264.17 |
$264.17 |
$473.55
|
|
X-ray optic foramina
|
$96.23 |
$96.23 |
$96.23 |
$171.00
|
|
X-ray pelvis 1-2 views
|
$116.22 |
$116.22 |
$116.22 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$116.22 |
$116.22 |
$116.22 |
$342.30
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$390.30 |
$390.30 |
$390.30 |
$742.00
|
|
X-ray ribs 2 views left
|
$96.23 |
$96.23 |
$96.23 |
$296.32
|
|
X-ray ribs 3 views bilateral
|
$116.22 |
$116.22 |
$116.22 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$116.22 |
$116.22 |
$116.22 |
$359.47
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$116.22 |
$116.22 |
$116.22 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$116.22 |
$116.22 |
$116.22 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$96.23 |
$96.23 |
$96.23 |
$285.60
|
|
X-ray scapula complete (both sides)
|
$116.22 |
$116.22 |
$116.22 |
$292.50
|
|
X-ray sella turcica
|
$96.23 |
$96.23 |
$96.23 |
$162.50
|
|
X-ray shoulder 1 view (both sides)
|
$96.23 |
$96.23 |
$96.23 |
$264.48
|
|
X-ray sinuses paranasal complete > 3 views
|
$96.23 |
$96.23 |
$96.23 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$599.23 |
$599.23 |
$599.23 |
$601.30
|
|
X-ray skull < 4 views
|
$116.22 |
$116.22 |
$116.22 |
$291.78
|
|
X-ray skull > 4 views complete
|
$116.22 |
$116.22 |
$116.22 |
$414.60
|
|
X-ray slg plne bdy sect without urogr
|
$116.22 |
$116.22 |
$116.22 |
$387.00
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$194.55 |
$194.55 |
$194.55 |
$557.70
|
|
X-ray spine single view
|
$96.23 |
$96.23 |
$96.23 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$96.23 |
$96.23 |
$96.23 |
$263.49
|
|
X-ray sternum > 2 views
|
$96.23 |
$96.23 |
$96.23 |
$269.75
|
|
X-ray surgical specimen
|
$599.23 |
$599.23 |
$599.23 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$194.55 |
$194.55 |
$194.55 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$96.23 |
$96.23 |
$96.23 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$116.22 |
$116.22 |
$116.22 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$116.22 |
$116.22 |
$116.22 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$96.23 |
$96.23 |
$96.23 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$96.23 |
$96.23 |
$96.23 |
$256.85
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$116.22 |
$116.22 |
$116.22 |
$385.80
|
|
X-ray tibia/fibula 2 views (both sides)
|
$96.23 |
$96.23 |
$96.23 |
$328.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$96.23 |
$96.23 |
$96.23 |
$264.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$194.55 |
$194.55 |
$194.55 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$194.55 |
$194.55 |
$194.55 |
$555.04
|
|
X-ray wrist 2 views (both sides)
|
$96.23 |
$96.23 |
$96.23 |
$290.40
|
|
X-ray xm phrnx&/crv esoph c+
|
$194.55 |
$194.55 |
$194.55 |
$324.20
|
|
Xylose absorption test blood &/or urine
|
$12.91 |
$12.91 |
$12.91 |
$64.28
|
|
Xyntha inj
|
$1.54 |
$1.54 |
$1.54 |
$1.54
|
|
Yersinia antibody
|
$13.19 |
$13.19 |
$13.19 |
$66.95
|
|
Yttrium y-90 ibritumomab ther
|
$56,824.55 |
$56,824.55 |
$56,824.55 |
$55,035.00
|
|
Ziconotide injection
|
$10.13 |
$10.13 |
$10.13 |
$2,604.08
|
|
Zika virus dna/rna amp probe
|
$51.31 |
$51.31 |
$51.31 |
$175.00
|
|
Zika virus igm antibody
|
$16.85 |
$16.85 |
$16.85 |
$75.40
|
|
Ziv-aflibercept 25 mg/ml intravenous solution (wrapper)
|
$7.98 |
$7.98 |
$7.98 |
$9.54
|
|
Zolbetuximab-clzb 100 mg intravenous solution
|
$33.56 |
$33.56 |
$33.56 |
$4,826.23
|