|
X-ray abdomen 1 view
|
$275.60 |
$275.60 |
$275.60 |
$255.00
|
|
X-ray abdomen 2 views
|
$323.70 |
$323.70 |
$323.70 |
$312.36
|
|
X-ray abdomen >=3 views
|
$367.90 |
$367.90 |
$367.90 |
$332.15
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$437.45 |
$437.45 |
$437.45 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$414.05 |
$414.05 |
$414.05 |
$271.44
|
|
X-ray ankle 2 views (both sides)
|
$369.20 |
$369.20 |
$369.20 |
$283.00
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$2,164.50 |
$2,164.50 |
$2,164.50 |
$768.30
|
|
X-ray bone age studies
|
$286.00 |
$286.00 |
$286.00 |
$246.75
|
|
X-ray bone length studies
|
$495.30 |
$495.30 |
$495.30 |
$287.25
|
|
X-ray bone survey complete
|
$607.75 |
$607.75 |
$607.75 |
$666.60
|
|
X-ray bone survey infant
|
$576.55 |
$576.55 |
$576.55 |
$410.73
|
|
X-ray cervical spine 2-3 views
|
$349.05 |
$349.05 |
$349.05 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$455.65 |
$455.65 |
$455.65 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$521.30 |
$521.30 |
$521.30 |
$515.35
|
|
X-ray clavicle complete (both sides)
|
$566.80 |
$566.80 |
$566.80 |
$299.65
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$716.95 |
$716.95 |
$716.95 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$967.20 |
$967.20 |
$967.20 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$462.80 |
$462.80 |
$462.80 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$631.80 |
$631.80 |
$631.80 |
$342.00
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$498.55 |
$498.55 |
$498.55 |
$486.24
|
|
X-ray exam entire spi 4/5 vw
|
$398.45 |
$398.45 |
$398.45 |
$486.01
|
|
X-ray exam entire spi 6/> vw
|
$545.35 |
$545.35 |
$545.35 |
$575.76
|
|
X-ray exam of arm infant
|
$717.60 |
$717.60 |
$717.60 |
$248.82
|
|
X-ray exam of eye sockets
|
$419.90 |
$419.90 |
$419.90 |
$349.05
|
|
X-ray exam of femur 1
|
$503.10 |
$503.10 |
$503.10 |
$232.36
|
|
X-ray exam of jaw joint
|
$331.50 |
$331.50 |
$331.50 |
$192.39
|
|
X-ray exam of middle ear
|
$341.25 |
$341.25 |
$341.25 |
$341.25
|
|
X-ray exam of penis
|
$1,056.25 |
$1,056.25 |
$1,056.25 |
$565.20
|
|
X-ray exam of perineum
|
$1,230.45 |
$1,230.45 |
$1,230.45 |
$420.93
|
|
X-ray exam of sinuses
|
$174.20 |
$174.20 |
$174.20 |
$211.00
|
|
X-ray exam si joints
|
$356.20 |
$356.20 |
$356.20 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$413.40 |
$413.40 |
$413.40 |
$395.59
|
|
X-ray eye detection foreign body (both sides)
|
$585.00 |
$585.00 |
$585.00 |
$235.00
|
|
X-ray facial bones complete > 3 views
|
$417.95 |
$417.95 |
$417.95 |
$366.60
|
|
X-ray fallopian tube
|
$3,471.00 |
$3,471.00 |
$3,471.00 |
$501.00
|
|
X-ray femur >=2 views (both sides)
|
$603.20 |
$603.20 |
$603.20 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$504.40 |
$504.40 |
$504.40 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$378.30 |
$378.30 |
$378.30 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$416.00 |
$416.00 |
$416.00 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$397.80 |
$397.80 |
$397.80 |
$316.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$565.50 |
$565.50 |
$565.50 |
$270.00
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$526.50 |
$526.50 |
$526.50 |
$370.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$397.15 |
$397.15 |
$397.15 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$549.90 |
$549.90 |
$549.90 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$659.75 |
$659.75 |
$659.75 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$315.25 |
$315.25 |
$315.25 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$231.40 |
$231.40 |
$231.40 |
$304.15
|
|
X-ray joint survey 1 view
|
$221.65 |
$221.65 |
$221.65 |
$211.00
|
|
X-ray knee 1-2 views (both sides)
|
$462.80 |
$462.80 |
$462.80 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$779.35 |
$779.35 |
$779.35 |
$353.25
|
|
X-ray knee ap standing bilateral
|
$276.25 |
$276.25 |
$276.25 |
$276.25
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$825.50 |
$825.50 |
$825.50 |
$249.13
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$363.35 |
$363.35 |
$363.35 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$488.80 |
$488.80 |
$488.80 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$583.05 |
$583.05 |
$583.05 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$386.75 |
$386.75 |
$386.75 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$254.80 |
$254.80 |
$254.80 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$326.30 |
$326.30 |
$326.30 |
$277.70
|
|
X-ray neck soft tissue
|
$253.50 |
$253.50 |
$253.50 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$450.45 |
$450.45 |
$450.45 |
$225.96
|
|
X-ray of mammary ducts
|
$1,220.05 |
$1,220.05 |
$1,220.05 |
$473.55
|
|
X-ray optic foramina
|
$278.85 |
$278.85 |
$278.85 |
$171.00
|
|
X-ray pelvis 1-2 views
|
$248.30 |
$248.30 |
$248.30 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$299.65 |
$299.65 |
$299.65 |
$342.30
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$842.40 |
$842.40 |
$842.40 |
$742.00
|
|
X-ray ribs 2 views left
|
$304.20 |
$304.20 |
$304.20 |
$296.32
|
|
X-ray ribs 3 views bilateral
|
$355.55 |
$355.55 |
$355.55 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$411.45 |
$411.45 |
$411.45 |
$359.47
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$438.75 |
$438.75 |
$438.75 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$448.50 |
$448.50 |
$448.50 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$324.35 |
$324.35 |
$324.35 |
$285.60
|
|
X-ray scapula complete (both sides)
|
$647.40 |
$647.40 |
$647.40 |
$292.50
|
|
X-ray sella turcica
|
$196.95 |
$196.95 |
$196.95 |
$162.50
|
|
X-ray shoulder 1 view (both sides)
|
$365.30 |
$365.30 |
$365.30 |
$264.48
|
|
X-ray sinuses paranasal complete > 3 views
|
$349.70 |
$349.70 |
$349.70 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$1,409.20 |
$1,409.20 |
$1,409.20 |
$601.30
|
|
X-ray skull < 4 views
|
$210.60 |
$210.60 |
$210.60 |
$291.78
|
|
X-ray skull > 4 views complete
|
$377.00 |
$377.00 |
$377.00 |
$414.60
|
|
X-ray slg plne bdy sect without urogr
|
$345.80 |
$345.80 |
$345.80 |
$387.00
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$817.70 |
$817.70 |
$817.70 |
$557.70
|
|
X-ray small intestine follow-through study
|
$620.75 |
$620.75 |
$620.75 |
$504.14
|
|
X-ray spine single view
|
$202.15 |
$202.15 |
$202.15 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$421.20 |
$421.20 |
$421.20 |
$263.49
|
|
X-ray sternum > 2 views
|
$339.30 |
$339.30 |
$339.30 |
$269.75
|
|
X-ray surgical specimen
|
$572.65 |
$572.65 |
$572.65 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$587.60 |
$587.60 |
$587.60 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$411.45 |
$411.45 |
$411.45 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$320.45 |
$320.45 |
$320.45 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$359.45 |
$359.45 |
$359.45 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$317.20 |
$317.20 |
$317.20 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$222.95 |
$222.95 |
$222.95 |
$256.85
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$286.65 |
$286.65 |
$286.65 |
$385.80
|
|
X-ray tibia/fibula 2 views (both sides)
|
$453.70 |
$453.70 |
$453.70 |
$328.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$456.30 |
$456.30 |
$456.30 |
$264.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$772.20 |
$772.20 |
$772.20 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$659.75 |
$659.75 |
$659.75 |
$555.04
|
|
X-ray wrist 2 views (both sides)
|
$432.90 |
$432.90 |
$432.90 |
$290.40
|
|
Xyntha inj
|
$2,778.16 |
$2,778.16 |
$2,778.16 |
$6.03
|
|
Yersinia antibody
|
$241.80 |
$241.80 |
$241.80 |
$66.95
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$109.40 |
$109.40 |
$109.40 |
$106.94
|
