|
X-ray exam of jaw joint
|
$205.20 |
$205.20 |
$205.20 |
$188.40
|
|
X-ray exam of jaw joint
|
$1,297.80 |
$1,297.80 |
$1,297.80 |
$452.00
|
|
X-ray exam of salivary gland
|
$450.00 |
$450.00 |
$450.00 |
$162.60
|
|
X-ray exam of sinuses
|
$316.80 |
$316.80 |
$316.80 |
$214.50
|
|
X-ray exam thorac spine4/>vw
|
$617.40 |
$617.40 |
$617.40 |
$387.40
|
|
X-ray eye detection foreign body (both sides)
|
$684.60 |
$684.60 |
$684.60 |
$238.29
|
|
X-ray facial bones complete > 3 views
|
$655.80 |
$655.80 |
$655.80 |
$381.75
|
|
X-ray femur >=2 views (both sides)
|
$515.40 |
$515.40 |
$515.40 |
$317.25
|
|
X-ray finger(s) >= 2 views (both sides)
|
$244.80 |
$244.80 |
$244.80 |
$241.05
|
|
X-ray foot 2 views (both sides)
|
$352.20 |
$352.20 |
$352.20 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$451.80 |
$451.80 |
$451.80 |
$322.20
|
|
X-ray hand 2 views (both sides)
|
$523.20 |
$523.20 |
$523.20 |
$291.20
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$483.60 |
$483.60 |
$483.60 |
$274.95
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$69.00 |
$69.00 |
$69.00 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$666.00 |
$666.00 |
$666.00 |
$374.40
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$252.00 |
$252.00 |
$252.00 |
$231.00
|
|
X-ray humerus >= 2 views left
|
$523.20 |
$523.20 |
$523.20 |
$309.31
|
|
X-ray joint survey 1 view
|
$238.80 |
$238.80 |
$238.80 |
$232.00
|
|
X-ray knee 1-2 views (both sides)
|
$483.60 |
$483.60 |
$483.60 |
$285.00
|
|
X-ray knee 3 views (both sides)
|
$502.20 |
$502.20 |
$502.20 |
$363.20
|
|
X-ray knee ap standing bilateral
|
$291.00 |
$291.00 |
$291.00 |
$252.50
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$404.40 |
$404.40 |
$404.40 |
$254.12
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$754.80 |
$754.80 |
$754.80 |
$369.15
|
|
X-ray lumbosacral spine >= 4 views
|
$824.40 |
$824.40 |
$824.40 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$1,350.60 |
$1,350.60 |
$1,350.60 |
$535.91
|
|
X-ray mandible complete > 4 views
|
$544.20 |
$544.20 |
$725.40 |
$361.61
|
|
X-ray mandible ltd <4 views
|
$210.60 |
$210.60 |
$210.60 |
$235.30
|
|
X-ray nasal bones complete > 3 views
|
$292.80 |
$292.80 |
$292.80 |
$274.65
|
|
X-ray neck soft tissue
|
$517.80 |
$517.80 |
$517.80 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$310.20 |
$310.20 |
$310.20 |
$225.60
|
|
X-ray of mammary ducts
|
$947.40 |
$947.40 |
$947.40 |
$568.26
|
|
X-ray pelvis 1-2 views
|
$533.40 |
$533.40 |
$533.40 |
$280.80
|
|
X-ray pelvis complete > 3 views
|
$417.60 |
$417.60 |
$554.40 |
$348.19
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$2,001.60 |
$2,001.60 |
$12,028.42 |
$755.50
|
|
X-ray ribs 2 views left
|
$528.00 |
$528.00 |
$528.00 |
$292.80
|
|
X-ray ribs 3 views bilateral
|
$712.20 |
$712.20 |
$712.20 |
$395.76
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$580.80 |
$580.80 |
$580.80 |
$356.20
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$554.40 |
$554.40 |
$735.00 |
$491.70
|
|
X-ray sacroiliac joints >= 3 views
|
$339.00 |
$339.00 |
$339.00 |
$312.75
|
|
X-ray sacrum/coccyx >= 2 views
|
$612.60 |
$612.60 |
$612.60 |
$288.80
|
|
X-ray scapula complete (both sides)
|
$354.60 |
$354.60 |
$469.80 |
$285.00
|
|
X-ray shoulder 1 view (both sides)
|
$325.80 |
$325.80 |
$325.80 |
$260.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$570.60 |
$570.60 |
$570.60 |
$345.60
|
|
X-ray sinus tract/fistula/abscess
|
$655.20 |
$655.20 |
$655.20 |
$606.89
|
|
X-ray skull < 4 views
|
$549.60 |
$549.60 |
$549.60 |
$292.50
|
|
X-ray skull > 4 views complete
|
$514.80 |
$514.80 |
$685.80 |
$417.50
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$913.80 |
$913.80 |
$913.80 |
$557.70
|
|
X-ray small intestine follow-through study
|
$838.80 |
$838.80 |
$838.80 |
$499.50
|
|
X-ray spine single view
|
$291.00 |
$291.00 |
$291.00 |
$251.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$374.40 |
$374.40 |
$374.40 |
$264.48
|
|
X-ray sternum > 2 views
|
$331.80 |
$331.80 |
$441.00 |
$274.65
|
|
X-ray surgical specimen
|
$1,089.00 |
$1,089.00 |
$1,447.80 |
$504.00
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$289.80 |
$289.80 |
$289.80 |
$523.25
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$523.20 |
$523.20 |
$523.20 |
$327.80
|
|
X-ray thoracic spine 2 views
|
$529.20 |
$529.20 |
$529.20 |
$320.45
|
|
X-ray thoracic spine 3 views
|
$601.20 |
$601.20 |
$601.20 |
$381.60
|
|
X-ray thoracolumbar spine >=2 views
|
$229.80 |
$229.80 |
$229.80 |
$282.50
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$430.80 |
$430.80 |
$430.80 |
$257.04
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$759.60 |
$759.60 |
$759.60 |
$352.95
|
|
X-ray tibia/fibula 2 views (both sides)
|
$505.20 |
$505.20 |
$505.20 |
$332.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$324.60 |
$324.60 |
$324.60 |
$258.50
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$1,172.40 |
$1,172.40 |
$1,172.40 |
$603.20
|
|
X-ray wrist 2 views (both sides)
|
$273.00 |
$273.00 |
$273.00 |
$290.40
|
|
Xylose absorption test blood &/or urine
|
$109.20 |
$109.20 |
$109.20 |
$99.89
|
|
Yersinia antibody
|
$55.80 |
$55.80 |
$55.80 |
$55.80
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$157.68 |
$157.68 |
$164.70 |
$93.06
|
|
Zika virus dna/rna amp probe
|
$198.60 |
$198.60 |
$198.60 |
$185.00
|
|
Zika virus igm antibody
|
$121.20 |
$121.20 |
$121.20 |
$85.00
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$265.08 |
$265.08 |
$265.08 |
$122.45
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$225.72 |
$225.72 |
$286.08 |
$452.69
|
