|
X-ray exam of eye sockets
|
$474.25 |
$474.25 |
$474.25 |
$349.05
|
|
X-ray exam of femur 1
|
$82.25 |
$82.25 |
$82.25 |
$232.36
|
|
X-ray exam of jaw joint
|
$91.00 |
$91.00 |
$91.00 |
$192.39
|
|
X-ray exam of middle ear
|
$1,828.88 |
$1,828.88 |
$1,828.88 |
$341.25
|
|
X-ray exam of sinuses
|
$89.60 |
$89.60 |
$89.60 |
$211.00
|
|
X-ray exam si joints
|
$420.35 |
$420.35 |
$2,317.00 |
$246.16
|
|
X-ray eye detection foreign body (both sides)
|
$1,831.00 |
$1,831.00 |
$1,831.00 |
$235.00
|
|
X-ray facial bones complete > 3 views
|
$467.60 |
$467.60 |
$467.60 |
$366.60
|
|
X-ray femur >=2 views (both sides)
|
$456.05 |
$456.05 |
$456.05 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$275.10 |
$275.10 |
$275.10 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$380.45 |
$380.45 |
$380.45 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$410.20 |
$410.20 |
$410.20 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$329.00 |
$329.00 |
$329.00 |
$316.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$401.10 |
$401.10 |
$401.10 |
$270.00
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$706.65 |
$706.65 |
$706.65 |
$370.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$487.90 |
$487.90 |
$2,382.00 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$633.85 |
$633.85 |
$2,349.44 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$729.05 |
$729.05 |
$7,141.00 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$387.10 |
$387.10 |
$387.10 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$360.85 |
$360.85 |
$360.85 |
$304.15
|
|
X-ray joint survey 1 view
|
$124.25 |
$124.25 |
$124.25 |
$211.00
|
|
X-ray knee 1-2 views (both sides)
|
$417.55 |
$417.55 |
$417.55 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$504.35 |
$504.35 |
$504.35 |
$353.25
|
|
X-ray knee ap standing bilateral
|
$492.80 |
$492.80 |
$1,831.00 |
$276.25
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$177.45 |
$177.45 |
$177.45 |
$249.13
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$2,103.65 |
$2,103.65 |
$2,701.00 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$926.80 |
$926.80 |
$926.80 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$1,093.75 |
$1,093.75 |
$3,194.00 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$679.35 |
$679.35 |
$679.35 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$455.35 |
$455.35 |
$455.35 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$291.55 |
$291.55 |
$291.55 |
$277.70
|
|
X-ray neck soft tissue
|
$251.30 |
$251.30 |
$251.30 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$96.60 |
$96.60 |
$2,125.36 |
$225.96
|
|
X-ray of mammary ducts
|
$707.35 |
$707.35 |
$707.35 |
$473.55
|
|
X-ray pelvis 1-2 views
|
$457.45 |
$457.45 |
$457.45 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$690.90 |
$690.90 |
$2,585.17 |
$342.30
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$1,771.70 |
$1,771.70 |
$9,955.00 |
$742.00
|
|
X-ray ribs 2 views left
|
$393.75 |
$393.75 |
$393.75 |
$296.32
|
|
X-ray ribs 3 views bilateral
|
$470.75 |
$470.75 |
$470.75 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$452.55 |
$452.55 |
$452.55 |
$359.47
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$561.40 |
$561.40 |
$5,642.00 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$494.55 |
$494.55 |
$494.55 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$411.95 |
$411.95 |
$411.95 |
$285.60
|
|
X-ray scapula complete (both sides)
|
$374.50 |
$374.50 |
$374.50 |
$292.50
|
|
X-ray sella turcica
|
$86.45 |
$86.45 |
$1,279.82 |
$162.50
|
|
X-ray shoulder 1 view (both sides)
|
$329.70 |
$329.70 |
$329.70 |
$264.48
|
|
X-ray sinuses paranasal complete > 3 views
|
$744.45 |
$744.45 |
$744.45 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$662.20 |
$662.20 |
$662.20 |
$601.30
|
|
X-ray skull < 4 views
|
$407.05 |
$407.05 |
$407.05 |
$291.78
|
|
X-ray skull > 4 views complete
|
$537.25 |
$537.25 |
$537.25 |
$414.60
|
|
X-ray slg plne bdy sect without urogr
|
$105.35 |
$105.35 |
$2,103.67 |
$387.00
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$676.20 |
$676.20 |
$5,417.92 |
$557.70
|
|
X-ray small intestine follow-through study
|
$453.25 |
$453.25 |
$3,521.00 |
$504.14
|
|
X-ray spine single view
|
$298.90 |
$298.90 |
$3,267.00 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$414.40 |
$414.40 |
$2,258.00 |
$263.49
|
|
X-ray sternum > 2 views
|
$336.70 |
$336.70 |
$336.70 |
$269.75
|
|
X-ray surgical specimen
|
$642.95 |
$642.95 |
$1,549.31 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$1,078.70 |
$1,078.70 |
$4,629.00 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$493.15 |
$493.15 |
$493.15 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$405.65 |
$405.65 |
$405.65 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$709.45 |
$709.45 |
$709.45 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$361.55 |
$361.55 |
$361.55 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$503.65 |
$503.65 |
$902.23 |
$256.85
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$1,065.40 |
$1,065.40 |
$6,486.00 |
$385.80
|
|
X-ray tibia/fibula 2 views (both sides)
|
$484.75 |
$484.75 |
$484.75 |
$328.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$258.65 |
$258.65 |
$258.65 |
$264.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$1,152.55 |
$1,152.55 |
$4,637.25 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$801.15 |
$801.15 |
$5,054.61 |
$555.04
|
|
X-ray wrist 2 views (both sides)
|
$300.65 |
$300.65 |
$300.65 |
$290.40
|
|
X-ray xm phrnx&/crv esoph c+
|
$271.95 |
$271.95 |
$271.95 |
$324.20
|
|
Yersinia antibody
|
$437.00 |
$437.00 |
$437.00 |
$66.95
|
|
Yttrium y-90 ibritumomab ther
|
$25,438.35 |
$25,438.35 |
$25,438.35 |
$55,035.00
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$60.86 |
$60.86 |
$60.86 |
$106.94
|
|
Zika virus dna/rna amp probe
|
$1,474.00 |
$1,474.00 |
$2,575.59 |
$175.00
|
|
Zika virus igm antibody
|
$318.78 |
$370.58 |
$532.00 |
$75.40
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$62.56 |
$632.00 |
$816.16 |
$121.56
|
|
Zolbetuximab-clzb 100 mg intravenous solution
|
$4,156.78 |
$4,156.78 |
$4,156.78 |
$4,848.00
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$24.00 |
$93.30 |
$93.30 |
$405.10
|
|
Zoster vaccine-live inj
|
$73.01 |
$73.01 |
$73.01 |
$235.20
|