|
X-ray eye detection foreign body (both sides)
|
$240.24 |
$240.24 |
$240.24 |
$235.00
|
|
X-ray facial bones complete > 3 views
|
$888.72 |
$888.72 |
$888.72 |
$366.60
|
|
X-ray femur >=2 views (both sides)
|
$556.08 |
$556.08 |
$556.08 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$451.92 |
$451.92 |
$451.92 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$369.60 |
$369.60 |
$369.60 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$284.34 |
$284.34 |
$284.34 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$284.34 |
$284.34 |
$284.34 |
$316.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$504.84 |
$504.84 |
$504.84 |
$270.00
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$1,207.50 |
$1,207.50 |
$1,207.50 |
$370.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$808.92 |
$808.92 |
$808.92 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$1,213.38 |
$1,213.38 |
$1,213.38 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$1,618.26 |
$1,618.26 |
$1,618.26 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$603.54 |
$603.54 |
$603.54 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$284.34 |
$284.34 |
$284.34 |
$304.15
|
|
X-ray joint survey 1 view
|
$141.12 |
$141.12 |
$141.12 |
$211.00
|
|
X-ray knee 1-2 views (both sides)
|
$511.56 |
$511.56 |
$511.56 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$598.08 |
$598.08 |
$598.08 |
$353.25
|
|
X-ray knee ap standing bilateral
|
$284.76 |
$284.76 |
$284.76 |
$276.25
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$595.56 |
$595.56 |
$595.56 |
$249.13
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$965.58 |
$965.58 |
$965.58 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$967.26 |
$967.26 |
$967.26 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$1,618.68 |
$1,618.68 |
$1,618.68 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$804.72 |
$804.72 |
$804.72 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$674.94 |
$674.94 |
$674.94 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$591.36 |
$591.36 |
$591.36 |
$277.70
|
|
X-ray neck soft tissue
|
$298.62 |
$298.62 |
$298.62 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$399.00 |
$399.00 |
$399.00 |
$225.96
|
|
X-ray optic foramina
|
$203.28 |
$284.76 |
$284.76 |
$171.00
|
|
X-ray pelvis 1-2 views
|
$534.66 |
$534.66 |
$534.66 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$668.22 |
$668.22 |
$668.22 |
$342.30
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$1,060.08 |
$1,060.08 |
$1,060.08 |
$742.00
|
|
X-ray ribs 2 views left
|
$400.26 |
$400.26 |
$400.26 |
$296.32
|
|
X-ray ribs 3 views bilateral
|
$1,202.88 |
$1,202.88 |
$1,202.88 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$976.08 |
$976.08 |
$976.08 |
$359.47
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$1,288.56 |
$1,288.56 |
$1,288.56 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$858.90 |
$858.90 |
$858.90 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$740.46 |
$740.46 |
$740.46 |
$285.60
|
|
X-ray scapula complete (both sides)
|
$512.82 |
$512.82 |
$512.82 |
$292.50
|
|
X-ray shoulder 1 view (both sides)
|
$462.00 |
$462.00 |
$462.00 |
$264.48
|
|
X-ray sinuses paranasal complete > 3 views
|
$1,073.52 |
$1,073.52 |
$1,073.52 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$1,300.32 |
$1,300.32 |
$1,300.32 |
$601.30
|
|
X-ray skull < 4 views
|
$596.82 |
$596.82 |
$596.82 |
$291.78
|
|
X-ray skull > 4 views complete
|
$1,020.18 |
$1,020.18 |
$1,020.18 |
$414.60
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$840.84 |
$840.84 |
$840.84 |
$557.70
|
|
X-ray small intestine follow-through study
|
$471.24 |
$471.24 |
$471.24 |
$504.14
|
|
X-ray spine single view
|
$634.62 |
$634.62 |
$634.62 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$534.66 |
$534.66 |
$534.66 |
$263.49
|
|
X-ray sternum > 2 views
|
$696.78 |
$696.78 |
$696.78 |
$269.75
|
|
X-ray surgical specimen
|
$1,559.04 |
$1,559.04 |
$1,559.04 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$840.84 |
$840.84 |
$840.84 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$719.04 |
$719.04 |
$719.04 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$829.92 |
$829.92 |
$829.92 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$1,064.28 |
$1,064.28 |
$1,064.28 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$918.54 |
$918.54 |
$918.54 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$323.40 |
$323.40 |
$323.40 |
$256.85
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$571.62 |
$571.62 |
$571.62 |
$385.80
|
|
X-ray tibia/fibula 2 views (both sides)
|
$393.54 |
$393.54 |
$393.54 |
$328.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$456.54 |
$456.54 |
$456.54 |
$264.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$1,064.70 |
$1,064.70 |
$1,064.70 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$942.48 |
$942.48 |
$942.48 |
$555.04
|
|
X-ray wrist 2 views (both sides)
|
$284.34 |
$284.34 |
$284.34 |
$290.40
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$214.10 |
$214.10 |
$214.10 |
$106.94
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$112.93 |
$112.93 |
$472.76 |
$121.56
|
|
Ziv-aflibercept 25 mg/ml intravenous solution (wrapper)
|
$11,032.56 |
$11,032.56 |
$11,032.56 |
$4,764.60
|
|
Zolbetuximab-clzb 100 mg intravenous solution
|
$21,168.00 |
$21,168.00 |
$21,168.00 |
$4,848.00
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$256.67 |
$256.67 |
$680.45 |
$405.10
|
