|
X-ray exam of sinuses
|
$66.73 |
$66.73 |
$1,374.57 |
$211.00
|
|
X-ray exam of tear duct
|
$5,070.83 |
$5,070.83 |
$5,070.83 |
$340.70
|
|
X-ray exam si joints
|
$420.35 |
$420.35 |
$1,987.86 |
$246.16
|
|
X-ray facial bones complete > 3 views
|
$488.10 |
$488.10 |
$2,572.42 |
$366.60
|
|
X-ray femur >=2 views (both sides)
|
$479.85 |
$479.85 |
$628.38 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$388.50 |
$388.50 |
$1,374.57 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$515.55 |
$515.55 |
$515.55 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$473.55 |
$473.55 |
$473.55 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$347.90 |
$347.90 |
$347.90 |
$316.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$356.46 |
$356.46 |
$356.46 |
$270.00
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$706.65 |
$706.65 |
$1,039.23 |
$370.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$482.30 |
$482.30 |
$1,039.23 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$633.85 |
$633.85 |
$1,039.23 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$729.05 |
$729.05 |
$1,981.80 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$387.10 |
$387.10 |
$628.38 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$445.60 |
$445.60 |
$445.60 |
$304.15
|
|
X-ray knee 1-2 views (both sides)
|
$494.20 |
$494.20 |
$494.20 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$595.35 |
$595.35 |
$595.35 |
$353.25
|
|
X-ray knee ap standing bilateral
|
$583.45 |
$583.45 |
$1,921.40 |
$276.25
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$167.58 |
$167.58 |
$167.58 |
$249.13
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$1,499.96 |
$1,499.96 |
$1,499.96 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$926.89 |
$926.89 |
$2,942.50 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$1,093.75 |
$1,093.75 |
$1,173.67 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$586.50 |
$586.50 |
$2,377.56 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$1,718.97 |
$1,718.97 |
$1,718.97 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$169.16 |
$169.16 |
$1,549.80 |
$277.70
|
|
X-ray neck soft tissue
|
$347.55 |
$347.55 |
$1,288.47 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$95.45 |
$95.45 |
$1,802.06 |
$225.96
|
|
X-ray of mammary ducts
|
$669.06 |
$669.06 |
$2,161.56 |
$473.55
|
|
X-ray pelvis 1-2 views
|
$457.46 |
$457.46 |
$1,643.45 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$690.90 |
$690.90 |
$2,069.41 |
$342.30
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$1,772.09 |
$1,772.09 |
$5,380.48 |
$742.00
|
|
X-ray ribs 3 views bilateral
|
$2,154.01 |
$2,154.01 |
$2,154.01 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$566.30 |
$566.30 |
$566.30 |
$359.47
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$889.00 |
$889.00 |
$2,226.51 |
$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 |
$1,919.87 |
$285.60
|
|
X-ray scapula complete (both sides)
|
$222.71 |
$222.71 |
$222.71 |
$292.50
|
|
X-ray sella turcica
|
$63.32 |
$63.32 |
$756.78 |
$162.50
|
|
X-ray shoulder 1 view (both sides)
|
$355.60 |
$355.60 |
$355.60 |
$264.48
|
|
X-ray sinuses paranasal complete > 3 views
|
$783.30 |
$783.30 |
$2,566.38 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$345.24 |
$345.24 |
$345.24 |
$601.30
|
|
X-ray skull < 4 views
|
$234.50 |
$234.50 |
$1,768.82 |
$291.78
|
|
X-ray skull > 4 views complete
|
$458.15 |
$458.15 |
$2,802.02 |
$414.60
|
|
X-ray slg plne bdy sect without urogr
|
$1,007.52 |
$1,007.52 |
$1,007.52 |
$387.00
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$770.70 |
$770.70 |
$3,924.34 |
$557.70
|
|
X-ray small intestine follow-through study
|
$523.95 |
$523.95 |
$1,672.14 |
$504.14
|
|
X-ray spine single view
|
$314.65 |
$314.65 |
$1,332.29 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$142.89 |
$142.89 |
$406.34 |
$263.49
|
|
X-ray sternum > 2 views
|
$336.35 |
$336.35 |
$1,741.63 |
$269.75
|
|
X-ray surgical specimen
|
$580.30 |
$580.30 |
$580.30 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$986.30 |
$986.30 |
$3,490.82 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$493.15 |
$493.15 |
$2,312.61 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$424.90 |
$424.90 |
$2,312.61 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$744.92 |
$744.92 |
$2,373.02 |
$387.60
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$628.38 |
$628.38 |
$628.38 |
$256.85
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$1,039.23 |
$1,039.23 |
$1,039.23 |
$385.80
|
|
X-ray tibia/fibula 2 views (both sides)
|
$583.96 |
$583.96 |
$583.96 |
$328.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$278.25 |
$278.25 |
$1,398.75 |
$264.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$1,054.20 |
$1,054.20 |
$1,054.20 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$446.42 |
$446.42 |
$446.42 |
$555.04
|
|
X-ray wrist 2 views (both sides)
|
$442.05 |
$442.05 |
$442.05 |
$290.40
|
|
Xylose absorption test blood &/or urine
|
$57.02 |
$57.02 |
$57.02 |
$64.28
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$393.27 |
$393.27 |
$393.27 |
$106.94
|
|
Zidovudine, oral, 100 mg
|
$4.08 |
$4.08 |
$4.08 |
$75.35
|
|
Zika virus dna/rna amp probe
|
$3,074.93 |
$3,074.93 |
$3,074.93 |
$175.00
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$63.35 |
$63.35 |
$2,913.43 |
$128.10
|
|
Ziv-aflibercept 25 mg/ml intravenous solution (wrapper)
|
$16,313.01 |
$16,313.01 |
$16,313.01 |
$9.54
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$6,416.06 |
$6,416.06 |
$6,416.06 |
$346.14
|
