|
Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/<
|
$1,439.40 |
$1,439.40 |
$1,439.40 |
$2,692.80
|
|
X-ray abdomen 1 view
|
$640.80 |
$640.80 |
$640.80 |
$258.50
|
|
X-ray abdomen 2 views
|
$553.80 |
$553.80 |
$553.80 |
$316.47
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$871.20 |
$871.20 |
$871.20 |
$418.63
|
|
X-ray ankle 2 views (both sides)
|
$578.40 |
$578.40 |
$578.40 |
$282.50
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$1,365.60 |
$1,365.60 |
$1,365.60 |
$773.40
|
|
X-ray bone age studies
|
$737.40 |
$737.40 |
$737.40 |
$251.40
|
|
X-ray bone length studies
|
$232.20 |
$232.20 |
$232.20 |
$285.30
|
|
X-ray bone survey complete
|
$2,170.20 |
$2,170.20 |
$2,170.20 |
$660.00
|
|
X-ray bone survey infant
|
$911.40 |
$911.40 |
$911.40 |
$394.69
|
|
X-ray cervical spine 2-3 views
|
$591.60 |
$591.60 |
$591.60 |
$333.83
|
|
X-ray cervical spine 4-5 views
|
$1,011.60 |
$1,011.60 |
$1,011.60 |
$457.05
|
|
X-ray cervical spine >= 6 views
|
$1,012.80 |
$1,012.80 |
$1,012.80 |
$508.50
|
|
X-ray clavicle complete (both sides)
|
$775.20 |
$775.20 |
$775.20 |
$300.05
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$1,495.80 |
$1,495.80 |
$1,495.80 |
$657.03
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$2,462.40 |
$2,462.40 |
$2,462.40 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$357.60 |
$357.60 |
$357.60 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$762.60 |
$762.60 |
$762.60 |
$364.12
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$1,231.80 |
$1,231.80 |
$1,231.80 |
$483.50
|
|
X-ray exam of femur 1
|
$544.20 |
$544.20 |
$544.20 |
$240.00
|
|
X-ray exam of sinuses
|
$666.00 |
$666.00 |
$666.00 |
$214.50
|
|
X-ray exam si joints
|
$553.80 |
$553.80 |
$553.80 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$165.60 |
$165.60 |
$165.60 |
$387.40
|
|
X-ray eye detection foreign body (both sides)
|
$492.00 |
$492.00 |
$492.00 |
$238.29
|
|
X-ray facial bones complete > 3 views
|
$664.20 |
$664.20 |
$664.20 |
$381.75
|
|
X-ray femur >=2 views (both sides)
|
$776.40 |
$776.40 |
$776.40 |
$317.25
|
|
X-ray finger(s) >= 2 views (both sides)
|
$614.40 |
$614.40 |
$614.40 |
$241.05
|
|
X-ray foot 2 views (both sides)
|
$385.80 |
$385.80 |
$385.80 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$496.20 |
$496.20 |
$496.20 |
$322.20
|
|
X-ray hand 2 views (both sides)
|
$481.20 |
$481.20 |
$481.20 |
$291.20
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$543.60 |
$543.60 |
$543.60 |
$274.95
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$1,144.80 |
$1,144.80 |
$1,144.80 |
$374.40
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$1,163.40 |
$1,163.40 |
$1,163.40 |
$424.05
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$329.40 |
$329.40 |
$329.40 |
$231.00
|
|
X-ray humerus >= 2 views left
|
$594.60 |
$594.60 |
$594.60 |
$309.31
|
|
X-ray knee 1-2 views (both sides)
|
$445.80 |
$445.80 |
$445.80 |
$285.00
|
|
X-ray knee 3 views (both sides)
|
$645.00 |
$645.00 |
$645.00 |
$363.20
|
|
X-ray knee ap standing bilateral
|
$402.60 |
$402.60 |
$402.60 |
$252.50
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$102.00 |
$102.00 |
$102.00 |
$369.15
|
|
X-ray lumbosacral spine >= 4 views
|
$1,033.80 |
$1,033.80 |
$1,033.80 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$758.40 |
$758.40 |
$758.40 |
$535.91
|
|
X-ray mandible complete > 4 views
|
$612.60 |
$612.60 |
$612.60 |
$361.61
|
|
X-ray mandible ltd <4 views
|
$154.80 |
$154.80 |
$154.80 |
$235.30
|
|
X-ray nasal bones complete > 3 views
|
$511.80 |
$511.80 |
$511.80 |
$274.65
|
|
X-ray neck soft tissue
|
$647.40 |
$647.40 |
$647.40 |
$237.43
|
|
X-ray pelvis 1-2 views
|
$603.60 |
$603.60 |
$603.60 |
$280.80
|
|
X-ray pelvis complete > 3 views
|
$542.40 |
$542.40 |
$542.40 |
$348.19
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$2,035.80 |
$2,035.80 |
$2,035.80 |
$755.50
|
|
X-ray ribs 2 views left
|
$466.20 |
$466.20 |
$466.20 |
$292.80
|
|
X-ray ribs 3 views bilateral
|
$600.00 |
$600.00 |
$600.00 |
$395.76
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$924.00 |
$924.00 |
$924.00 |
$356.20
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$696.60 |
$696.60 |
$696.60 |
$491.70
|
|
X-ray sacroiliac joints >= 3 views
|
$576.60 |
$576.60 |
$576.60 |
$312.75
|
|
X-ray sacrum/coccyx >= 2 views
|
$776.40 |
$776.40 |
$776.40 |
$288.80
|
|
X-ray scapula complete (both sides)
|
$803.40 |
$803.40 |
$803.40 |
$285.00
|
|
X-ray shoulder 1 view (both sides)
|
$508.20 |
$508.20 |
$508.20 |
$260.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$995.40 |
$995.40 |
$995.40 |
$345.60
|
|
X-ray sinus tract/fistula/abscess
|
$844.80 |
$844.80 |
$844.80 |
$606.89
|
|
X-ray skull < 4 views
|
$642.00 |
$642.00 |
$642.00 |
$292.50
|
|
X-ray skull > 4 views complete
|
$847.20 |
$847.20 |
$847.20 |
$417.50
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$1,458.00 |
$1,458.00 |
$1,458.00 |
$557.70
|
|
X-ray small intestine follow-through study
|
$2,362.80 |
$2,362.80 |
$2,362.80 |
$499.50
|
|
X-ray spine single view
|
$503.40 |
$503.40 |
$503.40 |
$251.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$127.80 |
$127.80 |
$127.80 |
$264.48
|
|
X-ray sternum > 2 views
|
$559.80 |
$559.80 |
$559.80 |
$274.65
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$942.00 |
$942.00 |
$942.00 |
$523.25
|
|
X-ray thoracic spine 2 views
|
$924.00 |
$924.00 |
$924.00 |
$320.45
|
|
X-ray thoracic spine 3 views
|
$735.60 |
$735.60 |
$735.60 |
$381.60
|
|
X-ray tibia/fibula 2 views (both sides)
|
$809.40 |
$809.40 |
$809.40 |
$332.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$430.80 |
$430.80 |
$430.80 |
$258.50
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$1,794.60 |
$1,794.60 |
$1,794.60 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$1,529.40 |
$1,529.40 |
$1,529.40 |
$603.20
|
|
X-ray wrist 2 views (both sides)
|
$534.60 |
$534.60 |
$534.60 |
$290.40
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$306.60 |
$306.60 |
$306.60 |
$93.06
|
|
Zika virus dna/rna amp probe
|
$286.80 |
$286.80 |
$286.80 |
$185.00
|
|
Zika virus igm antibody
|
$159.00 |
$159.00 |
$159.00 |
$85.00
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$344.30 |
$344.30 |
$344.30 |
$122.45
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$179.09 |
$179.09 |
$179.09 |
$452.69
|