|
X-ray abdomen 1 view
|
$183.54 |
$183.54 |
$183.54 |
$255.00
|
|
X-ray abdomen 2 views
|
$199.50 |
$199.50 |
$199.50 |
$312.36
|
|
X-ray abdomen >=3 views
|
$215.46 |
$215.46 |
$215.46 |
$332.15
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$101.46 |
$101.46 |
$101.46 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$50.73 |
$50.73 |
$50.73 |
$271.44
|
|
X-ray ankle 2 views (both sides)
|
$50.73 |
$50.73 |
$50.73 |
$283.00
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$407.55 |
$407.55 |
$407.55 |
$768.30
|
|
X-ray bone age studies
|
$60.99 |
$60.99 |
$60.99 |
$246.75
|
|
X-ray bone length studies
|
$60.99 |
$60.99 |
$60.99 |
$287.25
|
|
X-ray bone survey complete
|
$107.16 |
$107.16 |
$107.16 |
$666.60
|
|
X-ray bone survey infant
|
$75.81 |
$75.81 |
$75.81 |
$410.73
|
|
X-ray cervical spine 2-3 views
|
$91.20 |
$91.20 |
$91.20 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$94.62 |
$94.62 |
$94.62 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$132.81 |
$132.81 |
$132.81 |
$515.35
|
|
X-ray clavicle complete (both sides)
|
$50.73 |
$50.73 |
$50.73 |
$299.65
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$167.01 |
$167.01 |
$167.01 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$229.14 |
$229.14 |
$229.14 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$50.73 |
$50.73 |
$50.73 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$82.08 |
$82.08 |
$82.08 |
$342.00
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$118.56 |
$118.56 |
$118.56 |
$486.24
|
|
X-ray exam entire spi 4/5 vw
|
$148.77 |
$148.77 |
$148.77 |
$486.01
|
|
X-ray exam entire spi 6/> vw
|
$226.86 |
$226.86 |
$226.86 |
$575.76
|
|
X-ray exam of arm infant
|
$60.99 |
$60.99 |
$60.99 |
$248.82
|
|
X-ray exam of eye sockets
|
$60.99 |
$60.99 |
$60.99 |
$349.05
|
|
X-ray exam of femur 1
|
$90.06 |
$90.06 |
$90.06 |
$232.36
|
|
X-ray exam of sinuses
|
$50.73 |
$50.73 |
$50.73 |
$211.00
|
|
X-ray exam thorac spine4/>vw
|
$122.55 |
$122.55 |
$122.55 |
$395.59
|
|
X-ray eye detection foreign body (both sides)
|
$50.73 |
$50.73 |
$50.73 |
$235.00
|
|
X-ray facial bones complete > 3 views
|
$60.99 |
$60.99 |
$60.99 |
$366.60
|
|
X-ray femur >=2 views (both sides)
|
$104.31 |
$104.31 |
$104.31 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$50.73 |
$50.73 |
$50.73 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$63.27 |
$63.27 |
$63.27 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$71.25 |
$71.25 |
$71.25 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$60.99 |
$60.99 |
$60.99 |
$316.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$50.73 |
$50.73 |
$50.73 |
$270.00
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$210.33 |
$210.33 |
$210.33 |
$370.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$104.31 |
$104.31 |
$104.31 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$111.72 |
$111.72 |
$111.72 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$119.13 |
$119.13 |
$119.13 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$50.73 |
$50.73 |
$50.73 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$70.68 |
$70.68 |
$70.68 |
$304.15
|
|
X-ray joint survey 1 view
|
$66.12 |
$66.12 |
$66.12 |
$211.00
|
|
X-ray knee 1-2 views (both sides)
|
$71.25 |
$71.25 |
$71.25 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$142.50 |
$142.50 |
$142.50 |
$353.25
|
|
X-ray knee ap standing bilateral
|
$63.84 |
$63.84 |
$63.84 |
$276.25
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$50.73 |
$50.73 |
$50.73 |
$249.13
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$63.84 |
$63.84 |
$63.84 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$156.18 |
$156.18 |
$156.18 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$109.44 |
$109.44 |
$109.44 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$60.99 |
$60.99 |
$60.99 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$50.73 |
$50.73 |
$50.73 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$50.73 |
$50.73 |
$50.73 |
$277.70
|
|
X-ray neck soft tissue
|
$50.73 |
$50.73 |
$50.73 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$50.73 |
$50.73 |
$50.73 |
$225.96
|
|
X-ray of mammary ducts
|
$281.58 |
$281.58 |
$281.58 |
$473.55
|
|
X-ray pelvis 1-2 views
|
$62.70 |
$62.70 |
$62.70 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$119.70 |
$119.70 |
$119.70 |
$342.30
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$243.96 |
$243.96 |
$243.96 |
$742.00
|
|
X-ray ribs 2 views left
|
$98.04 |
$98.04 |
$98.04 |
$296.32
|
|
X-ray ribs 3 views bilateral
|
$196.08 |
$196.08 |
$196.08 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$98.04 |
$98.04 |
$98.04 |
$359.47
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$196.08 |
$196.08 |
$196.08 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$60.99 |
$60.99 |
$60.99 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$76.95 |
$76.95 |
$76.95 |
$285.60
|
|
X-ray scapula complete (both sides)
|
$60.99 |
$60.99 |
$60.99 |
$292.50
|
|
X-ray shoulder 1 view (both sides)
|
$50.73 |
$50.73 |
$50.73 |
$264.48
|
|
X-ray sinuses paranasal complete > 3 views
|
$57.00 |
$57.00 |
$57.00 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$314.64 |
$314.64 |
$314.64 |
$601.30
|
|
X-ray skull < 4 views
|
$60.99 |
$60.99 |
$60.99 |
$291.78
|
|
X-ray skull > 4 views complete
|
$65.55 |
$65.55 |
$65.55 |
$414.60
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$116.85 |
$116.85 |
$116.85 |
$557.70
|
|
X-ray small intestine follow-through study
|
$74.67 |
$74.67 |
$74.67 |
$504.14
|
|
X-ray spine single view
|
$63.84 |
$63.84 |
$63.84 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$50.73 |
$50.73 |
$50.73 |
$263.49
|
|
X-ray sternum > 2 views
|
$50.73 |
$50.73 |
$50.73 |
$269.75
|
|
X-ray surgical specimen
|
$443.46 |
$443.46 |
$443.46 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$201.21 |
$201.21 |
$201.21 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$51.30 |
$51.30 |
$51.30 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$94.62 |
$94.62 |
$94.62 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$111.15 |
$111.15 |
$111.15 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$99.18 |
$99.18 |
$99.18 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$50.73 |
$50.73 |
$50.73 |
$256.85
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$83.79 |
$83.79 |
$83.79 |
$385.80
|
|
X-ray tibia/fibula 2 views (both sides)
|
$78.09 |
$78.09 |
$78.09 |
$328.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$50.73 |
$50.73 |
$50.73 |
$264.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$200.07 |
$200.07 |
$200.07 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$191.52 |
$191.52 |
$191.52 |
$555.04
|
|
X-ray wrist 2 views (both sides)
|
$54.72 |
$54.72 |
$54.72 |
$290.40
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$3.08 |
$3.08 |
$3.08 |
$104.90
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$67.52 |
$67.52 |
$67.52 |
$121.10
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$95.14 |
$95.14 |
$95.14 |
$360.48
|
