|
Warde vitamin b6 (pyridoxine)
|
$160.68 |
$160.68 |
$160.68 |
$116.20
|
|
Warde vitamin c (ascorbic acid)
|
$79.04 |
$79.04 |
$79.04 |
$50.00
|
|
Warde vitamin d (1 25 dihydroxy)
|
$107.12 |
$107.12 |
$107.12 |
$138.50
|
|
Warde vitamin e (alpha-tocopherol)
|
$114.40 |
$114.40 |
$114.40 |
$59.25
|
|
Warde zinc
|
$81.12 |
$81.12 |
$81.12 |
$62.50
|
|
Warfarin respon genetic test
|
$879.32 |
$879.32 |
$879.32 |
$879.32
|
|
Wash harvest stem cells
|
$1,263.60 |
$1,263.60 |
$1,263.60 |
$1,263.60
|
|
Wbc automated
|
$23.40 |
$23.40 |
$23.40 |
$32.35
|
|
Wcd device interrogate
|
$109.20 |
$109.20 |
$109.20 |
$109.20
|
|
Wedging of cast
|
$499.20 |
$499.20 |
$499.20 |
$314.28
|
|
Wedging of clubfoot cast
|
$499.20 |
$499.20 |
$499.20 |
$314.28
|
|
Western blot test
|
$152.36 |
$152.36 |
$152.36 |
$150.00
|
|
Whole blood or red blood cells frozen/deglycerolized/washed leukocytes reduced each unit
|
$313.04 |
$313.04 |
$313.04 |
$696.45
|
|
Wilate injection
|
$6.31 |
$6.31 |
$6.31 |
$4.58
|
|
Wnd prep f/n/hf/g addl cm
|
$1,346.80 |
$1,346.80 |
$1,346.80 |
$811.00
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$860.08 |
$860.08 |
$860.08 |
$554.01
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$860.08 |
$860.08 |
$860.08 |
$579.70
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$276.12 |
$276.12 |
$276.12 |
$284.70
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$301.60 |
$301.60 |
$301.60 |
$438.75
|
|
Wrist arthroscopy
|
$1,471.60 |
$1,471.60 |
$1,471.60 |
$3,839.54
|
|
Wrist arthroscopy/surgery
|
$1,471.60 |
$1,471.60 |
$1,471.60 |
$3,839.54
|
|
Wrist arthroscopy/surgery
|
$1,471.60 |
$1,471.60 |
$1,471.60 |
$3,839.54
|
|
Wrist arthroscopy/surgery
|
$1,471.60 |
$1,471.60 |
$1,471.60 |
$3,839.54
|
|
Wrist endoscopy/surgery
|
$3,452.80 |
$3,452.80 |
$3,452.80 |
$3,452.80
|
|
Wrist X-ray
|
$431.60 |
$431.60 |
$431.60 |
$342.80
|
|
Xcapsl ctrc rmvl cplx w/ecp
|
$1,840.80 |
$1,840.80 |
$1,840.80 |
$4,760.49
|
|
Xcapsl ctrc rmvl cplx wo ecp
|
$1,159.60 |
$1,159.60 |
$1,159.60 |
$3,724.80
|
|
Xcapsl ctrc rmvl insj 1+
|
$8,652.80 |
$8,652.80 |
$8,652.80 |
$6,311.00
|
|
Xcapsl ctrc rmvl w/ecp
|
$4,581.20 |
$4,581.20 |
$4,581.20 |
$4,760.49
|
|
Xcpsl ctrc rmvl cplx insj 1+
|
$8,652.80 |
$8,652.80 |
$8,652.80 |
$7,316.99
|
|
Xe133 xenon 10mci
|
$931.75 |
$931.75 |
$931.75 |
$207.00
|
|
Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/<
|
$4,316.00 |
$4,316.00 |
$4,316.00 |
$2,692.80
|
|
Xfer tis s/a/l 10 sq cm/<
|
$3,562.00 |
$3,562.00 |
$3,562.00 |
$2,837.09
|
|
Xm archive tissue molec anal
|
$65.00 |
$65.00 |
$65.00 |
$49.84
|
|
Xpos opn axillary/sbclvn art w/cndt crtn
|
$4,492.80 |
$4,492.80 |
$4,492.80 |
$3,025.00
|
|
X-ray abdomen 1 view
|
$301.60 |
$301.60 |
$301.60 |
$258.50
|
|
X-ray abdomen 2 views
|
$327.60 |
$327.60 |
$327.60 |
$316.47
|
|
X-ray abdomen >=3 views
|
$431.60 |
$431.60 |
$431.60 |
$342.50
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$478.40 |
$478.40 |
$478.40 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$322.40 |
$322.40 |
$322.40 |
$270.20
|
|
X-ray ankle 2 views (both sides)
|
$301.60 |
$301.60 |
$301.60 |
$282.50
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$899.60 |
$899.60 |
$899.60 |
$773.40
|
|
X-ray assay calculus
|
$97.76 |
$97.76 |
$97.76 |
$33.60
|
|
X-ray bone age studies
|
$374.40 |
$374.40 |
$374.40 |
$251.40
|
|
X-ray bone length studies
|
$364.00 |
$364.00 |
$364.00 |
$285.30
|
|
X-ray bone survey complete
|
$920.40 |
$920.40 |
$920.40 |
$660.00
|
|
X-ray bone survey infant
|
$577.20 |
$577.20 |
$577.20 |
$394.69
|
|
X-ray cervical spine 2-3 views
|
$431.60 |
$431.60 |
$431.60 |
$333.83
|
|
X-ray cervical spine 4-5 views
|
$598.00 |
$598.00 |
$598.00 |
$457.05
|
|
X-ray cervical spine >= 6 views
|
$629.20 |
$629.20 |
$629.20 |
$508.50
|
|
X-ray clavicle complete (both sides)
|
$348.40 |
$348.40 |
$348.40 |
$300.05
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$707.20 |
$707.20 |
$707.20 |
$657.03
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$904.80 |
$904.80 |
$904.80 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$338.00 |
$338.00 |
$338.00 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$431.60 |
$431.60 |
$431.60 |
$364.12
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$478.40 |
$478.40 |
$478.40 |
$483.50
|
|
X-ray exam entire spi 4/5 vw
|
$936.00 |
$936.00 |
$936.00 |
$441.48
|
|
X-ray exam entire spi 6/> vw
|
$1,040.00 |
$1,040.00 |
$1,040.00 |
$517.80
|
|
X-ray exam of arm infant
|
$494.00 |
$494.00 |
$494.00 |
$248.44
|
|
X-ray exam of eye sockets
|
$473.20 |
$473.20 |
$473.20 |
$328.35
|
|
X-ray exam of femur 1
|
$265.20 |
$265.20 |
$265.20 |
$240.00
|
|
X-ray exam of jaw joint
|
$280.80 |
$280.80 |
$280.80 |
$188.40
|
|
X-ray exam of jaw joint
|
$899.60 |
$899.60 |
$899.60 |
$452.00
|
|
X-ray exam of mastoids
|
$296.40 |
$296.40 |
$296.40 |
$193.41
|
|
X-ray exam of middle ear
|
$1,222.00 |
$1,222.00 |
$1,222.00 |
$345.66
|
|
X-ray exam of penis
|
$832.00 |
$832.00 |
$832.00 |
$593.46
|
|
X-ray exam of perineum
|
$832.00 |
$832.00 |
$832.00 |
$577.85
|
|
X-ray exam of salivary gland
|
$452.40 |
$452.40 |
$452.40 |
$162.60
|
|
X-ray exam of sinuses
|
$254.80 |
$254.80 |
$254.80 |
$214.50
|
|
X-ray exam of tear duct
|
$993.20 |
$993.20 |
$993.20 |
$467.50
|
|
X-ray exam of teeth
|
$265.20 |
$265.20 |
$265.20 |
$119.66
|
|
X-ray exam of teeth
|
$894.40 |
$894.40 |
$894.40 |
$328.08
|
|
X-ray exam si joints
|
$421.20 |
$421.20 |
$421.20 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$499.20 |
$499.20 |
$499.20 |
$387.40
|
|
X-ray eye detection foreign body (both sides)
|
$254.80 |
$254.80 |
$254.80 |
$238.29
|
|
X-ray facial bones complete > 3 views
|
$494.00 |
$494.00 |
$494.00 |
$381.75
|
|
X-ray fallopian tube
|
$327.60 |
$327.60 |
$327.60 |
$532.38
|
|
X-ray femur >=2 views (both sides)
|
$390.00 |
$390.00 |
$390.00 |
$317.25
|
|
X-ray finger(s) >= 2 views (both sides)
|
$265.20 |
$265.20 |
$265.20 |
$241.05
|
|
X-ray foot 2 views (both sides)
|
$301.60 |
$301.60 |
$301.60 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$353.60 |
$353.60 |
$353.60 |
$322.20
|
|
X-ray hand 2 views (both sides)
|
$291.20 |
$291.20 |
$291.20 |
$291.20
|
|
X-ray head for orthodontia
|
$239.20 |
$239.20 |
$239.20 |
$158.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$296.40 |
$296.40 |
$296.40 |
$274.95
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$546.00 |
$546.00 |
$546.00 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$374.40 |
$374.40 |
$374.40 |
$374.40
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$494.00 |
$494.00 |
$494.00 |
$424.05
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$993.20 |
$993.20 |
$993.20 |
$505.60
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$358.80 |
$358.80 |
$358.80 |
$231.00
|
|
X-ray humerus >= 2 views left
|
$369.20 |
$369.20 |
$369.20 |
$309.31
|
|
X-ray joint survey 1 view
|
$494.00 |
$494.00 |
$494.00 |
$232.00
|
|
X-ray knee 1-2 views (both sides)
|
$338.00 |
$338.00 |
$338.00 |
$285.00
|
|
X-ray knee 3 views (both sides)
|
$405.60 |
$405.60 |
$405.60 |
$363.20
|
|
X-ray knee ap standing bilateral
|
$286.00 |
$286.00 |
$286.00 |
$252.50
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$338.00 |
$338.00 |
$338.00 |
$254.12
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$431.60 |
$431.60 |
$431.60 |
$369.15
|
|
X-ray lumbosacral spine >= 4 views
|
$681.20 |
$681.20 |
$681.20 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$748.80 |
$748.80 |
$748.80 |
$535.91
|
|
X-ray male genital tract
|
$1,206.40 |
$1,206.40 |
$1,206.40 |
$603.50
|
|
X-ray mandible complete > 4 views
|
$504.40 |
$504.40 |
$504.40 |
$361.61
|
