|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$327.63 |
$327.63 |
$327.63 |
$288.91
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$678.03 |
$678.03 |
$678.03 |
$436.15
|
|
Wrist X-ray
|
$398.58 |
$398.58 |
$398.58 |
$343.70
|
|
Xe133 xenon 10mci
|
$136.66 |
$136.66 |
$136.66 |
$299.00
|
|
X-ray abdomen 1 view
|
$240.90 |
$240.90 |
$240.90 |
$255.00
|
|
X-ray abdomen 2 views
|
$383.25 |
$383.25 |
$383.25 |
$312.36
|
|
X-ray abdomen >=3 views
|
$397.71 |
$397.71 |
$397.71 |
$332.15
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$479.61 |
$479.61 |
$479.61 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$321.06 |
$321.06 |
$321.06 |
$271.44
|
|
X-ray ankle 2 views (both sides)
|
$315.36 |
$315.36 |
$315.36 |
$283.00
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$582.98 |
$582.98 |
$582.98 |
$768.30
|
|
X-ray bone age studies
|
$295.22 |
$295.22 |
$295.22 |
$246.75
|
|
X-ray bone length studies
|
$388.51 |
$388.51 |
$388.51 |
$287.25
|
|
X-ray bone survey complete
|
$531.30 |
$531.30 |
$531.30 |
$666.60
|
|
X-ray bone survey infant
|
$249.66 |
$249.66 |
$249.66 |
$410.73
|
|
X-ray cervical spine 2-3 views
|
$349.53 |
$349.53 |
$349.53 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$472.17 |
$472.17 |
$472.17 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$604.44 |
$604.44 |
$604.44 |
$515.35
|
|
X-ray clavicle complete (both sides)
|
$285.14 |
$285.14 |
$285.14 |
$299.65
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$569.84 |
$569.84 |
$569.84 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$798.92 |
$798.92 |
$798.92 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$269.81 |
$269.81 |
$269.81 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$321.50 |
$321.50 |
$321.50 |
$342.00
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$467.79 |
$467.79 |
$467.79 |
$486.24
|
|
X-ray exam entire spi 4/5 vw
|
$254.48 |
$254.48 |
$254.48 |
$486.01
|
|
X-ray exam entire spi 6/> vw
|
$487.94 |
$487.94 |
$487.94 |
$575.76
|
|
X-ray exam of arm infant
|
$195.79 |
$195.79 |
$195.79 |
$248.82
|
|
X-ray exam of eye sockets
|
$582.98 |
$582.98 |
$582.98 |
$349.05
|
|
X-ray exam of femur 1
|
$403.84 |
$403.84 |
$403.84 |
$232.36
|
|
X-ray exam of jaw joint
|
$85.85 |
$85.85 |
$85.85 |
$192.39
|
|
X-ray exam of mastoids
|
$93.74 |
$93.74 |
$93.74 |
$191.91
|
|
X-ray exam of middle ear
|
$364.86 |
$364.86 |
$364.86 |
$341.25
|
|
X-ray exam of salivary gland
|
$169.07 |
$169.07 |
$169.07 |
$124.24
|
|
X-ray exam of sinuses
|
$381.94 |
$381.94 |
$381.94 |
$211.00
|
|
X-ray exam thorac spine4/>vw
|
$595.25 |
$595.25 |
$595.25 |
$395.59
|
|
X-ray eye detection foreign body (both sides)
|
$465.60 |
$465.60 |
$465.60 |
$235.00
|
|
X-ray facial bones complete > 3 views
|
$448.08 |
$448.08 |
$448.08 |
$366.60
|
|
X-ray fallopian tube
|
$901.85 |
$901.85 |
$901.85 |
$501.00
|
|
X-ray femur >=2 views (both sides)
|
$403.84 |
$403.84 |
$403.84 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$251.85 |
$251.85 |
$251.85 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$276.38 |
$276.38 |
$276.38 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$142.79 |
$142.79 |
$142.79 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$284.27 |
$284.27 |
$284.27 |
$316.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$307.04 |
$307.04 |
$307.04 |
$270.00
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$428.37 |
$428.37 |
$428.37 |
$370.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$291.27 |
$291.27 |
$291.27 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$428.37 |
$428.37 |
$428.37 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$231.27 |
$231.27 |
$231.27 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$291.27 |
$291.27 |
$291.27 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$142.79 |
$142.79 |
$142.79 |
$304.15
|
|
X-ray knee 1-2 views (both sides)
|
$263.68 |
$263.68 |
$263.68 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$321.50 |
$321.50 |
$321.50 |
$353.25
|
|
X-ray knee ap standing bilateral
|
$305.29 |
$305.29 |
$305.29 |
$276.25
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$185.72 |
$185.72 |
$185.72 |
$249.13
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$502.83 |
$502.83 |
$502.83 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$614.96 |
$614.96 |
$614.96 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$808.11 |
$808.11 |
$808.11 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$448.08 |
$448.08 |
$448.08 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$389.82 |
$389.82 |
$389.82 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$303.98 |
$303.98 |
$303.98 |
$277.70
|
|
X-ray neck soft tissue
|
$356.10 |
$356.10 |
$356.10 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$312.74 |
$312.74 |
$312.74 |
$225.96
|
|
X-ray of mammary ducts
|
$509.84 |
$509.84 |
$509.84 |
$473.55
|
|
X-ray pelvis 1-2 views
|
$280.76 |
$280.76 |
$280.76 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$418.73 |
$418.73 |
$418.73 |
$342.30
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$444.57 |
$444.57 |
$444.57 |
$742.00
|
|
X-ray ribs 2 views left
|
$479.18 |
$479.18 |
$479.18 |
$296.32
|
|
X-ray ribs 3 views bilateral
|
$593.93 |
$593.93 |
$593.93 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$216.81 |
$216.81 |
$216.81 |
$359.47
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$778.33 |
$778.33 |
$778.33 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$340.33 |
$340.33 |
$340.33 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$283.39 |
$283.39 |
$283.39 |
$285.60
|
|
X-ray scapula complete (both sides)
|
$289.08 |
$289.08 |
$289.08 |
$292.50
|
|
X-ray shoulder 1 view (both sides)
|
$256.23 |
$256.23 |
$256.23 |
$264.48
|
|
X-ray sinuses paranasal complete > 3 views
|
$483.12 |
$483.12 |
$483.12 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$413.91 |
$413.91 |
$413.91 |
$601.30
|
|
X-ray skull < 4 views
|
$289.96 |
$289.96 |
$289.96 |
$291.78
|
|
X-ray skull > 4 views complete
|
$368.36 |
$368.36 |
$368.36 |
$414.60
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$574.22 |
$574.22 |
$574.22 |
$557.70
|
|
X-ray small intestine follow-through study
|
$269.81 |
$269.81 |
$269.81 |
$504.14
|
|
X-ray spine single view
|
$185.72 |
$185.72 |
$185.72 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$310.11 |
$310.11 |
$310.11 |
$263.49
|
|
X-ray sternum > 2 views
|
$262.80 |
$262.80 |
$262.80 |
$269.75
|
|
X-ray surgical specimen
|
$542.69 |
$542.69 |
$542.69 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$731.03 |
$731.03 |
$731.03 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$331.57 |
$331.57 |
$331.57 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$445.01 |
$445.01 |
$445.01 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$500.20 |
$500.20 |
$500.20 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$485.75 |
$485.75 |
$485.75 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$254.48 |
$254.48 |
$254.48 |
$256.85
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$617.58 |
$617.58 |
$617.58 |
$385.80
|
|
X-ray tibia/fibula 2 views (both sides)
|
$142.79 |
$142.79 |
$142.79 |
$328.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$194.04 |
$194.04 |
$194.04 |
$264.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$575.97 |
$575.97 |
$575.97 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$487.50 |
$487.50 |
$487.50 |
$555.04
|
|
X-ray wrist 2 views (both sides)
|
$331.13 |
$331.13 |
$331.13 |
$290.40
|
|
X-ray xm phrnx&/crv esoph c+
|
$335.07 |
$335.07 |
$335.07 |
$324.20
|
|
Zika virus dna/rna amp probe
|
$57.82 |
$57.82 |
$57.82 |
$175.00
|
|
Zika virus igm antibody
|
$32.77 |
$32.77 |
$32.77 |
$75.40
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$29.35 |
$29.35 |
$29.35 |
$121.56
|