|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$406.98 |
$406.98 |
$406.98 |
$288.91
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$760.92 |
$760.92 |
$760.92 |
$436.15
|
|
Wrist X-ray
|
$970.02 |
$970.02 |
$970.02 |
$343.70
|
|
Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/<
|
$3,803.07 |
$3,803.07 |
$3,803.07 |
$2,830.00
|
|
Xfer tis s/a/l 10 sq cm/<
|
$3,885.18 |
$3,885.18 |
$3,885.18 |
$2,623.24
|
|
X-ray abdomen 1 view
|
$548.25 |
$548.25 |
$548.25 |
$255.00
|
|
X-ray abdomen 2 views
|
$1,281.63 |
$1,281.63 |
$1,281.63 |
$312.36
|
|
X-ray abdomen >=3 views
|
$2,146.08 |
$2,146.08 |
$2,146.08 |
$332.15
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$2,146.08 |
$2,146.08 |
$2,146.08 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$1,013.88 |
$1,013.88 |
$1,013.88 |
$271.44
|
|
X-ray ankle 2 views (both sides)
|
$902.70 |
$902.70 |
$902.70 |
$283.00
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$3,366.00 |
$3,366.00 |
$3,366.00 |
$768.30
|
|
X-ray bone age studies
|
$1,194.42 |
$1,194.42 |
$1,194.42 |
$246.75
|
|
X-ray bone length studies
|
$749.70 |
$749.70 |
$749.70 |
$287.25
|
|
X-ray bone survey complete
|
$1,803.87 |
$1,803.87 |
$1,803.87 |
$666.60
|
|
X-ray bone survey infant
|
$913.92 |
$913.92 |
$913.92 |
$410.73
|
|
X-ray cervical spine 2-3 views
|
$1,166.37 |
$1,166.37 |
$1,166.37 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$1,597.83 |
$1,597.83 |
$1,597.83 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$1,597.83 |
$1,597.83 |
$1,597.83 |
$515.35
|
|
X-ray clavicle complete (both sides)
|
$850.17 |
$850.17 |
$850.17 |
$299.65
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$1,745.73 |
$1,745.73 |
$1,745.73 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$1,877.31 |
$1,877.31 |
$1,877.31 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$772.65 |
$772.65 |
$772.65 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$974.10 |
$974.10 |
$974.10 |
$342.00
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$1,076.10 |
$1,076.10 |
$1,076.10 |
$486.24
|
|
X-ray exam entire spi 4/5 vw
|
$1,130.67 |
$1,130.67 |
$1,130.67 |
$486.01
|
|
X-ray exam of arm infant
|
$477.36 |
$477.36 |
$477.36 |
$248.82
|
|
X-ray exam of eye sockets
|
$1,342.32 |
$1,342.32 |
$1,342.32 |
$349.05
|
|
X-ray exam of femur 1
|
$501.84 |
$501.84 |
$501.84 |
$232.36
|
|
X-ray exam of jaw joint
|
$860.37 |
$860.37 |
$860.37 |
$192.39
|
|
X-ray exam of mastoids
|
$156.57 |
$156.57 |
$156.57 |
$191.91
|
|
X-ray exam of sinuses
|
$793.56 |
$793.56 |
$793.56 |
$211.00
|
|
X-ray exam si joints
|
$695.64 |
$695.64 |
$695.64 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$1,209.21 |
$1,209.21 |
$1,209.21 |
$395.59
|
|
X-ray eye detection foreign body (both sides)
|
$202.98 |
$202.98 |
$202.98 |
$235.00
|
|
X-ray facial bones complete > 3 views
|
$1,406.07 |
$1,406.07 |
$1,406.07 |
$366.60
|
|
X-ray femur >=2 views (both sides)
|
$1,130.67 |
$1,130.67 |
$1,130.67 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$644.13 |
$644.13 |
$644.13 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$992.46 |
$992.46 |
$992.46 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$901.68 |
$901.68 |
$901.68 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$700.74 |
$700.74 |
$700.74 |
$316.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$833.85 |
$833.85 |
$833.85 |
$270.00
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$1,130.67 |
$1,130.67 |
$1,130.67 |
$370.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$1,130.67 |
$1,130.67 |
$1,130.67 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$1,130.67 |
$1,130.67 |
$1,130.67 |
$409.24
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$682.38 |
$682.38 |
$682.38 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$956.25 |
$956.25 |
$956.25 |
$304.15
|
|
X-ray knee 1-2 views (both sides)
|
$828.24 |
$828.24 |
$828.24 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$1,112.82 |
$1,112.82 |
$1,112.82 |
$353.25
|
|
X-ray knee ap standing bilateral
|
$659.94 |
$659.94 |
$659.94 |
$276.25
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$781.32 |
$781.32 |
$781.32 |
$249.13
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$1,313.76 |
$1,313.76 |
$1,313.76 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$1,633.02 |
$1,633.02 |
$1,633.02 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$1,710.03 |
$1,710.03 |
$1,710.03 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$1,368.84 |
$1,368.84 |
$1,368.84 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$768.57 |
$768.57 |
$768.57 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$1,054.68 |
$1,054.68 |
$1,054.68 |
$277.70
|
|
X-ray neck soft tissue
|
$531.93 |
$531.93 |
$531.93 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$343.23 |
$343.23 |
$343.23 |
$225.96
|
|
X-ray optic foramina
|
$642.60 |
$642.60 |
$642.60 |
$171.00
|
|
X-ray pelvis 1-2 views
|
$810.90 |
$810.90 |
$810.90 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$951.66 |
$951.66 |
$951.66 |
$342.30
|
|
Xray place prox ext thor ao
|
$21,218.55 |
$21,218.55 |
$21,218.55 |
$1,046.10
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$1,822.23 |
$1,822.23 |
$1,822.23 |
$742.00
|
|
X-ray ribs 2 views left
|
$1,267.86 |
$1,267.86 |
$1,267.86 |
$296.32
|
|
X-ray ribs 3 views bilateral
|
$1,391.79 |
$1,391.79 |
$1,391.79 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$1,373.43 |
$1,373.43 |
$1,373.43 |
$359.47
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$1,391.79 |
$1,391.79 |
$1,391.79 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$1,012.35 |
$1,012.35 |
$1,012.35 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$1,078.14 |
$1,078.14 |
$1,078.14 |
$285.60
|
|
X-ray scapula complete (both sides)
|
$1,012.35 |
$1,012.35 |
$1,012.35 |
$292.50
|
|
X-ray shoulder 1 view (both sides)
|
$850.17 |
$850.17 |
$850.17 |
$264.48
|
|
X-ray sinuses paranasal complete > 3 views
|
$1,291.32 |
$1,291.32 |
$1,291.32 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$1,092.42 |
$1,092.42 |
$1,092.42 |
$601.30
|
|
X-ray skull < 4 views
|
$896.58 |
$896.58 |
$896.58 |
$291.78
|
|
X-ray skull > 4 views complete
|
$896.58 |
$896.58 |
$896.58 |
$414.60
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$1,511.13 |
$1,511.13 |
$1,511.13 |
$557.70
|
|
X-ray small intestine follow-through study
|
$357.00 |
$357.00 |
$357.00 |
$504.14
|
|
X-ray spine single view
|
$686.46 |
$686.46 |
$686.46 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$952.68 |
$952.68 |
$952.68 |
$263.49
|
|
X-ray sternum > 2 views
|
$1,002.15 |
$1,002.15 |
$1,002.15 |
$269.75
|
|
X-ray surgical specimen
|
$1,241.34 |
$1,241.34 |
$1,241.34 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$839.97 |
$839.97 |
$839.97 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$1,216.35 |
$1,216.35 |
$1,216.35 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$1,098.03 |
$1,098.03 |
$1,098.03 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$1,167.39 |
$1,167.39 |
$1,167.39 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$1,149.03 |
$1,149.03 |
$1,149.03 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$682.38 |
$682.38 |
$682.38 |
$256.85
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$1,130.67 |
$1,130.67 |
$1,130.67 |
$385.80
|
|
X-ray tibia/fibula 2 views (both sides)
|
$902.70 |
$902.70 |
$902.70 |
$328.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$992.46 |
$992.46 |
$992.46 |
$264.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$1,568.25 |
$1,568.25 |
$1,568.25 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$1,102.62 |
$1,102.62 |
$1,102.62 |
$555.04
|
|
X-ray wrist 2 views (both sides)
|
$767.04 |
$767.04 |
$767.04 |
$290.40
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$148.77 |
$148.77 |
$148.77 |
$106.94
|
|
Zika virus dna/rna amp probe
|
$255.00 |
$255.00 |
$255.00 |
$175.00
|
|
Zika virus igm antibody
|
$140.25 |
$140.25 |
$140.25 |
$75.40
|
|
Zinc paste band w >=3"<5"/yd
|
$23.51 |
$23.51 |
$23.51 |
$17.56
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$275.36 |
$275.36 |
$275.36 |
$121.56
|
|
Zolbetuximab-clzb 100 mg intravenous solution
|
$4,826.23 |
$4,826.23 |
$4,826.23 |
$4,848.00
|