|
Warde zinc
|
$5.09 |
$5.09 |
$5.09 |
$62.50
|
|
Wbc automated
|
$55.80 |
$55.80 |
$55.80 |
$32.80
|
|
Whole blood for transfusion
|
$164.89 |
$164.89 |
$164.89 |
$479.50
|
|
Whole blood or red blood cells frozen/deglycerolized/washed leukocytes reduced each unit
|
$289.89 |
$289.89 |
$289.89 |
$740.15
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$411.53 |
$411.53 |
$411.53 |
$558.97
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$411.53 |
$411.53 |
$411.53 |
$611.25
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$162.94 |
$162.94 |
$162.94 |
$288.91
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$411.53 |
$411.53 |
$411.53 |
$436.15
|
|
Xcellistem, 1 mg
|
$3,260.96 |
$3,260.96 |
$3,260.96 |
$3,638.47
|
|
X-ray abdomen 1 view
|
$282.63 |
$282.63 |
$282.63 |
$255.00
|
|
X-ray abdomen 2 views
|
$449.47 |
$449.47 |
$449.47 |
$312.36
|
|
X-ray abdomen >=3 views
|
$757.49 |
$757.49 |
$757.49 |
$332.15
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$565.26 |
$565.26 |
$565.26 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$194.47 |
$194.47 |
$194.47 |
$271.44
|
|
X-ray bone age studies
|
$265.89 |
$265.89 |
$265.89 |
$246.75
|
|
X-ray bone length studies
|
$381.12 |
$381.12 |
$381.12 |
$287.25
|
|
X-ray bone survey complete
|
$1,095.64 |
$1,095.64 |
$1,095.64 |
$666.60
|
|
X-ray bone survey infant
|
$1,106.80 |
$1,106.80 |
$1,106.80 |
$410.73
|
|
X-ray cervical spine 2-3 views
|
$451.98 |
$451.98 |
$451.98 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$610.18 |
$610.18 |
$610.18 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$782.04 |
$782.04 |
$782.04 |
$515.35
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$649.52 |
$649.52 |
$649.52 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$908.99 |
$908.99 |
$908.99 |
$820.15
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$454.50 |
$454.50 |
$454.50 |
$486.24
|
|
X-ray exam entire spi 4/5 vw
|
$1,074.43 |
$1,074.43 |
$1,074.43 |
$486.01
|
|
X-ray exam entire spi 6/> vw
|
$1,340.88 |
$1,340.88 |
$1,340.88 |
$575.76
|
|
X-ray exam of mastoids
|
$331.46 |
$331.46 |
$331.46 |
$191.91
|
|
X-ray exam of middle ear
|
$314.16 |
$314.16 |
$314.16 |
$341.25
|
|
X-ray exam of penis
|
$726.80 |
$726.80 |
$726.80 |
$565.20
|
|
X-ray exam of sinuses
|
$368.56 |
$368.56 |
$368.56 |
$211.00
|
|
X-ray exam si joints
|
$399.53 |
$399.53 |
$399.53 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$469.84 |
$469.84 |
$469.84 |
$395.59
|
|
X-ray facial bones complete > 3 views
|
$459.52 |
$459.52 |
$459.52 |
$366.60
|
|
X-ray fallopian tube
|
$2,604.47 |
$2,604.47 |
$2,604.47 |
$501.00
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$361.87 |
$361.87 |
$361.87 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$453.10 |
$453.10 |
$453.10 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$566.37 |
$566.37 |
$566.37 |
$508.00
|
|
X-ray joint survey 1 view
|
$692.76 |
$692.76 |
$692.76 |
$211.00
|
|
X-ray knee ap standing bilateral
|
$360.47 |
$360.47 |
$360.47 |
$276.25
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$434.69 |
$434.69 |
$434.69 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$526.76 |
$526.76 |
$526.76 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$688.30 |
$688.30 |
$688.30 |
$559.65
|
|
X-ray male genital tract
|
$399.25 |
$399.25 |
$399.25 |
$286.04
|
|
X-ray mandible complete > 4 views
|
$375.54 |
$375.54 |
$375.54 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$326.71 |
$326.71 |
$326.71 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$472.63 |
$472.63 |
$472.63 |
$277.70
|
|
X-ray neck soft tissue
|
$281.24 |
$281.24 |
$281.24 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$372.47 |
$372.47 |
$372.47 |
$225.96
|
|
X-ray optic foramina
|
$209.25 |
$209.25 |
$209.25 |
$171.00
|
|
X-ray pelvis 1-2 views
|
$264.50 |
$264.50 |
$264.50 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$394.23 |
$394.23 |
$394.23 |
$342.30
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$539.31 |
$539.31 |
$539.31 |
$742.00
|
|
X-ray ribs 3 views bilateral
|
$466.49 |
$466.49 |
$466.49 |
$394.34
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$611.57 |
$611.57 |
$611.57 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$473.75 |
$473.75 |
$473.75 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$391.72 |
$391.72 |
$391.72 |
$285.60
|
|
X-ray sella turcica
|
$120.53 |
$120.53 |
$120.53 |
$162.50
|
|
X-ray sinuses paranasal complete > 3 views
|
$466.21 |
$466.21 |
$466.21 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$372.75 |
$372.75 |
$372.75 |
$601.30
|
|
X-ray skull < 4 views
|
$427.43 |
$427.43 |
$427.43 |
$291.78
|
|
X-ray skull > 4 views complete
|
$542.94 |
$542.94 |
$542.94 |
$414.60
|
|
X-ray slg plne bdy sect without urogr
|
$520.90 |
$520.90 |
$520.90 |
$387.00
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$451.43 |
$451.43 |
$451.43 |
$557.70
|
|
X-ray small intestine follow-through study
|
$176.33 |
$176.33 |
$176.33 |
$504.14
|
|
X-ray spine single view
|
$303.56 |
$303.56 |
$303.56 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$304.95 |
$304.95 |
$304.95 |
$263.49
|
|
X-ray sternum > 2 views
|
$258.36 |
$258.36 |
$258.36 |
$269.75
|
|
X-ray surgical specimen
|
$514.20 |
$514.20 |
$514.20 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$577.53 |
$577.53 |
$577.53 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$371.35 |
$371.35 |
$371.35 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$353.22 |
$353.22 |
$353.22 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$395.63 |
$395.63 |
$395.63 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$256.41 |
$256.41 |
$256.41 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$318.06 |
$318.06 |
$318.06 |
$256.85
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$859.60 |
$859.60 |
$859.60 |
$385.80
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$508.34 |
$508.34 |
$508.34 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$496.62 |
$496.62 |
$496.62 |
$555.04
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$37.95 |
$37.95 |
$37.95 |
$106.94
|
|
Zika virus igm antibody
|
$20.87 |
$20.87 |
$20.87 |
$75.40
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$13.40 |
$13.40 |
$13.40 |
$121.56
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$1,273.08 |
$1,273.08 |
$1,273.08 |
$405.10
|