|
Warde vitamin b-1 (thiamine)
|
$5.84 |
$5.84 |
$5.84 |
$78.65
|
|
Warde vitamin b6 (pyridoxine)
|
$4.09 |
$4.09 |
$4.09 |
$116.00
|
|
Warde vitamin c (ascorbic acid)
|
$10.52 |
$10.52 |
$10.52 |
$45.60
|
|
Warde vitamin d (1 25 dihydroxy)
|
$9.35 |
$9.35 |
$9.35 |
$138.50
|
|
Warde vitamin e (alpha-tocopherol)
|
$4.09 |
$4.09 |
$4.09 |
$55.00
|
|
Warde zinc
|
$6.76 |
$6.76 |
$6.76 |
$62.50
|
|
Wbc automated
|
$26.28 |
$26.28 |
$26.28 |
$32.80
|
|
Whole blood for transfusion
|
$436.25 |
$436.25 |
$436.25 |
$479.50
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$782.56 |
$782.56 |
$782.56 |
$558.97
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$782.56 |
$782.56 |
$782.56 |
$611.25
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$332.30 |
$332.30 |
$332.30 |
$288.91
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$670.44 |
$670.44 |
$670.44 |
$436.15
|
|
X-ray abdomen 1 view
|
$564.73 |
$564.73 |
$564.73 |
$255.00
|
|
X-ray abdomen 2 views
|
$841.55 |
$841.55 |
$841.55 |
$312.36
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$1,056.46 |
$1,056.46 |
$1,056.46 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$300.18 |
$300.18 |
$300.18 |
$271.44
|
|
X-ray bone age studies
|
$227.18 |
$227.18 |
$227.18 |
$246.75
|
|
X-ray bone length studies
|
$683.28 |
$683.28 |
$683.28 |
$287.25
|
|
X-ray bone survey complete
|
$919.80 |
$919.80 |
$919.80 |
$666.60
|
|
X-ray bone survey infant
|
$605.61 |
$605.61 |
$605.61 |
$410.73
|
|
X-ray cervical spine 2-3 views
|
$515.68 |
$515.68 |
$515.68 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$696.72 |
$696.72 |
$696.72 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$870.75 |
$870.75 |
$870.75 |
$515.35
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$995.72 |
$995.72 |
$995.72 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$1,394.01 |
$1,394.01 |
$1,394.01 |
$820.15
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$946.08 |
$946.08 |
$946.08 |
$486.24
|
|
X-ray exam entire spi 4/5 vw
|
$891.19 |
$891.19 |
$891.19 |
$486.01
|
|
X-ray exam entire spi 6/> vw
|
$1,111.94 |
$1,111.94 |
$1,111.94 |
$575.76
|
|
X-ray exam of eye sockets
|
$731.17 |
$731.17 |
$731.17 |
$349.05
|
|
X-ray exam of sinuses
|
$409.39 |
$409.39 |
$409.39 |
$211.00
|
|
X-ray exam si joints
|
$607.95 |
$607.95 |
$607.95 |
$246.16
|
|
X-ray facial bones complete > 3 views
|
$560.06 |
$560.06 |
$560.06 |
$366.60
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$700.80 |
$700.80 |
$700.80 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$880.68 |
$880.68 |
$880.68 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$1,100.26 |
$1,100.26 |
$1,100.26 |
$508.00
|
|
X-ray knee ap standing bilateral
|
$438.00 |
$438.00 |
$438.00 |
$276.25
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$699.05 |
$699.05 |
$699.05 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$852.64 |
$852.64 |
$852.64 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$1,184.94 |
$1,184.94 |
$1,184.94 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$412.89 |
$412.89 |
$412.89 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$359.75 |
$359.75 |
$359.75 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$421.07 |
$421.07 |
$421.07 |
$277.70
|
|
X-ray neck soft tissue
|
$467.20 |
$467.20 |
$467.20 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$196.23 |
$196.23 |
$196.23 |
$225.96
|
|
X-ray pelvis 1-2 views
|
$468.96 |
$468.96 |
$468.96 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$656.42 |
$656.42 |
$656.42 |
$342.30
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$874.84 |
$874.84 |
$874.84 |
$742.00
|
|
X-ray ribs 3 views bilateral
|
$870.75 |
$870.75 |
$870.75 |
$394.34
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$1,098.51 |
$1,098.51 |
$1,098.51 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$698.47 |
$698.47 |
$698.47 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$602.11 |
$602.11 |
$602.11 |
$285.60
|
|
X-ray sinuses paranasal complete > 3 views
|
$514.51 |
$514.51 |
$514.51 |
$339.00
|
|
X-ray skull < 4 views
|
$459.61 |
$459.61 |
$459.61 |
$291.78
|
|
X-ray skull > 4 views complete
|
$666.35 |
$666.35 |
$666.35 |
$414.60
|
|
X-ray slg plne bdy sect without urogr
|
$195.64 |
$195.64 |
$195.64 |
$387.00
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$977.62 |
$977.62 |
$977.62 |
$557.70
|
|
X-ray small intestine follow-through study
|
$1,777.70 |
$1,777.70 |
$1,777.70 |
$504.14
|
|
X-ray spine single view
|
$279.74 |
$279.74 |
$279.74 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$290.25 |
$290.25 |
$290.25 |
$263.49
|
|
X-ray sternum > 2 views
|
$391.28 |
$391.28 |
$391.28 |
$269.75
|
|
X-ray surgical specimen
|
$568.24 |
$568.24 |
$568.24 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$937.32 |
$937.32 |
$937.32 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$317.70 |
$317.70 |
$317.70 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$797.16 |
$797.16 |
$797.16 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$866.08 |
$866.08 |
$866.08 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$422.82 |
$422.82 |
$422.82 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$605.61 |
$605.61 |
$605.61 |
$256.85
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$713.07 |
$713.07 |
$713.07 |
$385.80
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$1,236.33 |
$1,236.33 |
$1,236.33 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$996.89 |
$996.89 |
$996.89 |
$555.04
|
|
Yersinia antibody
|
$21.20 |
$21.20 |
$21.20 |
$66.95
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$117.97 |
$117.97 |
$117.97 |
$106.94
|
|
Zika virus dna/rna amp probe
|
$77.09 |
$77.09 |
$77.09 |
$175.00
|
|
Zika virus igm antibody
|
$43.69 |
$43.69 |
$43.69 |
$75.40
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$220.76 |
$220.76 |
$220.76 |
$121.56
|
|
Ziv-aflibercept 25 mg/ml intravenous solution (wrapper)
|
$3,358.00 |
$3,358.00 |
$3,358.00 |
$4,764.60
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$4,555.20 |
$4,555.20 |
$4,555.20 |
$405.10
|