|
Warde vitamin e (alpha-tocopherol)
|
$4.41 |
$4.41 |
$8.57 |
$55.00
|
|
Warde zinc
|
$3.53 |
$3.53 |
$6.86 |
$62.50
|
|
Wbc automated
|
$19.11 |
$19.11 |
$190.15 |
$32.80
|
|
Western blot test
|
$27.93 |
$27.93 |
$54.25 |
$153.18
|
|
Whfo nontorsion joint prefab
|
$35.87 |
$35.87 |
$35.87 |
$188.80
|
|
Whole blood for transfusion
|
$511.27 |
$511.27 |
$511.27 |
$479.50
|
|
Whole blood or red blood cells frozen/deglycerolized/washed leukocytes reduced each unit
|
$476.58 |
$476.58 |
$476.58 |
$740.15
|
|
Whole blood/red blood cells leukocytes reduced cmv negative each unit
|
$603.88 |
$603.88 |
$603.88 |
$495.00
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$667.09 |
$667.09 |
$667.09 |
$558.97
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$667.09 |
$667.09 |
$667.09 |
$611.25
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$322.82 |
$322.82 |
$322.82 |
$288.91
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$667.09 |
$667.09 |
$667.09 |
$436.15
|
|
Xcellistem, 1 mg
|
$1,356.81 |
$1,356.81 |
$1,356.81 |
$3,638.47
|
|
X-ray abdomen 1 view
|
$367.21 |
$367.21 |
$367.21 |
$255.00
|
|
X-ray abdomen 2 views
|
$594.77 |
$594.77 |
$594.77 |
$312.36
|
|
X-ray abdomen >=3 views
|
$851.72 |
$851.72 |
$851.72 |
$332.15
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$734.12 |
$734.12 |
$734.12 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$450.41 |
$450.41 |
$450.41 |
$271.44
|
|
X-ray bone age studies
|
$170.82 |
$170.82 |
$170.82 |
$246.75
|
|
X-ray bone length studies
|
$372.50 |
$372.50 |
$372.50 |
$287.25
|
|
X-ray bone survey complete
|
$818.79 |
$818.79 |
$818.79 |
$666.60
|
|
X-ray bone survey infant
|
$827.03 |
$827.03 |
$827.03 |
$410.73
|
|
X-ray cervical spine 2-3 views
|
$545.08 |
$545.08 |
$545.08 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$735.59 |
$735.59 |
$735.59 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$942.86 |
$942.86 |
$942.86 |
$515.35
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$1,895.13 |
$1,895.13 |
$1,895.13 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$2,672.17 |
$2,672.17 |
$2,672.17 |
$820.15
|
|
Xray endovasc thor ao repr
|
$3,482.43 |
$3,482.43 |
$3,482.43 |
$1,889.01
|
|
Xray endovasc thor ao repr
|
$3,449.21 |
$3,449.21 |
$3,449.21 |
$2,266.32
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$813.80 |
$813.80 |
$813.80 |
$486.24
|
|
X-ray exam entire spi 4/5 vw
|
$315.47 |
$315.47 |
$315.47 |
$486.01
|
|
X-ray exam entire spi 6/> vw
|
$299.30 |
$299.30 |
$299.30 |
$575.76
|
|
X-ray exam of eye sockets
|
$398.08 |
$398.08 |
$398.08 |
$349.05
|
|
X-ray exam of mastoids
|
$422.19 |
$422.19 |
$422.19 |
$191.91
|
|
X-ray exam of middle ear
|
$194.34 |
$194.34 |
$194.34 |
$341.25
|
|
X-ray exam of salivary gland
|
$260.19 |
$260.19 |
$260.19 |
$124.24
|
|
X-ray exam of sinuses
|
$302.82 |
$302.82 |
$302.82 |
$211.00
|
|
X-ray exam si joints
|
$446.59 |
$446.59 |
$446.59 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$862.01 |
$862.01 |
$862.01 |
$395.59
|
|
X-ray facial bones complete > 3 views
|
$521.27 |
$521.27 |
$521.27 |
$366.60
|
|
X-ray fallopian tube
|
$794.10 |
$794.10 |
$794.10 |
$501.00
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$1,193.06 |
$1,193.06 |
$1,193.06 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$1,193.06 |
$1,193.06 |
$1,193.06 |
$409.24
|
|
X-ray joint survey 1 view
|
$196.69 |
$196.69 |
$196.69 |
$211.00
|
|
X-ray knee ap standing bilateral
|
$578.89 |
$578.89 |
$578.89 |
$276.25
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$602.41 |
$602.41 |
$602.41 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$730.30 |
$730.30 |
$730.30 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$954.03 |
$954.03 |
$954.03 |
$559.65
|
|
X-ray male genital tract
|
$640.04 |
$640.04 |
$640.04 |
$286.04
|
|
X-ray mandible complete > 4 views
|
$361.04 |
$361.04 |
$361.04 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$313.70 |
$313.70 |
$313.70 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$442.77 |
$442.77 |
$442.77 |
$277.70
|
|
X-ray neck soft tissue
|
$379.56 |
$379.56 |
$379.56 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$274.60 |
$274.60 |
$274.60 |
$225.96
|
|
X-ray optic foramina
|
$330.46 |
$330.46 |
$330.46 |
$171.00
|
|
X-ray pelvis 1-2 views
|
$258.14 |
$258.14 |
$258.14 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$349.57 |
$349.57 |
$349.57 |
$342.30
|
|
Xray place prox ext thor ao
|
$1,564.08 |
$1,564.08 |
$1,564.08 |
$1,005.84
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$1,023.12 |
$1,023.12 |
$1,023.12 |
$742.00
|
|
X-ray ribs 3 views bilateral
|
$607.11 |
$607.11 |
$607.11 |
$394.34
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$795.86 |
$795.86 |
$795.86 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$525.38 |
$525.38 |
$525.38 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$437.77 |
$437.77 |
$437.77 |
$285.60
|
|
X-ray sella turcica
|
$311.94 |
$311.94 |
$311.94 |
$162.50
|
|
X-ray sinuses paranasal complete > 3 views
|
$383.38 |
$383.38 |
$383.38 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$531.26 |
$531.26 |
$531.26 |
$601.30
|
|
X-ray skull < 4 views
|
$360.45 |
$360.45 |
$360.45 |
$291.78
|
|
X-ray skull > 4 views complete
|
$448.94 |
$448.94 |
$448.94 |
$414.60
|
|
X-ray slg plne bdy sect without urogr
|
$691.20 |
$691.20 |
$691.20 |
$387.00
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$1,020.18 |
$1,020.18 |
$1,020.18 |
$557.70
|
|
X-ray small intestine follow-through study
|
$1,754.60 |
$1,754.60 |
$1,754.60 |
$504.14
|
|
X-ray spine single view
|
$296.36 |
$296.36 |
$296.36 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$410.13 |
$410.13 |
$410.13 |
$263.49
|
|
X-ray sternum > 2 views
|
$347.81 |
$347.81 |
$347.81 |
$269.75
|
|
X-ray surgical specimen
|
$217.27 |
$217.27 |
$217.27 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$974.61 |
$974.61 |
$974.61 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$560.07 |
$560.07 |
$560.07 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$644.75 |
$644.75 |
$644.75 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$724.42 |
$724.42 |
$724.42 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$385.73 |
$385.73 |
$385.73 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$315.47 |
$315.47 |
$315.47 |
$256.85
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$808.50 |
$808.50 |
$808.50 |
$385.80
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$1,175.71 |
$1,175.71 |
$1,175.71 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$1,238.33 |
$1,238.33 |
$1,238.33 |
$555.04
|
|
X-ray xm phrnx&/crv esoph c+
|
$942.27 |
$942.27 |
$942.27 |
$324.20
|
|
Yersinia antibody
|
$38.22 |
$38.22 |
$74.23 |
$66.95
|
|
Yttrium y-90 ibritumomab ther
|
$20,674.38 |
$20,674.38 |
$20,674.38 |
$55,035.00
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$33.52 |
$33.52 |
$33.52 |
$106.94
|
|
Zika virus dna/rna amp probe
|
$38.81 |
$38.81 |
$75.38 |
$175.00
|
|
Zika virus igm antibody
|
$22.00 |
$22.00 |
$42.72 |
$75.40
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$62.92 |
$62.92 |
$114.78 |
$121.56
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$4,968.60 |
$4,968.60 |
$4,968.60 |
$405.10
|
|
Zoster vaccine-live inj
|
$244.02 |
$244.02 |
$244.02 |
$235.20
|