|
Warde vitamin c (ascorbic acid)
|
$1.31 |
$1.31 |
$1.31 |
$50.00
|
|
Warde vitamin d (1 25 dihydroxy)
|
$1.05 |
$1.05 |
$1.05 |
$136.80
|
|
Warde vitamin e (alpha-tocopherol)
|
$0.63 |
$0.63 |
$0.63 |
$59.20
|
|
Warde zinc
|
$0.29 |
$0.29 |
$0.29 |
$62.50
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$33.39 |
$33.39 |
$33.39 |
$284.70
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$44.17 |
$44.17 |
$44.17 |
$437.41
|
|
Wrist X-ray
|
$116.41 |
$116.41 |
$116.41 |
$342.80
|
|
X-ray abdomen 1 view
|
$87.36 |
$87.36 |
$87.36 |
$258.00
|
|
X-ray abdomen 2 views
|
$133.98 |
$133.98 |
$133.98 |
$316.47
|
|
X-ray abdomen >=3 views
|
$92.75 |
$92.75 |
$92.75 |
$342.50
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$134.89 |
$134.89 |
$134.89 |
$417.30
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$99.26 |
$99.26 |
$99.26 |
$270.20
|
|
X-ray ankle 2 views (both sides)
|
$79.17 |
$79.17 |
$79.17 |
$282.50
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$183.40 |
$183.40 |
$183.40 |
$773.40
|
|
X-ray bone age studies
|
$68.53 |
$68.53 |
$68.53 |
$250.20
|
|
X-ray bone length studies
|
$144.27 |
$144.27 |
$144.27 |
$285.30
|
|
X-ray bone survey complete
|
$189.63 |
$189.63 |
$189.63 |
$660.00
|
|
X-ray bone survey infant
|
$112.07 |
$112.07 |
$112.07 |
$394.69
|
|
X-ray cervical spine 2-3 views
|
$145.95 |
$145.95 |
$145.95 |
$333.11
|
|
X-ray cervical spine 4-5 views
|
$153.44 |
$153.44 |
$153.44 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$165.06 |
$165.06 |
$165.06 |
$508.50
|
|
X-ray clavicle complete (both sides)
|
$105.98 |
$105.98 |
$105.98 |
$300.05
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$276.92 |
$276.92 |
$276.92 |
$652.19
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$314.16 |
$314.16 |
$314.16 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$79.17 |
$79.17 |
$79.17 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$133.77 |
$133.77 |
$133.77 |
$364.12
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$163.94 |
$163.94 |
$163.94 |
$483.50
|
|
X-ray exam of arm infant
|
$79.17 |
$79.17 |
$79.17 |
$248.44
|
|
X-ray exam of eye sockets
|
$77.07 |
$77.07 |
$77.07 |
$328.35
|
|
X-ray exam of femur 1
|
$83.23 |
$83.23 |
$83.23 |
$240.00
|
|
X-ray exam of sinuses
|
$110.46 |
$110.46 |
$110.46 |
$214.50
|
|
X-ray exam thorac spine4/>vw
|
$139.37 |
$139.37 |
$139.37 |
$387.40
|
|
X-ray eye detection foreign body (both sides)
|
$147.63 |
$147.63 |
$147.63 |
$238.29
|
|
X-ray facial bones complete > 3 views
|
$151.69 |
$151.69 |
$151.69 |
$381.75
|
|
X-ray femur >=2 views (both sides)
|
$120.54 |
$120.54 |
$120.54 |
$317.25
|
|
X-ray finger(s) >= 2 views (both sides)
|
$76.79 |
$76.79 |
$76.79 |
$241.05
|
|
X-ray foot 2 views (both sides)
|
$79.17 |
$79.17 |
$79.17 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$104.86 |
$104.86 |
$104.86 |
$322.20
|
|
X-ray hand 2 views (both sides)
|
$79.17 |
$79.17 |
$79.17 |
$291.20
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$79.17 |
$79.17 |
$79.17 |
$274.95
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$114.94 |
$114.94 |
$114.94 |
$376.40
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$145.53 |
$145.53 |
$145.53 |
$374.40
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$165.90 |
$165.90 |
$165.90 |
$424.05
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$105.21 |
$105.21 |
$105.21 |
$231.00
|
|
X-ray humerus >= 2 views left
|
$79.17 |
$79.17 |
$79.17 |
$309.31
|
|
X-ray knee 1-2 views (both sides)
|
$94.15 |
$94.15 |
$94.15 |
$285.00
|
|
X-ray knee 3 views (both sides)
|
$122.22 |
$122.22 |
$122.22 |
$363.20
|
|
X-ray knee ap standing bilateral
|
$90.02 |
$90.02 |
$90.02 |
$252.50
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$84.07 |
$84.07 |
$84.07 |
$254.12
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$35.70 |
$35.70 |
$35.70 |
$369.15
|
|
X-ray lumbosacral spine >= 4 views
|
$203.14 |
$203.14 |
$203.14 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$219.59 |
$219.59 |
$219.59 |
$535.91
|
|
X-ray mandible complete > 4 views
|
$141.26 |
$141.26 |
$141.26 |
$361.61
|
|
X-ray nasal bones complete > 3 views
|
$110.46 |
$110.46 |
$110.46 |
$274.65
|
|
X-ray neck soft tissue
|
$110.46 |
$110.46 |
$110.46 |
$237.43
|
|
X-ray pelvis 1-2 views
|
$84.00 |
$84.00 |
$84.00 |
$280.80
|
|
X-ray pelvis complete > 3 views
|
$113.75 |
$113.75 |
$113.75 |
$348.19
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$170.73 |
$170.73 |
$170.73 |
$754.50
|
|
X-ray ribs 2 views left
|
$117.53 |
$117.53 |
$117.53 |
$292.80
|
|
X-ray ribs 3 views bilateral
|
$124.46 |
$124.46 |
$124.46 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$137.55 |
$137.55 |
$137.55 |
$354.91
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$140.42 |
$140.42 |
$140.42 |
$491.70
|
|
X-ray sacroiliac joints >= 3 views
|
$111.30 |
$111.30 |
$111.30 |
$312.00
|
|
X-ray sacrum/coccyx >= 2 views
|
$105.14 |
$105.14 |
$105.14 |
$288.80
|
|
X-ray scapula complete (both sides)
|
$90.79 |
$90.79 |
$90.79 |
$285.00
|
|
X-ray shoulder 1 view (both sides)
|
$83.23 |
$83.23 |
$83.23 |
$260.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$153.37 |
$153.37 |
$153.37 |
$345.24
|
|
X-ray skull < 4 views
|
$132.65 |
$132.65 |
$132.65 |
$292.00
|
|
X-ray skull > 4 views complete
|
$159.46 |
$159.46 |
$159.46 |
$417.50
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$169.26 |
$169.26 |
$169.26 |
$557.70
|
|
X-ray small intestine follow-through study
|
$169.26 |
$169.26 |
$169.26 |
$499.50
|
|
X-ray spine single view
|
$83.72 |
$83.72 |
$83.72 |
$250.56
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$107.73 |
$107.73 |
$107.73 |
$264.48
|
|
X-ray sternum > 2 views
|
$90.02 |
$90.02 |
$90.02 |
$274.65
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$144.90 |
$144.90 |
$144.90 |
$522.22
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$87.22 |
$87.22 |
$87.22 |
$327.80
|
|
X-ray thoracic spine 2 views
|
$119.28 |
$119.28 |
$119.28 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$102.20 |
$102.20 |
$102.20 |
$380.82
|
|
X-ray thoracolumbar spine >=2 views
|
$101.15 |
$101.15 |
$101.15 |
$282.50
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$100.24 |
$100.24 |
$100.24 |
$257.04
|
|
X-ray tibia/fibula 2 views (both sides)
|
$110.39 |
$110.39 |
$110.39 |
$332.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$75.11 |
$75.11 |
$75.11 |
$258.50
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$219.03 |
$219.03 |
$219.03 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$201.67 |
$201.67 |
$201.67 |
$603.20
|
|
X-ray wrist 2 views (both sides)
|
$87.29 |
$87.29 |
$87.29 |
$290.40
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$1.12 |
$1.12 |
$1.12 |
$93.12
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$8.96 |
$8.96 |
$8.96 |
$122.69
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$196.35 |
$196.35 |
$196.35 |
$452.69
|