|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$235.00 |
$235.00 |
$235.00 |
$284.70
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$132.60 |
$132.60 |
$132.60 |
$438.75
|
|
Wrist arthroscopy
|
$324.20 |
$324.20 |
$324.20 |
$3,839.54
|
|
Wrist arthroscopy/surgery
|
$355.80 |
$355.80 |
$355.80 |
$3,839.54
|
|
Wrist arthroscopy/surgery
|
$370.80 |
$370.80 |
$370.80 |
$3,839.54
|
|
Wrist endoscopy/surgery
|
$549.40 |
$549.40 |
$549.40 |
$3,452.80
|
|
Wrist X-ray
|
$319.00 |
$319.00 |
$319.00 |
$342.80
|
|
Xcapsl ctrc rmvl cplx wo ecp
|
$518.80 |
$518.80 |
$518.80 |
$3,724.80
|
|
Xcapsl ctrc rmvl insj 1+
|
$477.40 |
$477.40 |
$477.40 |
$6,311.00
|
|
Xcpsl ctrc rmvl cplx insj 1+
|
$611.60 |
$611.60 |
$611.60 |
$7,316.99
|
|
Xe133 xenon 10mci
|
$673.40 |
$673.40 |
$673.40 |
$207.00
|
|
Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/<
|
$541.00 |
$541.00 |
$541.00 |
$2,692.80
|
|
Xfer tis s/a/l 10 sq cm/<
|
$501.80 |
$501.80 |
$501.80 |
$2,837.09
|
|
Xpos opn fmrl eprst aor uni add-on
|
$129.00 |
$129.00 |
$129.00 |
$2,087.40
|
|
X-ray abdomen 1 view
|
$131.80 |
$131.80 |
$131.80 |
$258.50
|
|
X-ray abdomen 2 views
|
$185.40 |
$185.40 |
$185.40 |
$316.47
|
|
X-ray abdomen >=3 views
|
$10.00 |
$10.00 |
$10.00 |
$342.50
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$285.60 |
$285.60 |
$285.60 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$196.20 |
$196.20 |
$196.20 |
$270.20
|
|
X-ray ankle 2 views (both sides)
|
$242.40 |
$242.40 |
$242.40 |
$282.50
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$503.80 |
$503.80 |
$503.80 |
$773.40
|
|
X-ray bone age studies
|
$93.00 |
$93.00 |
$93.00 |
$251.40
|
|
X-ray bone length studies
|
$154.00 |
$154.00 |
$154.00 |
$285.30
|
|
X-ray bone survey complete
|
$330.00 |
$330.00 |
$330.00 |
$660.00
|
|
X-ray bone survey infant
|
$200.20 |
$200.20 |
$200.20 |
$394.69
|
|
X-ray cervical spine 2-3 views
|
$214.60 |
$214.60 |
$214.60 |
$333.83
|
|
X-ray cervical spine 4-5 views
|
$237.40 |
$237.40 |
$237.40 |
$457.05
|
|
X-ray cervical spine >= 6 views
|
$306.60 |
$306.60 |
$306.60 |
$508.50
|
|
X-ray clavicle complete (both sides)
|
$290.80 |
$290.80 |
$290.80 |
$300.05
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$381.80 |
$381.80 |
$381.80 |
$657.03
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$483.80 |
$483.80 |
$483.80 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$293.80 |
$293.80 |
$293.80 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$309.00 |
$309.00 |
$309.00 |
$364.12
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$257.20 |
$257.20 |
$257.20 |
$483.50
|
|
X-ray exam entire spi 4/5 vw
|
$208.80 |
$208.80 |
$208.80 |
$441.48
|
|
X-ray exam entire spi 6/> vw
|
$249.60 |
$249.60 |
$249.60 |
$517.80
|
|
X-ray exam of arm infant
|
$98.60 |
$98.60 |
$98.60 |
$248.44
|
|
X-ray exam of eye sockets
|
$186.80 |
$186.80 |
$186.80 |
$328.35
|
|
X-ray exam of femur 1
|
$235.60 |
$235.60 |
$235.60 |
$240.00
|
|
X-ray exam of jaw joint
|
$209.80 |
$209.80 |
$209.80 |
$188.40
|
|
X-ray exam of mastoids
|
$1,139.80 |
$1,139.80 |
$1,139.80 |
$193.41
|
|
X-ray exam of salivary gland
|
$6.40 |
$6.40 |
$6.40 |
$162.60
|
|
X-ray exam of sinuses
|
$142.60 |
$142.60 |
$142.60 |
$214.50
|
|
X-ray exam si joints
|
$137.40 |
$137.40 |
$137.40 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$260.00 |
$260.00 |
$260.00 |
$387.40
|
|
X-ray eye detection foreign body (both sides)
|
$139.00 |
$139.00 |
$139.00 |
$238.29
|
|
X-ray facial bones complete > 3 views
|
$204.20 |
$204.20 |
$204.20 |
$381.75
|
|
X-ray femur >=2 views (both sides)
|
$286.00 |
$286.00 |
$286.00 |
$317.25
|
|
X-ray finger(s) >= 2 views (both sides)
|
$236.40 |
$236.40 |
$236.40 |
$241.05
|
|
X-ray foot 2 views (both sides)
|
$241.60 |
$241.60 |
$241.60 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$313.00 |
$313.00 |
$313.00 |
$322.20
|
|
X-ray hand 2 views (both sides)
|
$248.40 |
$248.40 |
$248.40 |
$291.20
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$240.00 |
$240.00 |
$240.00 |
$274.95
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$253.20 |
$253.20 |
$253.20 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$208.80 |
$208.80 |
$208.80 |
$374.40
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$227.00 |
$227.00 |
$227.00 |
$424.05
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$286.60 |
$286.60 |
$286.60 |
$505.60
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$190.00 |
$190.00 |
$190.00 |
$231.00
|
|
X-ray humerus >= 2 views left
|
$296.20 |
$296.20 |
$296.20 |
$309.31
|
|
X-ray joint survey 1 view
|
$147.00 |
$147.00 |
$147.00 |
$232.00
|
|
X-ray knee 1-2 views (both sides)
|
$235.80 |
$235.80 |
$235.80 |
$285.00
|
|
X-ray knee 3 views (both sides)
|
$304.20 |
$304.20 |
$304.20 |
$363.20
|
|
X-ray knee ap standing bilateral
|
$142.00 |
$142.00 |
$142.00 |
$252.50
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$70.80 |
$70.80 |
$70.80 |
$254.12
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$175.40 |
$175.40 |
$175.40 |
$369.15
|
|
X-ray lumbosacral spine >= 4 views
|
$286.00 |
$286.00 |
$286.00 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$304.40 |
$304.40 |
$304.40 |
$535.91
|
|
X-ray mandible complete > 4 views
|
$317.40 |
$317.40 |
$317.40 |
$361.61
|
|
X-ray mandible ltd <4 views
|
$153.00 |
$153.00 |
$153.00 |
$235.30
|
|
X-ray nasal bones complete > 3 views
|
$156.20 |
$156.20 |
$156.20 |
$274.65
|
|
X-ray neck soft tissue
|
$152.60 |
$152.60 |
$152.60 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$73.40 |
$73.40 |
$73.40 |
$225.60
|
|
X-ray of mammary ducts
|
$356.60 |
$356.60 |
$356.60 |
$568.26
|
|
X-ray optic foramina
|
$108.00 |
$108.00 |
$108.00 |
$188.40
|
|
X-ray pelvis 1-2 views
|
$185.20 |
$185.20 |
$185.20 |
$280.80
|
|
X-ray pelvis complete > 3 views
|
$216.60 |
$216.60 |
$216.60 |
$348.19
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$598.40 |
$598.40 |
$598.40 |
$755.50
|
|
X-ray ribs 2 views left
|
$172.00 |
$172.00 |
$172.00 |
$292.80
|
|
X-ray ribs 3 views bilateral
|
$258.20 |
$258.20 |
$258.20 |
$395.76
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$251.80 |
$251.80 |
$251.80 |
$356.20
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$351.40 |
$351.40 |
$351.40 |
$491.70
|
|
X-ray sacroiliac joints >= 3 views
|
$173.20 |
$173.20 |
$173.20 |
$312.75
|
|
X-ray sacrum/coccyx >= 2 views
|
$186.40 |
$186.40 |
$186.40 |
$288.80
|
|
X-ray scapula complete (both sides)
|
$308.40 |
$308.40 |
$308.40 |
$285.00
|
|
X-ray sella turcica
|
$97.00 |
$97.00 |
$97.00 |
$162.50
|
|
X-ray shoulder 1 view (both sides)
|
$268.00 |
$268.00 |
$268.00 |
$260.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$202.20 |
$202.20 |
$202.20 |
$345.60
|
|
X-ray sinus tract/fistula/abscess
|
$446.00 |
$446.00 |
$446.00 |
$606.89
|
|
X-ray skull < 4 views
|
$178.80 |
$178.80 |
$178.80 |
$292.50
|
|
X-ray skull > 4 views complete
|
$272.20 |
$272.20 |
$272.20 |
$417.50
|
|
X-ray slg plne bdy sect without urogr
|
$230.80 |
$230.80 |
$230.80 |
$399.82
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$403.20 |
$403.20 |
$403.20 |
$557.70
|
|
X-ray small intestine follow-through study
|
$80.60 |
$80.60 |
$80.60 |
$499.50
|
|
X-ray spine single view
|
$156.80 |
$156.80 |
$156.80 |
$251.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$128.80 |
$128.80 |
$128.80 |
$264.48
|
|
X-ray sternum > 2 views
|
$192.60 |
$192.60 |
$192.60 |
$274.65
|
|
X-ray surgical specimen
|
$399.80 |
$399.80 |
$399.80 |
$504.00
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$268.60 |
$268.60 |
$268.60 |
$523.25
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$218.20 |
$218.20 |
$218.20 |
$327.80
|
|
X-ray thoracic spine 2 views
|
$209.00 |
$209.00 |
$209.00 |
$320.45
|
