|
Whfo nontorsion joint prefab
|
$4,761.00 |
$4,761.00 |
$4,761.00 |
$188.80
|
|
Whfo w/joint(s) custom fab
|
$831.13 |
$831.13 |
$831.13 |
$436.49
|
|
Whole blood for transfusion
|
$740.28 |
$951.54 |
$1,541.50 |
$479.50
|
|
Whole blood or red blood cells frozen/deglycerolized/washed leukocytes reduced each unit
|
$1,837.00 |
$2,981.44 |
$3,559.00 |
$740.15
|
|
Whole blood/red blood cells leukocytes reduced cmv negative each unit
|
$1,860.23 |
$1,860.23 |
$2,912.00 |
$495.00
|
|
Wnd prep f/n/hf/g addl cm
|
$2,191.32 |
$2,191.32 |
$2,191.32 |
$865.80
|
|
Wound closure by adhesive
|
$312.16 |
$312.16 |
$312.16 |
$170.95
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$521.25 |
$521.25 |
$1,560.50 |
$558.97
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$915.75 |
$915.75 |
$1,560.50 |
$611.25
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$356.15 |
$611.00 |
$1,394.11 |
$288.91
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$534.04 |
$805.00 |
$1,733.75 |
$436.15
|
|
Wrist X-ray
|
$1,088.28 |
$1,088.28 |
$1,088.28 |
$343.70
|
|
Xe133 xenon 10mci
|
$150.38 |
$150.38 |
$436.00 |
$299.00
|
|
Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/<
|
$5,030.19 |
$5,030.19 |
$5,030.19 |
$2,830.00
|
|
Xm archive tissue molec anal
|
$322.98 |
$322.98 |
$1,710.25 |
$47.85
|
|
Xpos opn fmrl eprst aor uni add-on
|
$7,514.18 |
$7,514.18 |
$7,514.18 |
$2,160.89
|
|
X-ray abdomen 1 view
|
$141.16 |
$240.00 |
$789.73 |
$255.00
|
|
X-ray abdomen 2 views
|
$274.29 |
$465.50 |
$1,149.40 |
$312.36
|
|
X-ray abdomen >=3 views
|
$274.29 |
$465.50 |
$1,168.94 |
$332.15
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$1,300.50 |
$1,300.50 |
$1,409.56 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$866.92 |
$1,147.25 |
$2,105.77 |
$271.44
|
|
X-ray ankle 2 views (both sides)
|
$1,106.01 |
$1,106.01 |
$1,106.01 |
$283.00
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$1,730.05 |
$1,730.05 |
$1,730.05 |
$768.30
|
|
X-ray bone age studies
|
$727.61 |
$727.61 |
$1,073.50 |
$246.75
|
|
X-ray bone length studies
|
$301.22 |
$739.30 |
$1,233.00 |
$287.25
|
|
X-ray bone survey complete
|
$2,270.99 |
$2,270.99 |
$4,936.50 |
$666.60
|
|
X-ray bone survey infant
|
$1,523.26 |
$1,523.26 |
$1,727.50 |
$410.73
|
|
X-ray cervical spine 2-3 views
|
$1,266.44 |
$1,266.44 |
$1,344.25 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$1,658.00 |
$1,658.00 |
$1,927.64 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$1,330.59 |
$1,923.00 |
$2,361.12 |
$515.35
|
|
X-ray clavicle complete (both sides)
|
$820.74 |
$820.74 |
$1,092.96 |
$299.65
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$832.61 |
$2,409.75 |
$2,772.42 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$2,496.75 |
$2,496.75 |
$3,055.04 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$932.80 |
$932.80 |
$932.80 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$464.29 |
$464.29 |
$1,049.98 |
$342.00
|
|
Xray endovasc thor ao repr
|
$2,056.50 |
$2,056.50 |
$2,056.50 |
$1,889.01
|
|
Xray endovasc thor ao repr
|
$3,729.92 |
$3,729.92 |
$3,729.92 |
$2,266.32
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$802.25 |
$802.25 |
$1,763.36 |
$486.24
|
|
X-ray exam entire spi 4/5 vw
|
$920.50 |
$920.50 |
$1,718.26 |
$486.01
|
|
X-ray exam entire spi 6/> vw
|
$407.75 |
$407.75 |
$2,061.88 |
$575.76
|
|
X-ray exam of arm infant
|
$2,874.62 |
$2,874.62 |
$2,874.62 |
$248.82
|
|
X-ray exam of eye sockets
|
$1,441.50 |
$1,441.50 |
$1,859.92 |
$349.05
|
|
X-ray exam of femur 1
|
$301.22 |
$301.22 |
$301.22 |
$232.36
|
|
X-ray exam of jaw joint
|
$1,498.86 |
$1,498.86 |
$1,498.86 |
$192.39
|
|
X-ray exam of penis
|
$663.16 |
$663.16 |
$663.16 |
$565.20
|
|
X-ray exam of perineum
|
$801.00 |
$801.00 |
$4,315.00 |
$420.93
|
|
X-ray exam of sinuses
|
$431.56 |
$800.50 |
$1,015.69 |
$211.00
|
|
X-ray exam of tear duct
|
$1,058.76 |
$1,058.76 |
$1,058.76 |
$340.70
|
|
X-ray exam si joints
|
$277.54 |
$646.00 |
$1,177.07 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$1,883.58 |
$1,883.58 |
$1,883.58 |
$395.59
|
|
X-ray eye detection foreign body (both sides)
|
$1,502.84 |
$1,502.84 |
$1,502.84 |
$235.00
|
|
X-ray facial bones complete > 3 views
|
$931.16 |
$1,441.50 |
$1,607.46 |
$366.60
|
|
X-ray fallopian tube
|
$1,995.88 |
$1,995.88 |
$3,074.00 |
$501.00
|
|
X-ray femur >=2 views (both sides)
|
$220.70 |
$258.50 |
$311.15 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$954.63 |
$954.63 |
$954.63 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$941.03 |
$941.03 |
$941.03 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$477.25 |
$477.25 |
$967.84 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$966.21 |
$966.21 |
$966.21 |
$316.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$972.34 |
$972.34 |
$972.34 |
$270.00
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$365.51 |
$427.25 |
$2,125.35 |
$370.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$365.51 |
$427.25 |
$2,302.46 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$365.51 |
$427.25 |
$2,762.95 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$696.85 |
$813.00 |
$3,315.56 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$220.70 |
$258.50 |
$1,475.94 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$1,096.90 |
$1,096.90 |
$1,096.90 |
$304.15
|
|
X-ray knee 1-2 views (both sides)
|
$1,096.39 |
$1,096.39 |
$1,096.39 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$1,151.96 |
$1,151.96 |
$1,151.96 |
$353.25
|
|
X-ray knee ap standing bilateral
|
$1,342.52 |
$1,342.52 |
$1,342.52 |
$276.25
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$1,859.00 |
$1,859.00 |
$1,859.00 |
$249.13
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$1,128.25 |
$1,128.25 |
$2,123.53 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$1,119.75 |
$1,119.75 |
$2,613.30 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$2,913.50 |
$2,913.50 |
$3,135.96 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$627.67 |
$836.50 |
$1,677.33 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$762.25 |
$762.25 |
$1,498.86 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$981.76 |
$1,138.75 |
$1,239.41 |
$277.70
|
|
X-ray neck soft tissue
|
$1,003.70 |
$1,119.00 |
$1,260.00 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$711.00 |
$711.00 |
$939.53 |
$225.96
|
|
X-ray of mammary ducts
|
$1,879.35 |
$1,879.35 |
$4,140.00 |
$473.55
|
|
X-ray pelvis 1-2 views
|
$762.25 |
$762.25 |
$945.42 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$905.25 |
$960.75 |
$1,097.25 |
$342.30
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$1,684.24 |
$1,684.24 |
$2,443.50 |
$742.00
|
|
X-ray ribs 2 views left
|
$1,567.63 |
$1,567.63 |
$1,567.63 |
$296.32
|
|
X-ray ribs 3 views bilateral
|
$1,429.25 |
$1,429.25 |
$2,507.92 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$2,258.63 |
$2,258.63 |
$2,258.63 |
$359.47
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$920.79 |
$1,890.75 |
$2,622.35 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$1,432.25 |
$1,432.25 |
$1,432.25 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$617.32 |
$696.75 |
$1,230.95 |
$285.60
|
|
X-ray scapula complete (both sides)
|
$1,115.86 |
$1,115.86 |
$1,115.86 |
$292.50
|
|
X-ray sella turcica
|
$899.15 |
$899.15 |
$899.15 |
$162.50
|
|
X-ray shoulder 1 view (both sides)
|
$631.75 |
$631.75 |
$851.38 |
$264.48
|
|
X-ray sinuses paranasal complete > 3 views
|
$1,187.03 |
$1,545.50 |
$1,648.32 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$1,566.96 |
$1,566.96 |
$2,277.39 |
$601.30
|
|
X-ray skull < 4 views
|
$795.80 |
$950.50 |
$1,192.14 |
$291.78
|
|
X-ray skull > 4 views complete
|
$1,164.59 |
$1,497.00 |
$2,369.32 |
$414.60
|
|
X-ray slg plne bdy sect without urogr
|
$1,706.75 |
$1,706.75 |
$4,194.00 |
$387.00
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$1,073.05 |
$1,224.25 |
$1,898.37 |
$557.70
|
|
X-ray small intestine follow-through study
|
$1,817.38 |
$1,817.38 |
$2,822.50 |
$504.14
|
|
X-ray spine single view
|
$805.56 |
$940.25 |
$988.71 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$391.67 |
$1,128.25 |
$1,246.78 |
$263.49
|
|
X-ray sternum > 2 views
|
$808.49 |
$960.75 |
$1,243.13 |
$269.75
|