|
Warde t3 (triiodothyronine) reverse
|
$60.68 |
$60.68 |
$60.68 |
$70.85
|
|
Warde thyroid stimulating immunoglobulins
|
$195.81 |
$195.81 |
$195.81 |
$173.50
|
|
Warde topiramate therapeutic drug level
|
$237.99 |
$237.99 |
$237.99 |
$71.19
|
|
Warde virus isolation tissue culture innoculation presumptive id herpes simplex
|
$520.50 |
$520.50 |
$520.50 |
$127.20
|
|
Warde viscosity
|
$233.00 |
$233.00 |
$233.00 |
$52.65
|
|
Warde vitamin a
|
$231.80 |
$231.80 |
$231.80 |
$59.66
|
|
Warde vitamin b-1 (thiamine)
|
$423.86 |
$423.86 |
$423.86 |
$78.65
|
|
Warde vitamin b6 (pyridoxine)
|
$561.02 |
$561.02 |
$561.02 |
$116.00
|
|
Warde vitamin c (ascorbic acid)
|
$197.46 |
$197.46 |
$197.46 |
$45.60
|
|
Warde vitamin d (1 25 dihydroxy)
|
$335.64 |
$335.64 |
$335.64 |
$138.50
|
|
Warde vitamin e (alpha-tocopherol)
|
$283.11 |
$283.11 |
$283.11 |
$55.00
|
|
Warde zinc
|
$227.40 |
$227.40 |
$227.40 |
$62.50
|
|
Wbc automated
|
$107.89 |
$107.89 |
$107.89 |
$32.80
|
|
Whole blood or red blood cells frozen/deglycerolized/washed leukocytes reduced each unit
|
$6,333.29 |
$6,333.29 |
$6,333.29 |
$740.15
|
|
Wound closure by adhesive
|
$312.61 |
$312.61 |
$312.61 |
$153.40
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$6,986.36 |
$6,986.36 |
$6,986.36 |
$558.97
|
|
Wrist X-ray
|
$1,556.58 |
$1,556.58 |
$1,556.58 |
$343.70
|
|
X-ray abdomen 1 view
|
$1,332.18 |
$1,332.18 |
$1,332.18 |
$255.00
|
|
X-ray abdomen 2 views
|
$1,693.82 |
$1,693.82 |
$1,693.82 |
$312.36
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$2,213.93 |
$2,213.93 |
$2,213.93 |
$418.63
|
|
X-ray ankle 2 views (both sides)
|
$762.76 |
$762.76 |
$762.76 |
$283.00
|
|
X-ray cervical spine 2-3 views
|
$2,258.43 |
$2,258.43 |
$2,258.43 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$2,396.61 |
$2,396.61 |
$2,396.61 |
$455.65
|
|
X-ray clavicle complete (both sides)
|
$828.58 |
$828.58 |
$828.58 |
$299.65
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$2,710.26 |
$2,710.26 |
$2,710.26 |
$647.40
|
|
X-ray elbow 2 views (both sides)
|
$1,215.87 |
$1,215.87 |
$1,215.87 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$928.77 |
$928.77 |
$928.77 |
$342.00
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$1,670.28 |
$1,670.28 |
$1,670.28 |
$486.24
|
|
X-ray exam entire spi 4/5 vw
|
$2,213.93 |
$2,213.93 |
$2,213.93 |
$486.01
|
|
X-ray exam of eye sockets
|
$2,213.93 |
$2,213.93 |
$2,213.93 |
$349.05
|
|
X-ray exam of femur 1
|
$1,624.35 |
$1,624.35 |
$1,624.35 |
$232.36
|
|
X-ray exam of sinuses
|
$1,624.35 |
$1,624.35 |
$1,624.35 |
$211.00
|
|
X-ray exam si joints
|
$2,213.93 |
$2,213.93 |
$2,213.93 |
$246.16
|
|
X-ray facial bones complete > 3 views
|
$2,213.93 |
$2,213.93 |
$2,213.93 |
$366.60
|
|
X-ray femur >=2 views (both sides)
|
$1,356.32 |
$1,356.32 |
$1,356.32 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$1,624.35 |
$1,624.35 |
$1,624.35 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$1,051.53 |
$1,051.53 |
$1,051.53 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$1,029.37 |
$1,029.37 |
$1,029.37 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$1,096.36 |
$1,096.36 |
$1,096.36 |
$316.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$1,051.53 |
$1,051.53 |
$1,051.53 |
$270.00
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$1,998.08 |
$1,998.08 |
$1,998.08 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$418.07 |
$418.07 |
$418.07 |
$409.24
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$1,222.17 |
$1,222.17 |
$1,222.17 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$1,714.72 |
$1,714.72 |
$1,714.72 |
$304.15
|
|
X-ray knee 1-2 views (both sides)
|
$733.93 |
$733.93 |
$733.93 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$921.53 |
$921.53 |
$921.53 |
$353.25
|
|
X-ray knee ap standing bilateral
|
$1,624.35 |
$1,624.35 |
$1,624.35 |
$276.25
|
|
X-ray lumbosacral spine >= 4 views
|
$2,752.82 |
$2,752.82 |
$2,752.82 |
$505.83
|
|
X-ray mandible ltd <4 views
|
$1,108.15 |
$1,108.15 |
$1,108.15 |
$238.00
|
|
X-ray neck soft tissue
|
$1,624.35 |
$1,624.35 |
$1,624.35 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$1,624.35 |
$1,624.35 |
$1,624.35 |
$225.96
|
|
X-ray pelvis 1-2 views
|
$1,445.91 |
$1,445.91 |
$1,445.91 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$2,137.18 |
$2,137.18 |
$2,137.18 |
$342.30
|
|
X-ray ribs 2 views left
|
$317.67 |
$317.67 |
$317.67 |
$296.32
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$2,213.93 |
$2,213.93 |
$2,213.93 |
$359.47
|
|
X-ray sacrum/coccyx >= 2 views
|
$1,624.35 |
$1,624.35 |
$1,624.35 |
$285.60
|
|
X-ray scapula complete (both sides)
|
$955.34 |
$955.34 |
$955.34 |
$292.50
|
|
X-ray shoulder 1 view (both sides)
|
$605.04 |
$605.04 |
$605.04 |
$264.48
|
|
X-ray sinus tract/fistula/abscess
|
$1,937.60 |
$1,937.60 |
$1,937.60 |
$601.30
|
|
X-ray skull > 4 views complete
|
$2,213.93 |
$2,213.93 |
$2,213.93 |
$414.60
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$2,853.61 |
$2,853.61 |
$2,853.61 |
$557.70
|
|
X-ray spine single view
|
$1,624.35 |
$1,624.35 |
$1,624.35 |
$252.60
|
|
X-ray sternum > 2 views
|
$1,624.35 |
$1,624.35 |
$1,624.35 |
$269.75
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$1,194.59 |
$1,194.59 |
$1,194.59 |
$514.00
|
|
X-ray thoracic spine 2 views
|
$2,213.93 |
$2,213.93 |
$2,213.93 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$2,396.48 |
$2,396.48 |
$2,396.48 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$1,624.35 |
$1,624.35 |
$1,624.35 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$1,624.35 |
$1,624.35 |
$1,624.35 |
$256.85
|
|
X-ray tibia/fibula 2 views (both sides)
|
$1,403.95 |
$1,403.95 |
$1,403.95 |
$328.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$762.76 |
$762.76 |
$762.76 |
$264.00
|
|
X-ray wrist 2 views (both sides)
|
$995.75 |
$995.75 |
$995.75 |
$290.40
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$617.55 |
$617.55 |
$617.55 |
$346.14
|