|
Wound therapy negative pressure per session > 50 sq cm
|
$1,065.75 |
$1,065.75 |
$1,065.75 |
$579.70
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$392.25 |
$392.25 |
$392.25 |
$284.70
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$858.00 |
$858.00 |
$858.00 |
$438.75
|
|
Wrist X-ray
|
$319.50 |
$319.50 |
$319.50 |
$342.80
|
|
Xe133 xenon 10mci
|
$1,343.87 |
$1,343.87 |
$1,343.87 |
$207.00
|
|
Xm archive tissue molec anal
|
$78.75 |
$78.75 |
$78.75 |
$49.84
|
|
X-ray abdomen 1 view
|
$232.50 |
$232.50 |
$232.50 |
$258.50
|
|
X-ray abdomen 2 views
|
$276.75 |
$276.75 |
$276.75 |
$316.47
|
|
X-ray abdomen >=3 views
|
$312.75 |
$312.75 |
$312.75 |
$342.50
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$534.00 |
$534.00 |
$534.00 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$240.00 |
$240.00 |
$240.00 |
$270.20
|
|
X-ray ankle 2 views (both sides)
|
$232.50 |
$232.50 |
$232.50 |
$282.50
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$1,026.00 |
$1,026.00 |
$1,026.00 |
$773.40
|
|
X-ray assay calculus
|
$75.75 |
$75.75 |
$75.75 |
$33.60
|
|
X-ray bone age studies
|
$298.50 |
$298.50 |
$298.50 |
$251.40
|
|
X-ray bone length studies
|
$276.75 |
$276.75 |
$276.75 |
$285.30
|
|
X-ray bone survey complete
|
$708.00 |
$708.00 |
$708.00 |
$660.00
|
|
X-ray bone survey infant
|
$305.25 |
$305.25 |
$305.25 |
$394.69
|
|
X-ray cervical spine 2-3 views
|
$306.00 |
$306.00 |
$306.00 |
$333.83
|
|
X-ray cervical spine 4-5 views
|
$372.75 |
$372.75 |
$372.75 |
$457.05
|
|
X-ray cervical spine >= 6 views
|
$356.25 |
$356.25 |
$356.25 |
$508.50
|
|
X-ray clavicle complete (both sides)
|
$264.75 |
$264.75 |
$264.75 |
$300.05
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$509.25 |
$509.25 |
$509.25 |
$657.03
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$663.75 |
$663.75 |
$663.75 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$232.50 |
$232.50 |
$232.50 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$277.50 |
$277.50 |
$277.50 |
$364.12
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$458.25 |
$458.25 |
$458.25 |
$483.50
|
|
X-ray exam entire spi 4/5 vw
|
$473.25 |
$473.25 |
$473.25 |
$441.48
|
|
X-ray exam entire spi 6/> vw
|
$491.25 |
$491.25 |
$491.25 |
$517.80
|
|
X-ray exam of arm infant
|
$298.50 |
$298.50 |
$298.50 |
$248.44
|
|
X-ray exam of eye sockets
|
$298.50 |
$298.50 |
$298.50 |
$328.35
|
|
X-ray exam of femur 1
|
$240.00 |
$240.00 |
$240.00 |
$240.00
|
|
X-ray exam of jaw joint
|
$240.00 |
$240.00 |
$240.00 |
$188.40
|
|
X-ray exam of jaw joint
|
$652.50 |
$652.50 |
$652.50 |
$452.00
|
|
X-ray exam of mastoids
|
$296.25 |
$296.25 |
$296.25 |
$193.41
|
|
X-ray exam of middle ear
|
$1,400.25 |
$1,400.25 |
$1,400.25 |
$345.66
|
|
X-ray exam of penis
|
$296.25 |
$296.25 |
$296.25 |
$593.46
|
|
X-ray exam of perineum
|
$652.50 |
$652.50 |
$652.50 |
$577.85
|
|
X-ray exam of salivary gland
|
$240.00 |
$240.00 |
$240.00 |
$162.60
|
|
X-ray exam of sinuses
|
$240.00 |
$240.00 |
$240.00 |
$214.50
|
|
X-ray exam of tear duct
|
$652.50 |
$652.50 |
$652.50 |
$467.50
|
|
X-ray exam of teeth
|
$240.00 |
$240.00 |
$240.00 |
$119.66
|
|
X-ray exam of teeth
|
$652.50 |
$652.50 |
$652.50 |
$328.08
|
|
X-ray exam si joints
|
$298.50 |
$298.50 |
$298.50 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$296.25 |
$296.25 |
$296.25 |
$387.40
|
|
X-ray eye detection foreign body (both sides)
|
$240.00 |
$240.00 |
$240.00 |
$238.29
|
|
X-ray facial bones complete > 3 views
|
$298.50 |
$298.50 |
$298.50 |
$381.75
|
|
X-ray fallopian tube
|
$265.50 |
$265.50 |
$265.50 |
$532.38
|
|
X-ray femur >=2 views (both sides)
|
$330.00 |
$330.00 |
$330.00 |
$317.25
|
|
X-ray finger(s) >= 2 views (both sides)
|
$232.50 |
$232.50 |
$232.50 |
$241.05
|
|
X-ray foot 2 views (both sides)
|
$255.75 |
$255.75 |
$255.75 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$248.25 |
$248.25 |
$248.25 |
$322.20
|
|
X-ray hand 2 views (both sides)
|
$334.50 |
$334.50 |
$334.50 |
$291.20
|
|
X-ray head for orthodontia
|
$240.00 |
$240.00 |
$240.00 |
$158.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$232.50 |
$232.50 |
$232.50 |
$274.95
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$314.25 |
$314.25 |
$314.25 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$421.50 |
$421.50 |
$421.50 |
$374.40
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$633.75 |
$633.75 |
$633.75 |
$424.05
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$645.75 |
$645.75 |
$645.75 |
$505.60
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$240.00 |
$240.00 |
$240.00 |
$231.00
|
|
X-ray humerus >= 2 views left
|
$232.50 |
$232.50 |
$232.50 |
$309.31
|
|
X-ray joint survey 1 view
|
$296.25 |
$296.25 |
$296.25 |
$232.00
|
|
X-ray knee 1-2 views (both sides)
|
$250.50 |
$250.50 |
$250.50 |
$285.00
|
|
X-ray knee 3 views (both sides)
|
$342.75 |
$342.75 |
$342.75 |
$363.20
|
|
X-ray knee ap standing bilateral
|
$240.00 |
$240.00 |
$240.00 |
$252.50
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$240.00 |
$240.00 |
$240.00 |
$254.12
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$298.50 |
$298.50 |
$298.50 |
$369.15
|
|
X-ray lumbosacral spine >= 4 views
|
$436.50 |
$436.50 |
$436.50 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$318.00 |
$318.00 |
$318.00 |
$535.91
|
|
X-ray male genital tract
|
$652.50 |
$652.50 |
$652.50 |
$603.50
|
|
X-ray mandible complete > 4 views
|
$298.50 |
$298.50 |
$298.50 |
$361.61
|
|
X-ray mandible ltd <4 views
|
$240.00 |
$240.00 |
$240.00 |
$235.30
|
|
X-ray nasal bones complete > 3 views
|
$240.00 |
$240.00 |
$240.00 |
$274.65
|
|
X-ray neck soft tissue
|
$240.00 |
$240.00 |
$240.00 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$240.00 |
$240.00 |
$240.00 |
$225.60
|
|
X-ray of mammary ducts
|
$652.50 |
$652.50 |
$652.50 |
$568.26
|
|
X-ray optic foramina
|
$240.00 |
$240.00 |
$240.00 |
$188.40
|
|
X-ray pelvis 1-2 views
|
$276.75 |
$276.75 |
$276.75 |
$280.80
|
|
X-ray pelvis complete > 3 views
|
$312.75 |
$312.75 |
$312.75 |
$348.19
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$1,026.00 |
$1,026.00 |
$1,026.00 |
$755.50
|
|
X-ray ribs 2 views left
|
$298.50 |
$298.50 |
$298.50 |
$292.80
|
|
X-ray ribs 3 views bilateral
|
$400.50 |
$400.50 |
$400.50 |
$395.76
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$299.25 |
$299.25 |
$299.25 |
$356.20
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$473.25 |
$473.25 |
$473.25 |
$491.70
|
|
X-ray sacroiliac joints >= 3 views
|
$296.25 |
$296.25 |
$296.25 |
$312.75
|
|
X-ray sacrum/coccyx >= 2 views
|
$268.50 |
$268.50 |
$268.50 |
$288.80
|
|
X-ray scapula complete (both sides)
|
$298.50 |
$298.50 |
$298.50 |
$285.00
|
|
X-ray sella turcica
|
$240.00 |
$240.00 |
$240.00 |
$162.50
|
|
X-ray shoulder 1 view (both sides)
|
$240.00 |
$240.00 |
$240.00 |
$260.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$240.00 |
$240.00 |
$240.00 |
$345.60
|
|
X-ray sinus tract/fistula/abscess
|
$1,404.00 |
$1,404.00 |
$1,404.00 |
$606.89
|
|
X-ray skull < 4 views
|
$298.50 |
$298.50 |
$298.50 |
$292.50
|
|
X-ray skull > 4 views complete
|
$298.50 |
$298.50 |
$298.50 |
$417.50
|
|
X-ray slg plne bdy sect without urogr
|
$296.25 |
$296.25 |
$296.25 |
$399.82
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$509.25 |
$509.25 |
$509.25 |
$557.70
|
|
X-ray small intestine follow-through study
|
$480.00 |
$480.00 |
$480.00 |
$499.50
|
|
X-ray spine single view
|
$240.00 |
$240.00 |
$240.00 |
$251.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$240.00 |
$240.00 |
$240.00 |
$264.48
|
|
X-ray sternum > 2 views
|
$240.00 |
$240.00 |
$240.00 |
$274.65
|
|
X-ray surgical specimen
|
$1,374.75 |
$1,374.75 |
$1,374.75 |
$504.00
|
