|
Warde vitamin d (1 25 dihydroxy)
|
$469.70 |
$469.70 |
$469.70 |
$139.80
|
|
Warde vitamin e (alpha-tocopherol)
|
$165.90 |
$165.90 |
$165.90 |
$56.95
|
|
Warde zinc
|
$87.50 |
$87.50 |
$87.50 |
$64.80
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$811.30 |
$811.30 |
$811.30 |
$569.60
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$811.30 |
$811.30 |
$811.30 |
$594.00
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$403.20 |
$403.20 |
$403.20 |
$284.70
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$811.30 |
$811.30 |
$811.30 |
$435.20
|
|
Wrist X-ray
|
$441.00 |
$441.00 |
$441.00 |
$352.08
|
|
X-ray abdomen 1 view
|
$400.40 |
$400.40 |
$400.40 |
$258.00
|
|
X-ray abdomen 2 views
|
$483.70 |
$483.70 |
$483.70 |
$316.30
|
|
X-ray abdomen >=3 views
|
$483.70 |
$483.70 |
$483.70 |
$339.00
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$483.70 |
$483.70 |
$483.70 |
$410.33
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$660.80 |
$660.80 |
$660.80 |
$270.20
|
|
X-ray ankle 2 views (both sides)
|
$400.40 |
$400.40 |
$400.40 |
$283.00
|
|
X-ray bone age studies
|
$532.00 |
$532.00 |
$532.00 |
$251.40
|
|
X-ray bone length studies
|
$483.70 |
$483.70 |
$483.70 |
$285.30
|
|
X-ray bone survey complete
|
$483.70 |
$483.70 |
$483.70 |
$660.00
|
|
X-ray cervical spine 2-3 views
|
$441.00 |
$441.00 |
$441.00 |
$333.83
|
|
X-ray cervical spine 4-5 views
|
$483.70 |
$483.70 |
$483.70 |
$463.20
|
|
X-ray cervical spine >= 6 views
|
$483.70 |
$483.70 |
$483.70 |
$508.50
|
|
X-ray clavicle complete (both sides)
|
$441.00 |
$441.00 |
$441.00 |
$305.00
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$809.90 |
$809.90 |
$809.90 |
$666.90
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$891.10 |
$891.10 |
$891.10 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$400.40 |
$400.40 |
$400.40 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$441.00 |
$441.00 |
$441.00 |
$367.00
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$809.90 |
$809.90 |
$809.90 |
$484.80
|
|
X-ray exam of arm infant
|
$483.70 |
$483.70 |
$483.70 |
$246.75
|
|
X-ray exam of eye sockets
|
$483.70 |
$483.70 |
$483.70 |
$328.35
|
|
X-ray exam of sinuses
|
$400.40 |
$400.40 |
$400.40 |
$211.36
|
|
X-ray exam of teeth
|
$660.80 |
$660.80 |
$660.80 |
$119.66
|
|
X-ray exam si joints
|
$483.70 |
$483.70 |
$483.70 |
$246.16
|
|
X-ray eye detection foreign body (both sides)
|
$441.00 |
$441.00 |
$441.00 |
$238.29
|
|
X-ray facial bones complete > 3 views
|
$532.00 |
$532.00 |
$532.00 |
$381.75
|
|
X-ray femur >=2 views (both sides)
|
$400.40 |
$400.40 |
$400.40 |
$317.60
|
|
X-ray finger(s) >= 2 views (both sides)
|
$441.00 |
$441.00 |
$441.00 |
$241.50
|
|
X-ray foot 2 views (both sides)
|
$400.40 |
$400.40 |
$400.40 |
$291.55
|
|
X-ray forearm 2 views (both sides)
|
$441.00 |
$441.00 |
$441.00 |
$328.00
|
|
X-ray hand 2 views (both sides)
|
$725.90 |
$725.90 |
$725.90 |
$294.90
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$441.00 |
$441.00 |
$441.00 |
$278.95
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$798.00 |
$798.00 |
$798.00 |
$374.40
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$798.00 |
$798.00 |
$798.00 |
$421.20
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$725.90 |
$725.90 |
$725.90 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$400.40 |
$400.40 |
$400.40 |
$230.00
|
|
X-ray humerus >= 2 views left
|
$400.40 |
$400.40 |
$400.40 |
$309.31
|
|
X-ray knee 1-2 views (both sides)
|
$441.00 |
$441.00 |
$441.00 |
$298.65
|
|
X-ray knee 3 views (both sides)
|
$441.00 |
$441.00 |
$441.00 |
$363.60
|
|
X-ray knee ap standing bilateral
|
$600.60 |
$600.60 |
$600.60 |
$253.35
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$441.00 |
$441.00 |
$441.00 |
$253.60
|
|
X-ray lumbosacral spine >= 4 views
|
$532.00 |
$532.00 |
$532.00 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$483.70 |
$483.70 |
$483.70 |
$540.60
|
|
X-ray mandible complete > 4 views
|
$532.00 |
$532.00 |
$532.00 |
$363.20
|
|
X-ray mandible ltd <4 views
|
$400.40 |
$400.40 |
$400.40 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$441.00 |
$441.00 |
$441.00 |
$274.65
|
|
X-ray neck soft tissue
|
$441.00 |
$441.00 |
$441.00 |
$237.76
|
|
X-ray nose to rectum for foreign body child
|
$441.00 |
$441.00 |
$441.00 |
$226.85
|
|
X-ray pelvis 1-2 views
|
$483.70 |
$483.70 |
$483.70 |
$280.50
|
|
X-ray pelvis complete > 3 views
|
$483.70 |
$483.70 |
$483.70 |
$348.19
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$1,624.70 |
$1,624.70 |
$1,624.70 |
$762.50
|
|
X-ray ribs 2 views left
|
$400.40 |
$400.40 |
$400.40 |
$289.80
|
|
X-ray ribs 3 views bilateral
|
$725.90 |
$725.90 |
$725.90 |
$393.75
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$483.70 |
$483.70 |
$483.70 |
$357.60
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$725.90 |
$725.90 |
$725.90 |
$491.70
|
|
X-ray sacroiliac joints >= 3 views
|
$483.70 |
$483.70 |
$483.70 |
$309.11
|
|
X-ray sacrum/coccyx >= 2 views
|
$400.40 |
$400.40 |
$400.40 |
$288.80
|
|
X-ray scapula complete (both sides)
|
$532.00 |
$532.00 |
$532.00 |
$285.30
|
|
X-ray shoulder 1 view (both sides)
|
$400.40 |
$400.40 |
$400.40 |
$260.40
|
|
X-ray sinuses paranasal complete > 3 views
|
$400.40 |
$400.40 |
$400.40 |
$345.24
|
|
X-ray sinus tract/fistula/abscess
|
$2,494.80 |
$2,494.80 |
$2,494.80 |
$601.93
|
|
X-ray skull < 4 views
|
$483.70 |
$483.70 |
$483.70 |
$291.78
|
|
X-ray skull > 4 views complete
|
$483.70 |
$483.70 |
$483.70 |
$417.50
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$809.90 |
$809.90 |
$809.90 |
$557.50
|
|
X-ray small intestine follow-through study
|
$340.20 |
$340.20 |
$340.20 |
$490.20
|
|
X-ray spine single view
|
$400.40 |
$400.40 |
$400.40 |
$254.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$400.40 |
$400.40 |
$400.40 |
$267.50
|
|
X-ray sternum > 2 views
|
$441.00 |
$441.00 |
$441.00 |
$274.65
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$809.90 |
$809.90 |
$809.90 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$660.80 |
$660.80 |
$660.80 |
$327.80
|
|
X-ray thoracic spine 3 views
|
$532.00 |
$532.00 |
$532.00 |
$380.82
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$532.00 |
$532.00 |
$532.00 |
$346.40
|
|
X-ray tibia/fibula 2 views (both sides)
|
$441.00 |
$441.00 |
$441.00 |
$332.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$441.00 |
$441.00 |
$441.00 |
$259.50
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$1,011.50 |
$1,011.50 |
$1,011.50 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$891.10 |
$891.10 |
$891.10 |
$603.20
|
|
X-ray wrist 2 views (both sides)
|
$400.40 |
$400.40 |
$400.40 |
$290.40
|
|
Zika virus dna/rna amp probe
|
$578.90 |
$578.90 |
$578.90 |
$195.60
|
