|
Warde vitamin e (alpha-tocopherol)
|
$39.60 |
$39.60 |
$39.60 |
$59.25
|
|
Warde zinc
|
$89.28 |
$89.28 |
$89.28 |
$62.50
|
|
Wbc automated
|
$360.00 |
$360.00 |
$360.00 |
$32.35
|
|
Western blot test
|
$88.56 |
$88.56 |
$88.56 |
$150.00
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$646.56 |
$646.56 |
$646.56 |
$554.01
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$716.40 |
$716.40 |
$716.40 |
$579.70
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$214.56 |
$214.56 |
$214.56 |
$284.70
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$431.28 |
$431.28 |
$431.28 |
$438.75
|
|
Wrist X-ray
|
$446.40 |
$446.40 |
$446.40 |
$342.80
|
|
X-ray abdomen 1 view
|
$406.08 |
$406.08 |
$406.08 |
$258.50
|
|
X-ray abdomen 2 views
|
$425.52 |
$425.52 |
$425.52 |
$316.47
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$599.04 |
$599.04 |
$599.04 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$397.44 |
$397.44 |
$397.44 |
$270.20
|
|
X-ray ankle 2 views (both sides)
|
$332.64 |
$332.64 |
$332.64 |
$282.50
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$1,393.92 |
$1,393.92 |
$1,393.92 |
$773.40
|
|
X-ray bone age studies
|
$174.96 |
$174.96 |
$174.96 |
$251.40
|
|
X-ray bone length studies
|
$528.48 |
$528.48 |
$528.48 |
$285.30
|
|
X-ray bone survey complete
|
$887.76 |
$887.76 |
$887.76 |
$660.00
|
|
X-ray bone survey infant
|
$415.44 |
$415.44 |
$415.44 |
$394.69
|
|
X-ray cervical spine 2-3 views
|
$488.16 |
$488.16 |
$488.16 |
$333.83
|
|
X-ray cervical spine 4-5 views
|
$556.56 |
$556.56 |
$556.56 |
$457.05
|
|
X-ray cervical spine >= 6 views
|
$771.12 |
$771.12 |
$771.12 |
$508.50
|
|
X-ray clavicle complete (both sides)
|
$446.40 |
$446.40 |
$446.40 |
$300.05
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$416.16 |
$416.16 |
$416.16 |
$657.03
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$1,028.88 |
$1,028.88 |
$1,028.88 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$390.96 |
$390.96 |
$390.96 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$424.08 |
$424.08 |
$424.08 |
$364.12
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$641.52 |
$641.52 |
$641.52 |
$483.50
|
|
X-ray exam of arm infant
|
$299.52 |
$299.52 |
$299.52 |
$248.44
|
|
X-ray exam of eye sockets
|
$325.44 |
$325.44 |
$325.44 |
$328.35
|
|
X-ray exam of femur 1
|
$196.56 |
$196.56 |
$196.56 |
$240.00
|
|
X-ray exam of sinuses
|
$240.48 |
$240.48 |
$240.48 |
$214.50
|
|
X-ray exam si joints
|
$288.00 |
$288.00 |
$288.00 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$315.36 |
$315.36 |
$315.36 |
$387.40
|
|
X-ray eye detection foreign body (both sides)
|
$295.92 |
$295.92 |
$295.92 |
$238.29
|
|
X-ray facial bones complete > 3 views
|
$432.72 |
$432.72 |
$432.72 |
$381.75
|
|
X-ray femur >=2 views (both sides)
|
$221.04 |
$221.04 |
$221.04 |
$317.25
|
|
X-ray finger(s) >= 2 views (both sides)
|
$446.40 |
$446.40 |
$446.40 |
$241.05
|
|
X-ray foot 2 views (both sides)
|
$446.40 |
$446.40 |
$446.40 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$360.00 |
$360.00 |
$360.00 |
$322.20
|
|
X-ray hand 2 views (both sides)
|
$305.28 |
$305.28 |
$305.28 |
$291.20
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$388.80 |
$388.80 |
$388.80 |
$274.95
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$286.56 |
$286.56 |
$286.56 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$249.84 |
$249.84 |
$249.84 |
$374.40
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$322.56 |
$322.56 |
$322.56 |
$424.05
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$366.48 |
$366.48 |
$366.48 |
$505.60
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$221.04 |
$221.04 |
$221.04 |
$231.00
|
|
X-ray humerus >= 2 views left
|
$351.36 |
$351.36 |
$351.36 |
$309.31
|
|
X-ray joint survey 1 view
|
$269.28 |
$269.28 |
$269.28 |
$232.00
|
|
X-ray knee 1-2 views (both sides)
|
$402.48 |
$402.48 |
$402.48 |
$285.00
|
|
X-ray knee 3 views (both sides)
|
$496.08 |
$496.08 |
$496.08 |
$363.20
|
|
X-ray knee ap standing bilateral
|
$200.16 |
$200.16 |
$200.16 |
$252.50
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$158.40 |
$158.40 |
$158.40 |
$254.12
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$346.32 |
$346.32 |
$346.32 |
$369.15
|
|
X-ray lumbosacral spine >= 4 views
|
$827.28 |
$827.28 |
$827.28 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$959.04 |
$959.04 |
$959.04 |
$535.91
|
|
X-ray mandible complete > 4 views
|
$372.24 |
$372.24 |
$372.24 |
$361.61
|
|
X-ray mandible ltd <4 views
|
$312.48 |
$312.48 |
$312.48 |
$235.30
|
|
X-ray nasal bones complete > 3 views
|
$478.08 |
$478.08 |
$478.08 |
$274.65
|
|
X-ray neck soft tissue
|
$292.32 |
$292.32 |
$292.32 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$276.48 |
$276.48 |
$276.48 |
$225.60
|
|
X-ray pelvis 1-2 views
|
$403.92 |
$403.92 |
$403.92 |
$280.80
|
|
X-ray pelvis complete > 3 views
|
$438.48 |
$438.48 |
$438.48 |
$348.19
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$972.72 |
$972.72 |
$972.72 |
$755.50
|
|
X-ray ribs 2 views left
|
$472.32 |
$472.32 |
$472.32 |
$292.80
|
|
X-ray ribs 3 views bilateral
|
$286.56 |
$286.56 |
$286.56 |
$395.76
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$558.00 |
$558.00 |
$558.00 |
$356.20
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$406.80 |
$406.80 |
$406.80 |
$491.70
|
|
X-ray sacroiliac joints >= 3 views
|
$388.80 |
$388.80 |
$388.80 |
$312.75
|
|
X-ray sacrum/coccyx >= 2 views
|
$438.48 |
$438.48 |
$438.48 |
$288.80
|
|
X-ray scapula complete (both sides)
|
$332.64 |
$332.64 |
$332.64 |
$285.00
|
|
X-ray shoulder 1 view (both sides)
|
$360.00 |
$360.00 |
$360.00 |
$260.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$478.08 |
$478.08 |
$478.08 |
$345.60
|
|
X-ray sinus tract/fistula/abscess
|
$1,005.12 |
$1,005.12 |
$1,005.12 |
$606.89
|
|
X-ray skull < 4 views
|
$236.16 |
$236.16 |
$236.16 |
$292.50
|
|
X-ray skull > 4 views complete
|
$585.36 |
$585.36 |
$585.36 |
$417.50
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$561.60 |
$561.60 |
$561.60 |
$557.70
|
|
X-ray small intestine follow-through study
|
$1,031.04 |
$1,031.04 |
$1,031.04 |
$499.50
|
|
X-ray spine single view
|
$195.84 |
$195.84 |
$195.84 |
$251.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$257.76 |
$257.76 |
$257.76 |
$264.48
|
|
X-ray sternum > 2 views
|
$301.68 |
$301.68 |
$301.68 |
$274.65
|
|
X-ray surgical specimen
|
$526.32 |
$526.32 |
$526.32 |
$504.00
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$998.64 |
$998.64 |
$998.64 |
$523.25
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$310.32 |
$310.32 |
$310.32 |
$327.80
|
|
X-ray thoracic spine 2 views
|
$286.56 |
$286.56 |
$286.56 |
$320.45
|
|
X-ray thoracic spine 3 views
|
$322.56 |
$322.56 |
$322.56 |
$381.60
|
|
X-ray thoracolumbar spine >=2 views
|
$321.12 |
$321.12 |
$321.12 |
$282.50
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$196.56 |
$196.56 |
$196.56 |
$257.04
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$286.56 |
$286.56 |
$286.56 |
$352.95
|
|
X-ray tibia/fibula 2 views (both sides)
|
$400.32 |
$400.32 |
$400.32 |
$332.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$540.00 |
$540.00 |
$540.00 |
$258.50
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$360.72 |
$360.72 |
$360.72 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$416.16 |
$416.16 |
$416.16 |
$603.20
|
|
X-ray wrist 2 views (both sides)
|
$374.40 |
$374.40 |
$374.40 |
$290.40
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$207.36 |
$207.36 |
$207.36 |
$452.69
|