|
Warde zinc
|
$113.76 |
$113.76 |
$113.76 |
$62.50
|
|
Wbc automated
|
$36.00 |
$36.00 |
$36.00 |
$32.35
|
|
Western blot test
|
$110.88 |
$110.88 |
$110.88 |
$150.00
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$645.84 |
$645.84 |
$645.84 |
$554.01
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$1,049.04 |
$1,049.04 |
$1,049.04 |
$579.70
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$288.00 |
$288.00 |
$288.00 |
$284.70
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$467.28 |
$467.28 |
$467.28 |
$438.75
|
|
Wrist X-ray
|
$517.68 |
$517.68 |
$517.68 |
$342.80
|
|
X-linked intellectual dblt
|
$1,296.00 |
$1,296.00 |
$1,296.00 |
$1,258.40
|
|
X-ray abdomen 1 view
|
$483.12 |
$483.12 |
$483.12 |
$258.50
|
|
X-ray abdomen 2 views
|
$509.76 |
$509.76 |
$509.76 |
$316.47
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$1,027.44 |
$1,027.44 |
$1,027.44 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$572.40 |
$572.40 |
$572.40 |
$270.20
|
|
X-ray ankle 2 views (both sides)
|
$370.80 |
$370.80 |
$370.80 |
$282.50
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$820.08 |
$820.08 |
$820.08 |
$773.40
|
|
X-ray bone age studies
|
$609.84 |
$609.84 |
$609.84 |
$251.40
|
|
X-ray bone length studies
|
$624.96 |
$624.96 |
$624.96 |
$285.30
|
|
X-ray bone survey complete
|
$946.08 |
$946.08 |
$946.08 |
$660.00
|
|
X-ray bone survey infant
|
$802.08 |
$802.08 |
$802.08 |
$394.69
|
|
X-ray cervical spine 2-3 views
|
$626.40 |
$626.40 |
$626.40 |
$333.83
|
|
X-ray cervical spine 4-5 views
|
$732.96 |
$732.96 |
$732.96 |
$457.05
|
|
X-ray cervical spine >= 6 views
|
$1,123.92 |
$1,123.92 |
$1,123.92 |
$508.50
|
|
X-ray clavicle complete (both sides)
|
$379.44 |
$379.44 |
$379.44 |
$300.05
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$1,206.00 |
$1,206.00 |
$1,206.00 |
$657.03
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$1,324.08 |
$1,324.08 |
$1,324.08 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$398.88 |
$398.88 |
$398.88 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$501.12 |
$501.12 |
$501.12 |
$364.12
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$793.44 |
$793.44 |
$793.44 |
$483.50
|
|
X-ray exam entire spi 4/5 vw
|
$731.52 |
$731.52 |
$731.52 |
$441.48
|
|
X-ray exam entire spi 6/> vw
|
$738.72 |
$738.72 |
$738.72 |
$517.80
|
|
X-ray exam of arm infant
|
$251.28 |
$251.28 |
$251.28 |
$248.44
|
|
X-ray exam of eye sockets
|
$607.68 |
$607.68 |
$607.68 |
$328.35
|
|
X-ray exam of femur 1
|
$250.56 |
$250.56 |
$250.56 |
$240.00
|
|
X-ray exam of sinuses
|
$227.52 |
$227.52 |
$227.52 |
$214.50
|
|
X-ray eye detection foreign body (both sides)
|
$545.76 |
$545.76 |
$545.76 |
$238.29
|
|
X-ray facial bones complete > 3 views
|
$781.20 |
$781.20 |
$781.20 |
$381.75
|
|
X-ray femur >=2 views (both sides)
|
$365.76 |
$365.76 |
$365.76 |
$317.25
|
|
X-ray finger(s) >= 2 views (both sides)
|
$347.04 |
$347.04 |
$347.04 |
$241.05
|
|
X-ray foot 2 views (both sides)
|
$362.16 |
$362.16 |
$362.16 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$396.00 |
$396.00 |
$396.00 |
$322.20
|
|
X-ray hand 2 views (both sides)
|
$288.72 |
$288.72 |
$288.72 |
$291.20
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$370.80 |
$370.80 |
$370.80 |
$274.95
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$332.64 |
$332.64 |
$332.64 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$465.12 |
$465.12 |
$465.12 |
$374.40
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$478.08 |
$478.08 |
$478.08 |
$424.05
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$534.96 |
$534.96 |
$534.96 |
$505.60
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$250.56 |
$250.56 |
$250.56 |
$231.00
|
|
X-ray humerus >= 2 views left
|
$517.68 |
$517.68 |
$517.68 |
$309.31
|
|
X-ray joint survey 1 view
|
$285.84 |
$285.84 |
$285.84 |
$232.00
|
|
X-ray knee 1-2 views (both sides)
|
$306.72 |
$306.72 |
$306.72 |
$285.00
|
|
X-ray knee 3 views (both sides)
|
$501.12 |
$501.12 |
$501.12 |
$363.20
|
|
X-ray knee ap standing bilateral
|
$313.92 |
$313.92 |
$313.92 |
$252.50
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$278.64 |
$278.64 |
$278.64 |
$254.12
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$594.72 |
$594.72 |
$594.72 |
$369.15
|
|
X-ray lumbosacral spine >= 4 views
|
$910.08 |
$910.08 |
$910.08 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$1,058.40 |
$1,058.40 |
$1,058.40 |
$535.91
|
|
X-ray mandible complete > 4 views
|
$821.52 |
$821.52 |
$821.52 |
$361.61
|
|
X-ray mandible ltd <4 views
|
$441.36 |
$441.36 |
$441.36 |
$235.30
|
|
X-ray nasal bones complete > 3 views
|
$564.48 |
$564.48 |
$564.48 |
$274.65
|
|
X-ray neck soft tissue
|
$448.56 |
$448.56 |
$448.56 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$354.96 |
$354.96 |
$354.96 |
$225.60
|
|
X-ray pelvis 1-2 views
|
$406.80 |
$406.80 |
$406.80 |
$280.80
|
|
X-ray pelvis complete > 3 views
|
$496.80 |
$496.80 |
$496.80 |
$348.19
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$1,103.76 |
$1,103.76 |
$1,103.76 |
$755.50
|
|
X-ray ribs 2 views left
|
$527.04 |
$527.04 |
$527.04 |
$292.80
|
|
X-ray ribs 3 views bilateral
|
$875.52 |
$875.52 |
$875.52 |
$395.76
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$629.28 |
$629.28 |
$629.28 |
$356.20
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$909.36 |
$909.36 |
$909.36 |
$491.70
|
|
X-ray sacroiliac joints >= 3 views
|
$562.32 |
$562.32 |
$562.32 |
$312.75
|
|
X-ray sacrum/coccyx >= 2 views
|
$538.56 |
$538.56 |
$538.56 |
$288.80
|
|
X-ray scapula complete (both sides)
|
$491.76 |
$491.76 |
$491.76 |
$285.00
|
|
X-ray shoulder 1 view (both sides)
|
$272.88 |
$272.88 |
$272.88 |
$260.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$655.20 |
$655.20 |
$655.20 |
$345.60
|
|
X-ray sinus tract/fistula/abscess
|
$1,151.28 |
$1,151.28 |
$1,151.28 |
$606.89
|
|
X-ray skull < 4 views
|
$372.24 |
$372.24 |
$372.24 |
$292.50
|
|
X-ray skull > 4 views complete
|
$771.84 |
$771.84 |
$771.84 |
$417.50
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$813.60 |
$813.60 |
$813.60 |
$557.70
|
|
X-ray small intestine follow-through study
|
$1,399.68 |
$1,399.68 |
$1,399.68 |
$499.50
|
|
X-ray spine single view
|
$521.28 |
$521.28 |
$521.28 |
$251.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$347.04 |
$347.04 |
$347.04 |
$264.48
|
|
X-ray sternum > 2 views
|
$560.16 |
$560.16 |
$560.16 |
$274.65
|
|
X-ray surgical specimen
|
$705.60 |
$705.60 |
$705.60 |
$504.00
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$1,074.96 |
$1,074.96 |
$1,074.96 |
$523.25
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$579.60 |
$579.60 |
$579.60 |
$327.80
|
|
X-ray thoracic spine 2 views
|
$363.60 |
$363.60 |
$363.60 |
$320.45
|
|
X-ray thoracic spine 3 views
|
$768.96 |
$768.96 |
$768.96 |
$381.60
|
|
X-ray thoracolumbar spine >=2 views
|
$396.72 |
$396.72 |
$396.72 |
$282.50
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$250.56 |
$250.56 |
$250.56 |
$257.04
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$412.56 |
$412.56 |
$412.56 |
$352.95
|
|
X-ray tibia/fibula 2 views (both sides)
|
$419.04 |
$419.04 |
$419.04 |
$332.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$499.00 |
$499.00 |
$499.00 |
$258.50
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$2,006.64 |
$2,006.64 |
$2,006.64 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$1,399.68 |
$1,399.68 |
$1,399.68 |
$603.20
|
|
X-ray wrist 2 views (both sides)
|
$348.48 |
$348.48 |
$348.48 |
$290.40
|
|
Zika virus igm antibody
|
$211.68 |
$211.68 |
$211.68 |
$85.00
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$248.72 |
$248.72 |
$248.72 |
$122.45
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$234.96 |
$234.96 |
$234.96 |
$452.69
|