|
Wound therapy negative pressure per session <= 50 sq cm
|
$1,245.75 |
$1,245.75 |
$1,245.75 |
$558.97
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$579.70 |
$579.70 |
$579.70 |
$611.25
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$237.60 |
$237.60 |
$237.60 |
$288.91
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$231.00 |
$231.00 |
$231.00 |
$436.15
|
|
Wrist X-ray
|
$427.35 |
$427.35 |
$427.35 |
$343.70
|
|
Xm archive tissue molec anal
|
$47.85 |
$47.85 |
$47.85 |
$47.85
|
|
Xpos opn fmrl eprst aor uni add-on
|
$8,009.10 |
$8,009.10 |
$8,009.10 |
$2,160.89
|
|
X-ray abdomen 1 view
|
$368.50 |
$368.50 |
$368.50 |
$255.00
|
|
X-ray abdomen 2 views
|
$491.70 |
$491.70 |
$491.70 |
$312.36
|
|
X-ray abdomen >=3 views
|
$522.50 |
$522.50 |
$522.50 |
$332.15
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$598.95 |
$598.95 |
$598.95 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$371.80 |
$371.80 |
$371.80 |
$271.44
|
|
X-ray ankle 2 views (both sides)
|
$351.45 |
$351.45 |
$351.45 |
$283.00
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$755.15 |
$755.15 |
$755.15 |
$768.30
|
|
X-ray bone age studies
|
$400.40 |
$400.40 |
$400.40 |
$246.75
|
|
X-ray bone length studies
|
$610.50 |
$610.50 |
$610.50 |
$287.25
|
|
X-ray bone survey complete
|
$666.05 |
$666.05 |
$666.05 |
$666.60
|
|
X-ray bone survey infant
|
$448.80 |
$448.80 |
$448.80 |
$410.73
|
|
X-ray cervical spine 2-3 views
|
$553.30 |
$553.30 |
$553.30 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$757.90 |
$757.90 |
$757.90 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$957.00 |
$957.00 |
$957.00 |
$515.35
|
|
X-ray clavicle complete (both sides)
|
$366.30 |
$366.30 |
$366.30 |
$299.65
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$716.10 |
$716.10 |
$716.10 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$1,361.80 |
$1,361.80 |
$1,361.80 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$289.30 |
$289.30 |
$289.30 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$470.80 |
$470.80 |
$470.80 |
$342.00
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$894.85 |
$894.85 |
$894.85 |
$486.24
|
|
X-ray exam of arm infant
|
$646.80 |
$646.80 |
$646.80 |
$248.82
|
|
X-ray exam of eye sockets
|
$504.90 |
$504.90 |
$504.90 |
$349.05
|
|
X-ray exam of femur 1
|
$105.05 |
$105.05 |
$105.05 |
$232.36
|
|
X-ray exam of jaw joint
|
$218.90 |
$218.90 |
$218.90 |
$192.39
|
|
X-ray exam of sinuses
|
$108.35 |
$108.35 |
$108.35 |
$211.00
|
|
X-ray exam si joints
|
$422.95 |
$422.95 |
$422.95 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$613.25 |
$613.25 |
$613.25 |
$395.59
|
|
X-ray eye detection foreign body (both sides)
|
$264.00 |
$264.00 |
$264.00 |
$235.00
|
|
X-ray facial bones complete > 3 views
|
$633.60 |
$633.60 |
$633.60 |
$366.60
|
|
X-ray femur >=2 views (both sides)
|
$285.45 |
$285.45 |
$285.45 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$400.95 |
$400.95 |
$400.95 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$332.20 |
$332.20 |
$332.20 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$360.80 |
$360.80 |
$360.80 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$325.60 |
$325.60 |
$325.60 |
$316.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$322.85 |
$322.85 |
$322.85 |
$270.00
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$548.35 |
$548.35 |
$548.35 |
$370.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$336.60 |
$336.60 |
$336.60 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$424.05 |
$424.05 |
$424.05 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$655.05 |
$655.05 |
$655.05 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$285.45 |
$285.45 |
$285.45 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$410.30 |
$410.30 |
$410.30 |
$304.15
|
|
X-ray joint survey 1 view
|
$184.80 |
$184.80 |
$184.80 |
$211.00
|
|
X-ray knee 1-2 views (both sides)
|
$377.30 |
$377.30 |
$377.30 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$487.85 |
$487.85 |
$487.85 |
$353.25
|
|
X-ray knee ap standing bilateral
|
$512.60 |
$512.60 |
$512.60 |
$276.25
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$326.15 |
$326.15 |
$326.15 |
$249.13
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$355.85 |
$355.85 |
$355.85 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$846.45 |
$846.45 |
$846.45 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$882.20 |
$882.20 |
$882.20 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$532.95 |
$532.95 |
$532.95 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$427.35 |
$427.35 |
$427.35 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$493.35 |
$493.35 |
$493.35 |
$277.70
|
|
X-ray neck soft tissue
|
$373.45 |
$373.45 |
$373.45 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$354.20 |
$354.20 |
$354.20 |
$225.96
|
|
X-ray of mammary ducts
|
$925.10 |
$925.10 |
$925.10 |
$473.55
|
|
X-ray optic foramina
|
$99.55 |
$99.55 |
$99.55 |
$171.00
|
|
X-ray pelvis 1-2 views
|
$349.25 |
$349.25 |
$349.25 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$379.50 |
$379.50 |
$379.50 |
$342.30
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$955.90 |
$955.90 |
$955.90 |
$742.00
|
|
X-ray ribs 2 views left
|
$460.35 |
$460.35 |
$460.35 |
$296.32
|
|
X-ray ribs 3 views bilateral
|
$397.10 |
$397.10 |
$397.10 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$460.35 |
$460.35 |
$460.35 |
$359.47
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$775.50 |
$775.50 |
$775.50 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$461.45 |
$461.45 |
$461.45 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$440.55 |
$440.55 |
$440.55 |
$285.60
|
|
X-ray scapula complete (both sides)
|
$315.15 |
$315.15 |
$315.15 |
$292.50
|
|
X-ray sella turcica
|
$99.55 |
$99.55 |
$99.55 |
$162.50
|
|
X-ray shoulder 1 view (both sides)
|
$279.40 |
$279.40 |
$279.40 |
$264.48
|
|
X-ray sinuses paranasal complete > 3 views
|
$432.85 |
$432.85 |
$432.85 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$998.80 |
$998.80 |
$998.80 |
$601.30
|
|
X-ray skull < 4 views
|
$493.35 |
$493.35 |
$493.35 |
$291.78
|
|
X-ray skull > 4 views complete
|
$585.75 |
$585.75 |
$585.75 |
$414.60
|
|
X-ray slg plne bdy sect without urogr
|
$906.95 |
$906.95 |
$906.95 |
$387.00
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$1,031.80 |
$1,031.80 |
$1,031.80 |
$557.70
|
|
X-ray small intestine follow-through study
|
$935.00 |
$935.00 |
$935.00 |
$504.14
|
|
X-ray spine single view
|
$401.50 |
$401.50 |
$401.50 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$444.95 |
$444.95 |
$444.95 |
$263.49
|
|
X-ray sternum > 2 views
|
$343.20 |
$343.20 |
$343.20 |
$269.75
|
|
X-ray surgical specimen
|
$706.75 |
$706.75 |
$706.75 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$670.45 |
$670.45 |
$670.45 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$435.60 |
$435.60 |
$435.60 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$427.90 |
$427.90 |
$427.90 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$583.55 |
$583.55 |
$583.55 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$130.90 |
$130.90 |
$130.90 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$606.10 |
$606.10 |
$606.10 |
$256.85
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$785.40 |
$785.40 |
$785.40 |
$385.80
|
|
X-ray tibia/fibula 2 views (both sides)
|
$453.20 |
$453.20 |
$453.20 |
$328.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$366.30 |
$366.30 |
$366.30 |
$264.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$838.20 |
$838.20 |
$838.20 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$838.20 |
$838.20 |
$838.20 |
$555.04
|
|
X-ray wrist 2 views (both sides)
|
$350.35 |
$350.35 |
$350.35 |
$290.40
|
|
X-ray xm phrnx&/crv esoph c+
|
$180.40 |
$180.40 |
$180.40 |
$324.20
|
|
Xylose absorption test blood &/or urine
|
$135.30 |
$135.30 |
$135.30 |
$64.28
|