|
Western blot test
|
$48.57 |
$273.00 |
$1,225.00 |
|
|
Wet mounts/ w preparations
|
$21.60 |
$63.60 |
$83.40 |
|
|
Whfo nontorsion joint prefab
|
$92.16 |
$92.16 |
$92.16 |
|
|
Whfo w/joint(s) custom fab
|
$240.60 |
$342.50 |
$835.80 |
|
|
Whole blood for transfusion
|
$302.84 |
$686.00 |
$1,829.60 |
|
|
Whole blood or red blood cells frozen/deglycerolized/washed leukocytes reduced each unit
|
$447.00 |
$940.80 |
$1,514.88 |
|
|
Whole blood/red blood cells leukocytes reduced cmv negative each unit
|
$302.84 |
$495.00 |
$1,311.20 |
|
|
Whole-Body Bone Scan (Nuclear Medicine)
|
$658.35 |
$1,537.60 |
$3,220.00 |
|
|
Whole body photography
|
$144.80 |
$144.80 |
$144.80 |
|
|
Whole mitochondrial genome
|
$2,478.96 |
$5,073.60 |
$8,570.40 |
|
|
Whole mitochondrial genome
|
$1,839.60 |
$2,314.20 |
$2,616.80 |
|
|
Whole Skeleton X-ray Survey
|
$127.50 |
$666.05 |
$1,484.00 |
|
|
Who nontorsion jnts pre cst
|
$505.00 |
$508.90 |
$525.00 |
|
|
Wilate injection
|
$1.60 |
$783.10 |
$4,537.57 |
|
|
Wnd prep f/n/hf/g addl cm
|
$298.40 |
$298.40 |
$402.50 |
|
|
Woman's shoe oxford brace
|
$162.40 |
$162.40 |
$162.40 |
|
|
Wound Cleaning and Dead Tissue Removal (up to 20 sq cm)
|
$168.75 |
$385.60 |
$721.60 |
|
|
Wound closure by adhesive
|
$75.00 |
$75.00 |
$258.40 |
|
|
Woundfix biowound plus xplus
|
$837.60 |
$837.60 |
$837.60 |
|
|
Wound pouch each
|
$313.92 |
$313.92 |
$313.92 |
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$168.75 |
$646.56 |
$4,313.40 |
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$112.50 |
$667.59 |
$1,049.04 |
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$70.80 |
$307.50 |
$1,120.32 |
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$75.00 |
$393.60 |
$1,194.48 |
|
|
Wrist arthroscopy
|
$2,222.40 |
$2,222.40 |
$41,626.70 |
|
|
Wrist arthroscopy/surgery
|
$2,382.40 |
$2,382.40 |
$24,137.67 |
|
|
Wrist arthroscopy/surgery
|
$2,464.00 |
$22,561.58 |
$54,583.25 |
|
|
Wrist arthroscopy/surgery
|
$2,875.20 |
$28,860.61 |
$44,268.29 |
|
|
Wrist arthroscopy/surgery
|
$2,576.00 |
$37,998.83 |
$54,583.25 |
|
|
Wrist arthroscopy/surgery
|
$2,672.00 |
$2,672.00 |
$23,716.36 |
|
|
Wrist endoscopy/surgery
|
$2,512.00 |
$11,071.22 |
$20,471.29 |
|
|
Wrist X-ray
|
$137.50 |
$441.00 |
$983.20 |
|
|
Wrist X-ray (2 views, both wrists)
|
$125.00 |
$374.40 |
$867.20 |
|
|
Xcapsl ctrc rmvl cplx w/ecp
|
$30,362.56 |
$30,362.56 |
$30,362.56 |
|
|
Xcapsl ctrc rmvl cplx wo ecp
|
$3,724.80 |
$16,524.93 |
$21,606.07 |
|
|
Xcapsl ctrc rmvl insj 1+
|
$23,041.72 |
$23,041.72 |
$28,379.31 |
|
|
Xcapsl ctrc rmvl w/ecp
|
$25,716.91 |
$25,716.91 |
$25,716.91 |
|
|
Xcpsl ctrc rmvl cplx insj 1+
|
$22,311.98 |
$22,311.98 |
$27,679.66 |
|
|
Xe133 xenon 10mci
|
$146.53 |
$414.40 |
$716.93 |
|
|
Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/<
|
$1,152.60 |
$1,950.00 |
$6,157.80 |
|
|
Xfer tis s/a/l 10 sq cm/<
|
$1,102.80 |
$1,335.60 |
$2,605.00 |
|
|
X-linked intellectual dblt
|
$1,296.00 |
$1,296.00 |
$1,296.00 |
|
|
Xm archive tissue molec anal
|
$25.00 |
$114.10 |
$223.20 |
|
|
Xpos opn axillary/sbclvn art w/cndt crtn
|
$1,819.20 |
$1,819.20 |
$1,819.20 |
|
|
Xpos opn fmrl eprst aor uni add-on
|
$362.88 |
$3,235.00 |
$11,381.76 |
|
|
X-ray abdomen >=3 views
|
$127.50 |
$389.40 |
$574.00 |
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$231.25 |
$885.00 |
$1,993.60 |
|
|
X-ray assay calculus
|
$64.28 |
$64.28 |
$64.28 |
|
|
X-ray bone length studies
|
$87.50 |
$468.80 |
$770.70 |
|
|
X-ray bone survey infant
|
$119.46 |
$460.00 |
$1,250.20 |
|
|
X-ray consultation
|
$38.82 |
$38.82 |
$38.82 |
|
|
Xray endovasc thor ao repr
|
$1,537.92 |
$6,075.00 |
$6,075.00 |
|
|
Xray endovasc thor ao repr
|
$250.00 |
$3,993.50 |
$5,845.00 |
|
|
X-ray exam entire spi 4/5 vw
|
$91.80 |
$393.60 |
$993.60 |
|
|
X-ray exam entire spi 6/> vw
|
$115.20 |
$453.00 |
$2,067.10 |
|
|
X-ray exam of arm infant
|
$112.50 |
$399.60 |
$1,133.40 |
|
|
X-ray exam of femur 1
|
$66.33 |
$280.00 |
$1,043.40 |
|
|
X-ray exam of jaw joint
|
$79.86 |
$185.00 |
$486.60 |
|
|
X-ray exam of jaw joint
|
$176.80 |
$307.23 |
$885.00 |
|
|
X-ray exam of mastoids
|
$61.38 |
$225.00 |
$612.00 |
|
|
X-ray exam of middle ear
|
$114.40 |
$352.50 |
$352.50 |
|
|
X-ray exam of penis
|
$298.32 |
$606.40 |
$1,950.00 |
|
|
X-ray exam of perineum
|
$275.55 |
$275.55 |
$588.00 |
|
|
X-ray exam of salivary gland
|
$53.13 |
$284.00 |
$355.00 |
|
|
X-ray exam of tear duct
|
$298.32 |
$680.00 |
$728.80 |
|
|
X-ray exam of teeth
|
$32.00 |
$245.40 |
$660.80 |
|
|
X-ray exam of teeth
|
$82.40 |
$276.00 |
$307.20 |
|
|
X-ray exam si joints
|
$69.60 |
$287.50 |
$519.60 |
|
|
X-ray exam thorac spine4/>vw
|
$167.97 |
$502.20 |
$810.72 |
|
|
X-ray eye detection foreign body (both sides)
|
$79.86 |
$289.80 |
$903.20 |
|
|
X-ray fallopian tube
|
$129.69 |
$707.40 |
$778.20 |
|
|
X-ray head for orthodontia
|
$41.60 |
$41.60 |
$53.13 |
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$83.40 |
$505.60 |
$1,606.40 |
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$175.00 |
$685.00 |
$2,597.60 |
|
|
X-ray joint survey 1 view
|
$88.11 |
$354.00 |
$574.40 |
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$71.28 |
$370.00 |
$1,179.60 |
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$61.05 |
$415.80 |
$810.72 |
|
|
X-ray male genital tract
|
$182.40 |
$182.40 |
$273.90 |
|
|
X-ray mandible ltd <4 views
|
$87.50 |
$314.43 |
$687.60 |
|
|
X-ray nose to rectum for foreign body child
|
$87.50 |
$322.40 |
$484.80 |
|
|
X-ray of mammary ducts
|
$231.60 |
$800.00 |
$2,513.40 |
|
|
X-ray optic foramina
|
$53.13 |
$99.55 |
$208.08 |
|
|
Xray place dist ext thor ao
|
$1,674.00 |
$4,111.20 |
$5,510.00 |
|
|
Xray place prox ext thor ao
|
$1,521.36 |
$5,510.00 |
$5,510.00 |
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$231.25 |
$912.60 |
$1,624.70 |
|
|
X-ray ribs 2 views left
|
$110.55 |
$415.44 |
$659.40 |
|
|
X-ray sella turcica
|
$53.13 |
$162.50 |
$199.92 |
|
|
X-ray sinus tract/fistula/abscess
|
$325.00 |
$910.00 |
$2,494.80 |
|
|
X-ray slg plne bdy sect without urogr
|
$88.11 |
$537.00 |
$2,487.60 |
|
|
X-ray small intestine follow-through study
|
$189.75 |
$580.80 |
$1,503.36 |
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$125.00 |
$347.04 |
$706.30 |
|
|
X-ray surgical specimen
|
$294.03 |
$477.00 |
$1,184.40 |
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$87.50 |
$272.50 |
$613.20 |
|
|
X-ray xm phrnx&/crv esoph c+
|
$175.00 |
$180.40 |
$799.20 |
|
|
Xtrnl ecg rec up to 48 hrs
|
$253.60 |
$282.60 |
$282.60 |
|
|
Xylose absorption test blood &/or urine
|
$64.28 |
$135.30 |
$398.40 |
|
|
Yersinia antibody
|
$33.60 |
$144.20 |
$175.68 |
|
|
Yttrium y-90 ibritumomab ther
|
$30,077.40 |
$65,419.20 |
$65,419.20 |
|
|
Ziconotide injection
|
$17.88 |
$793.71 |
$793.71 |
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$6.31 |
$115.50 |
$473.72 |
|
