|
Warde vitamin a
|
$219.60 |
$219.60 |
$219.60 |
$68.00
|
|
Warde vitamin b-1 (thiamine)
|
$333.00 |
$333.00 |
$333.00 |
$99.27
|
|
Warde vitamin b6 (pyridoxine)
|
$274.80 |
$274.80 |
$274.80 |
$127.40
|
|
Warde vitamin c (ascorbic acid)
|
$136.80 |
$136.80 |
$136.80 |
$51.30
|
|
Warde vitamin d (1 25 dihydroxy)
|
$599.40 |
$599.40 |
$599.40 |
$182.52
|
|
Warde vitamin e (alpha-tocopherol)
|
$274.20 |
$274.20 |
$274.20 |
$64.28
|
|
Warde zinc
|
$244.80 |
$244.80 |
$244.80 |
$67.20
|
|
Wbc automated
|
$68.40 |
$68.40 |
$68.40 |
$32.80
|
|
Western blot test
|
$234.60 |
$234.60 |
$234.60 |
$170.40
|
|
Whole blood for transfusion
|
$643.20 |
$643.20 |
$643.20 |
$400.68
|
|
Whole blood or red blood cells frozen/deglycerolized/washed leukocytes reduced each unit
|
$1,362.00 |
$1,362.00 |
$1,362.00 |
$511.20
|
|
Whole blood/red blood cells leukocytes reduced cmv negative each unit
|
$855.00 |
$855.00 |
$855.00 |
$432.00
|
|
Wilate injection
|
$2.94 |
$2.94 |
$2.94 |
$1.27
|
|
Wnd prep f/n/hf/g addl cm
|
$966.00 |
$966.00 |
$966.00 |
$865.80
|
|
Wound closure by adhesive
|
$75.00 |
$75.00 |
$75.00 |
$156.65
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$175.80 |
$175.80 |
$175.80 |
$501.80
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$201.60 |
$201.60 |
$201.60 |
$558.97
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$137.40 |
$146.40 |
$146.40 |
$275.88
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$157.80 |
$157.80 |
$244.20 |
$370.00
|
|
Wrist X-ray
|
$516.00 |
$516.00 |
$516.00 |
$311.20
|
|
Xe133 xenon 10mci
|
$177.00 |
$177.00 |
$177.00 |
$299.00
|
|
Xm archive tissue molec anal
|
$48.00 |
$48.00 |
$48.00 |
$48.00
|
|
X-ray abdomen 1 view
|
$258.00 |
$258.00 |
$258.00 |
$243.00
|
|
X-ray abdomen 2 views
|
$270.00 |
$270.00 |
$270.00 |
$281.50
|
|
X-ray abdomen >=3 views
|
$291.00 |
$291.00 |
$291.00 |
$309.38
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$340.20 |
$340.20 |
$340.20 |
$359.84
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$234.60 |
$234.60 |
$234.60 |
$246.42
|
|
X-ray ankle 2 views (both sides)
|
$295.20 |
$295.20 |
$295.20 |
$239.39
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$1,010.40 |
$1,010.40 |
$1,010.40 |
$718.20
|
|
X-ray bone age studies
|
$172.80 |
$172.80 |
$172.80 |
$227.08
|
|
X-ray bone length studies
|
$277.80 |
$277.80 |
$295.20 |
$258.70
|
|
X-ray bone survey complete
|
$660.00 |
$660.00 |
$660.00 |
$569.03
|
|
X-ray bone survey infant
|
$427.80 |
$427.80 |
$427.80 |
$362.40
|
|
X-ray cervical spine 2-3 views
|
$249.60 |
$249.60 |
$249.60 |
$307.30
|
|
X-ray cervical spine 4-5 views
|
$348.00 |
$348.00 |
$348.00 |
$439.14
|
|
X-ray cervical spine >= 6 views
|
$367.80 |
$367.80 |
$367.80 |
$478.69
|
|
X-ray clavicle complete (both sides)
|
$384.00 |
$384.00 |
$384.00 |
$277.00
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$674.40 |
$674.40 |
$674.40 |
$594.68
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$856.20 |
$856.20 |
$856.20 |
$785.86
|
|
X-ray elbow 2 views (both sides)
|
$320.40 |
$320.40 |
$320.40 |
$280.80
|
|
X-ray elbow >= 3 views (both sides)
|
$516.00 |
$516.00 |
$516.00 |
$325.88
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$484.80 |
$484.80 |
$484.80 |
$434.76
|
|
X-ray exam entire spi 4/5 vw
|
$397.80 |
$397.80 |
$397.80 |
$441.48
|
|
X-ray exam entire spi 6/> vw
|
$517.80 |
$517.80 |
$517.80 |
$562.90
|
|
X-ray exam of arm infant
|
$200.40 |
$200.40 |
$200.40 |
$238.26
|
|
X-ray exam of eye sockets
|
$247.80 |
$247.80 |
$247.80 |
$321.48
|
|
X-ray exam of femur 1
|
$194.40 |
$194.40 |
$194.40 |
$194.40
|
|
X-ray exam of jaw joint
|
$429.60 |
$429.60 |
$429.60 |
$370.89
|
|
X-ray exam of middle ear
|
$151.80 |
$151.80 |
$151.80 |
$322.45
|
|
X-ray exam of perineum
|
$258.00 |
$258.00 |
$258.00 |
$330.96
|
|
X-ray exam of salivary gland
|
$162.60 |
$162.60 |
$162.60 |
$124.24
|
|
X-ray exam of sinuses
|
$192.00 |
$192.00 |
$192.00 |
$192.00
|
|
X-ray exam of tear duct
|
$258.00 |
$258.00 |
$258.00 |
$340.70
|
|
X-ray exam of teeth
|
$113.40 |
$113.40 |
$113.40 |
$97.54
|
|
X-ray exam of teeth
|
$142.20 |
$142.20 |
$142.20 |
$267.78
|
|
X-ray exam thorac spine4/>vw
|
$258.00 |
$258.00 |
$258.00 |
$365.00
|
|
X-ray eye detection foreign body (both sides)
|
$516.00 |
$516.00 |
$516.00 |
$227.80
|
|
X-ray facial bones complete > 3 views
|
$273.00 |
$273.00 |
$273.00 |
$336.00
|
|
X-ray femur >=2 views (both sides)
|
$390.00 |
$390.00 |
$390.00 |
$288.00
|
|
X-ray finger(s) >= 2 views (both sides)
|
$303.60 |
$303.60 |
$303.60 |
$233.55
|
|
X-ray foot 2 views (both sides)
|
$290.40 |
$290.40 |
$290.40 |
$270.40
|
|
X-ray forearm 2 views (both sides)
|
$367.20 |
$367.20 |
$367.20 |
$317.62
|
|
X-ray hand 2 views (both sides)
|
$343.20 |
$343.20 |
$343.20 |
$267.20
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$516.00 |
$516.00 |
$516.00 |
$243.10
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$376.80 |
$376.80 |
$376.80 |
$300.00
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$274.80 |
$274.80 |
$274.80 |
$313.45
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$376.80 |
$376.80 |
$376.80 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$478.80 |
$478.80 |
$478.80 |
$477.10
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$172.80 |
$172.80 |
$172.80 |
$186.60
|
|
X-ray humerus >= 2 views left
|
$362.40 |
$362.40 |
$362.40 |
$285.00
|
|
X-ray joint survey 1 view
|
$147.60 |
$147.60 |
$147.60 |
$211.00
|
|
X-ray knee 1-2 views (both sides)
|
$417.60 |
$417.60 |
$417.60 |
$271.70
|
|
X-ray knee 3 views (both sides)
|
$229.20 |
$458.40 |
$458.40 |
$319.24
|
|
X-ray knee ap standing bilateral
|
$208.80 |
$208.80 |
$208.80 |
$238.80
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$271.20 |
$271.20 |
$271.20 |
$227.92
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$258.00 |
$258.00 |
$258.00 |
$342.55
|
|
X-ray lumbosacral spine >= 4 views
|
$346.80 |
$346.80 |
$346.80 |
$475.04
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$362.40 |
$362.40 |
$362.40 |
$513.63
|
|
X-ray mandible complete > 4 views
|
$259.20 |
$259.20 |
$259.20 |
$320.90
|
|
X-ray mandible ltd <4 views
|
$162.60 |
$162.60 |
$162.60 |
$200.20
|
|
X-ray nasal bones complete > 3 views
|
$193.20 |
$193.20 |
$193.20 |
$260.52
|
|
X-ray neck soft tissue
|
$172.80 |
$172.80 |
$172.80 |
$221.10
|
|
X-ray nose to rectum for foreign body child
|
$258.00 |
$258.00 |
$258.00 |
$201.00
|
|
X-ray of mammary ducts
|
$258.00 |
$258.00 |
$258.00 |
$437.00
|
|
X-ray optic foramina
|
$303.60 |
$303.60 |
$303.60 |
$165.09
|
|
X-ray pelvis 1-2 views
|
$186.00 |
$186.00 |
$258.00 |
$242.58
|
|
X-ray pelvis complete > 3 views
|
$226.20 |
$226.20 |
$226.20 |
$295.75
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$258.00 |
$258.00 |
$258.00 |
$663.18
|
|
X-ray ribs 2 views left
|
$204.60 |
$204.60 |
$204.60 |
$281.45
|
|
X-ray ribs 3 views bilateral
|
$292.20 |
$292.20 |
$292.20 |
$361.20
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$226.80 |
$226.80 |
$226.80 |
$327.21
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$309.60 |
$309.60 |
$309.60 |
$463.45
|
|
X-ray sacroiliac joints >= 3 views
|
$236.40 |
$236.40 |
$236.40 |
$270.40
|
|
X-ray sacrum/coccyx >= 2 views
|
$219.00 |
$219.00 |
$219.00 |
$260.00
|
|
X-ray scapula complete (both sides)
|
$444.00 |
$444.00 |
$444.00 |
$264.80
|
|
X-ray shoulder 1 view (both sides)
|
$325.20 |
$325.20 |
$325.20 |
$242.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$283.80 |
$283.80 |
$283.80 |
$324.53
|
|
X-ray sinus tract/fistula/abscess
|
$263.40 |
$263.40 |
$263.40 |
$529.75
|
|
X-ray skull < 4 views
|
$232.80 |
$232.80 |
$232.80 |
$277.54
|
|
X-ray skull > 4 views complete
|
$306.60 |
$306.60 |
$306.60 |
$404.30
|
