|
Wbc automated
|
$75.00 |
$75.00 |
$75.00 |
$32.50
|
|
Western blot test
|
$187.80 |
$187.80 |
$187.80 |
$170.40
|
|
Whole blood/red blood cells leukocytes reduced cmv negative each unit
|
$432.00 |
$432.00 |
$432.00 |
$432.00
|
|
Wnd prep f/n/hf/g addl cm
|
$947.40 |
$947.40 |
$947.40 |
$865.80
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$240.00 |
$240.00 |
$240.00 |
$275.88
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$178.20 |
$178.20 |
$178.20 |
$370.00
|
|
Wrist X-ray
|
$552.00 |
$552.00 |
$552.00 |
$311.20
|
|
X-ray abdomen 1 view
|
$254.40 |
$254.40 |
$254.40 |
$243.00
|
|
X-ray abdomen 2 views
|
$260.40 |
$260.40 |
$260.40 |
$281.50
|
|
X-ray abdomen >=3 views
|
$357.60 |
$357.60 |
$357.60 |
$309.38
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$536.40 |
$536.40 |
$536.40 |
$359.84
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$343.20 |
$343.20 |
$343.20 |
$246.42
|
|
X-ray ankle 2 views (both sides)
|
$511.20 |
$511.20 |
$511.20 |
$240.00
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$1,479.60 |
$1,479.60 |
$1,479.60 |
$734.43
|
|
X-ray bone age studies
|
$361.80 |
$361.80 |
$361.80 |
$227.08
|
|
X-ray bone length studies
|
$256.80 |
$256.80 |
$256.80 |
$258.70
|
|
X-ray bone survey complete
|
$730.80 |
$730.80 |
$730.80 |
$569.03
|
|
X-ray bone survey infant
|
$427.80 |
$427.80 |
$427.80 |
$362.40
|
|
X-ray cervical spine 2-3 views
|
$277.20 |
$277.20 |
$277.20 |
$308.40
|
|
X-ray cervical spine 4-5 views
|
$402.00 |
$402.00 |
$402.00 |
$439.14
|
|
X-ray cervical spine >= 6 views
|
$535.20 |
$535.20 |
$535.20 |
$479.05
|
|
X-ray clavicle complete (both sides)
|
$612.00 |
$612.00 |
$612.00 |
$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)
|
$460.80 |
$460.80 |
$460.80 |
$281.40
|
|
X-ray elbow >= 3 views (both sides)
|
$556.80 |
$556.80 |
$556.80 |
$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
|
$517.80 |
$517.80 |
$517.80 |
$441.48
|
|
X-ray exam entire spi 6/> vw
|
$673.20 |
$673.20 |
$673.20 |
$562.90
|
|
X-ray exam of arm infant
|
$324.00 |
$324.00 |
$324.00 |
$238.26
|
|
X-ray exam of eye sockets
|
$362.40 |
$362.40 |
$362.40 |
$321.48
|
|
X-ray exam of femur 1
|
$244.80 |
$244.80 |
$244.80 |
$194.40
|
|
X-ray exam of sinuses
|
$216.00 |
$216.00 |
$216.00 |
$192.00
|
|
X-ray exam thorac spine4/>vw
|
$598.20 |
$598.20 |
$598.20 |
$365.00
|
|
X-ray eye detection foreign body (both sides)
|
$493.20 |
$493.20 |
$493.20 |
$227.80
|
|
X-ray facial bones complete > 3 views
|
$399.60 |
$399.60 |
$399.60 |
$337.95
|
|
X-ray femur >=2 views (both sides)
|
$489.60 |
$489.60 |
$489.60 |
$290.44
|
|
X-ray finger(s) >= 2 views (both sides)
|
$374.40 |
$374.40 |
$374.40 |
$233.55
|
|
X-ray foot 2 views (both sides)
|
$477.60 |
$477.60 |
$477.60 |
$270.40
|
|
X-ray forearm 2 views (both sides)
|
$506.40 |
$506.40 |
$506.40 |
$317.62
|
|
X-ray hand 2 views (both sides)
|
$501.60 |
$501.60 |
$501.60 |
$270.00
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$444.00 |
$444.00 |
$444.00 |
$243.10
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$362.40 |
$362.40 |
$362.40 |
$300.00
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$265.20 |
$265.20 |
$265.20 |
$313.45
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$362.40 |
$362.40 |
$362.40 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$461.40 |
$461.40 |
$461.40 |
$477.10
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$166.80 |
$166.80 |
$166.80 |
$187.20
|
|
X-ray humerus >= 2 views left
|
$530.40 |
$530.40 |
$530.40 |
$285.00
|
|
X-ray joint survey 1 view
|
$235.20 |
$235.20 |
$235.20 |
$211.00
|
|
X-ray knee 1-2 views (both sides)
|
$520.80 |
$520.80 |
$520.80 |
$271.70
|
|
X-ray knee 3 views (both sides)
|
$705.60 |
$705.60 |
$705.60 |
$319.24
|
|
X-ray knee ap standing bilateral
|
$260.40 |
$260.40 |
$260.40 |
$243.09
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$409.20 |
$409.20 |
$409.20 |
$227.92
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$509.40 |
$509.40 |
$509.40 |
$345.15
|
|
X-ray lumbosacral spine >= 4 views
|
$480.00 |
$480.00 |
$480.00 |
$475.04
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$544.80 |
$544.80 |
$544.80 |
$513.63
|
|
X-ray mandible complete > 4 views
|
$377.40 |
$377.40 |
$377.40 |
$323.70
|
|
X-ray mandible ltd <4 views
|
$198.00 |
$198.00 |
$198.00 |
$200.20
|
|
X-ray nasal bones complete > 3 views
|
$244.80 |
$244.80 |
$244.80 |
$260.52
|
|
X-ray neck soft tissue
|
$195.60 |
$195.60 |
$195.60 |
$221.10
|
|
X-ray nose to rectum for foreign body child
|
$254.40 |
$254.40 |
$254.40 |
$201.00
|
|
X-ray of mammary ducts
|
$790.80 |
$790.80 |
$790.80 |
$437.00
|
|
X-ray pelvis 1-2 views
|
$232.80 |
$232.80 |
$232.80 |
$242.58
|
|
X-ray pelvis complete > 3 views
|
$330.00 |
$330.00 |
$330.00 |
$299.46
|
|
X-ray ribs 2 views left
|
$202.80 |
$202.80 |
$202.80 |
$281.45
|
|
X-ray ribs 3 views bilateral
|
$326.40 |
$326.40 |
$326.40 |
$361.20
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$253.20 |
$253.20 |
$253.20 |
$327.21
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$343.20 |
$343.20 |
$343.20 |
$466.80
|
|
X-ray sacroiliac joints >= 3 views
|
$345.60 |
$345.60 |
$345.60 |
$270.40
|
|
X-ray sacrum/coccyx >= 2 views
|
$285.60 |
$285.60 |
$285.60 |
$260.65
|
|
X-ray scapula complete (both sides)
|
$652.80 |
$652.80 |
$652.80 |
$264.80
|
|
X-ray shoulder 1 view (both sides)
|
$448.80 |
$448.80 |
$448.80 |
$242.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$315.60 |
$315.60 |
$315.60 |
$324.53
|
|
X-ray skull < 4 views
|
$341.40 |
$341.40 |
$341.40 |
$277.54
|
|
X-ray skull > 4 views complete
|
$448.80 |
$448.80 |
$448.80 |
$404.30
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$440.40 |
$440.40 |
$440.40 |
$511.38
|
|
X-ray small intestine follow-through study
|
$330.60 |
$330.60 |
$330.60 |
$470.16
|
|
X-ray spine single view
|
$252.60 |
$252.60 |
$252.60 |
$225.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$297.60 |
$297.60 |
$297.60 |
$236.88
|
|
X-ray sternum > 2 views
|
$284.40 |
$284.40 |
$284.40 |
$230.00
|
|
X-ray surgical specimen
|
$682.80 |
$682.80 |
$682.80 |
$457.47
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$361.20 |
$361.20 |
$361.20 |
$463.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$384.00 |
$384.00 |
$384.00 |
$276.00
|
|
X-ray thoracic spine 2 views
|
$348.00 |
$348.00 |
$348.00 |
$286.65
|
|
X-ray thoracic spine 3 views
|
$387.60 |
$387.60 |
$387.60 |
$343.00
|
|
X-ray thoracolumbar spine >=2 views
|
$294.00 |
$294.00 |
$294.00 |
$269.10
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$252.00 |
$252.00 |
$252.00 |
$211.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$502.80 |
$502.80 |
$502.80 |
$346.50
|
|
X-ray tibia/fibula 2 views (both sides)
|
$554.40 |
$554.40 |
$554.40 |
$306.47
|
|
X-ray toe(s) > 2 views (both sides)
|
$350.40 |
$350.40 |
$350.40 |
$225.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$704.40 |
$704.40 |
$704.40 |
$590.20
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$659.40 |
$659.40 |
$659.40 |
$497.93
|
|
X-ray wrist 2 views (both sides)
|
$499.20 |
$499.20 |
$499.20 |
$268.49
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$130.33 |
$130.33 |
$130.33 |
$83.13
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$69.19 |
$69.19 |
$69.19 |
$201.50
|
