|
Warde vitamin e (alpha-tocopherol)
|
$73.41 |
$73.41 |
$73.41 |
$55.00
|
|
Warde zinc
|
$89.95 |
$89.95 |
$89.95 |
$62.50
|
|
Wbc automated
|
$69.59 |
$69.59 |
$69.59 |
$32.80
|
|
Western blot test
|
$78.07 |
$78.07 |
$78.07 |
$153.18
|
|
Whole blood or red blood cells frozen/deglycerolized/washed leukocytes reduced each unit
|
$330.10 |
$330.10 |
$330.10 |
$740.15
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$233.78 |
$233.78 |
$233.78 |
$558.97
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$104.80 |
$104.80 |
$104.80 |
$288.91
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$291.06 |
$291.06 |
$291.06 |
$436.15
|
|
Wrist X-ray
|
$377.62 |
$377.62 |
$377.62 |
$343.70
|
|
Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/<
|
$1,509.60 |
$1,509.60 |
$1,509.60 |
$2,830.00
|
|
X-ray abdomen 1 view
|
$383.98 |
$383.98 |
$383.98 |
$255.00
|
|
X-ray abdomen 2 views
|
$437.44 |
$437.44 |
$437.44 |
$312.36
|
|
X-ray abdomen >=3 views
|
$187.96 |
$187.96 |
$187.96 |
$332.15
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$663.58 |
$663.58 |
$663.58 |
$418.63
|
|
X-ray ankle 2 views (both sides)
|
$344.95 |
$344.95 |
$344.95 |
$283.00
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$571.51 |
$571.51 |
$571.51 |
$768.30
|
|
X-ray bone age studies
|
$247.79 |
$247.79 |
$247.79 |
$246.75
|
|
X-ray bone length studies
|
$202.39 |
$202.39 |
$202.39 |
$287.25
|
|
X-ray bone survey complete
|
$358.52 |
$358.52 |
$358.52 |
$666.60
|
|
X-ray bone survey infant
|
$227.84 |
$227.84 |
$227.84 |
$410.73
|
|
X-ray cervical spine 2-3 views
|
$470.96 |
$470.96 |
$470.96 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$654.67 |
$654.67 |
$654.67 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$772.62 |
$772.62 |
$772.62 |
$515.35
|
|
X-ray clavicle complete (both sides)
|
$387.80 |
$387.80 |
$387.80 |
$299.65
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$610.12 |
$610.12 |
$610.12 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$683.52 |
$683.52 |
$683.52 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$390.34 |
$390.34 |
$390.34 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$433.62 |
$433.62 |
$433.62 |
$342.00
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$451.86 |
$451.86 |
$451.86 |
$486.24
|
|
X-ray exam entire spi 4/5 vw
|
$283.00 |
$283.00 |
$283.00 |
$486.01
|
|
X-ray exam of arm infant
|
$179.90 |
$179.90 |
$179.90 |
$248.82
|
|
X-ray exam of eye sockets
|
$179.05 |
$179.05 |
$179.05 |
$349.05
|
|
X-ray exam of jaw joint
|
$142.56 |
$142.56 |
$142.56 |
$192.39
|
|
X-ray exam of perineum
|
$231.24 |
$231.24 |
$231.24 |
$420.93
|
|
X-ray exam of sinuses
|
$280.88 |
$280.88 |
$280.88 |
$211.00
|
|
X-ray exam si joints
|
$222.75 |
$222.75 |
$222.75 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$409.01 |
$409.01 |
$409.01 |
$395.59
|
|
X-ray eye detection foreign body (both sides)
|
$134.08 |
$134.08 |
$134.08 |
$235.00
|
|
X-ray facial bones complete > 3 views
|
$386.52 |
$386.52 |
$386.52 |
$366.60
|
|
X-ray femur >=2 views (both sides)
|
$492.17 |
$492.17 |
$492.17 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$332.22 |
$332.22 |
$332.22 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$344.95 |
$344.95 |
$344.95 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$302.94 |
$302.94 |
$302.94 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$271.97 |
$271.97 |
$271.97 |
$316.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$266.45 |
$266.45 |
$266.45 |
$270.00
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$168.02 |
$168.02 |
$168.02 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$706.01 |
$706.01 |
$706.01 |
$409.24
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$164.63 |
$164.63 |
$164.63 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$433.62 |
$433.62 |
$433.62 |
$304.15
|
|
X-ray knee 1-2 views (both sides)
|
$330.94 |
$330.94 |
$330.94 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$324.16 |
$324.16 |
$324.16 |
$353.25
|
|
X-ray knee ap standing bilateral
|
$205.36 |
$205.36 |
$205.36 |
$276.25
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$228.27 |
$228.27 |
$228.27 |
$249.13
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$619.88 |
$619.88 |
$619.88 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$633.03 |
$633.03 |
$633.03 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$695.40 |
$695.40 |
$695.40 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$367.01 |
$367.01 |
$367.01 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$160.81 |
$160.81 |
$160.81 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$299.55 |
$299.55 |
$299.55 |
$277.70
|
|
X-ray neck soft tissue
|
$335.61 |
$335.61 |
$335.61 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$247.79 |
$247.79 |
$247.79 |
$225.96
|
|
X-ray pelvis 1-2 views
|
$414.53 |
$414.53 |
$414.53 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$356.83 |
$356.83 |
$356.83 |
$342.30
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$362.34 |
$362.34 |
$362.34 |
$742.00
|
|
X-ray ribs 2 views left
|
$495.57 |
$495.57 |
$495.57 |
$296.32
|
|
X-ray ribs 3 views bilateral
|
$334.34 |
$334.34 |
$334.34 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$596.97 |
$596.97 |
$596.97 |
$359.47
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$531.20 |
$531.20 |
$531.20 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$441.68 |
$441.68 |
$441.68 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$377.62 |
$377.62 |
$377.62 |
$285.60
|
|
X-ray scapula complete (both sides)
|
$313.97 |
$313.97 |
$313.97 |
$292.50
|
|
X-ray shoulder 1 view (both sides)
|
$348.34 |
$348.34 |
$348.34 |
$264.48
|
|
X-ray sinuses paranasal complete > 3 views
|
$400.10 |
$400.10 |
$400.10 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$352.58 |
$352.58 |
$352.58 |
$601.30
|
|
X-ray skull < 4 views
|
$342.82 |
$342.82 |
$342.82 |
$291.78
|
|
X-ray skull > 4 views complete
|
$552.42 |
$552.42 |
$552.42 |
$414.60
|
|
X-ray slg plne bdy sect without urogr
|
$673.76 |
$673.76 |
$673.76 |
$387.00
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$600.79 |
$600.79 |
$600.79 |
$557.70
|
|
X-ray small intestine follow-through study
|
$348.76 |
$348.76 |
$348.76 |
$504.14
|
|
X-ray spine single view
|
$263.06 |
$263.06 |
$263.06 |
$252.60
|
|
X-ray sternum > 2 views
|
$278.33 |
$278.33 |
$278.33 |
$269.75
|
|
X-ray surgical specimen
|
$279.18 |
$279.18 |
$279.18 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$615.64 |
$615.64 |
$615.64 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$211.30 |
$211.30 |
$211.30 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$341.13 |
$341.13 |
$341.13 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$487.08 |
$487.08 |
$487.08 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$189.23 |
$189.23 |
$189.23 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$219.78 |
$219.78 |
$219.78 |
$256.85
|
|
X-ray tibia/fibula 2 views (both sides)
|
$357.67 |
$357.67 |
$357.67 |
$328.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$332.22 |
$332.22 |
$332.22 |
$264.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$924.09 |
$924.09 |
$924.09 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$437.86 |
$437.86 |
$437.86 |
$555.04
|
|
X-ray wrist 2 views (both sides)
|
$343.67 |
$343.67 |
$343.67 |
$290.40
|
|
Xylose absorption test blood &/or urine
|
$123.47 |
$123.47 |
$123.47 |
$64.28
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$108.16 |
$108.16 |
$108.16 |
$128.10
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$186.21 |
$186.21 |
$186.21 |
$346.14
|