|
Warde vitamin a
|
$13.44 |
$13.44 |
$13.44 |
$68.00
|
|
Warde vitamin b-1 (thiamine)
|
$24.64 |
$24.64 |
$24.64 |
$99.27
|
|
Warde vitamin b6 (pyridoxine)
|
$33.04 |
$33.04 |
$33.04 |
$127.40
|
|
Warde vitamin c (ascorbic acid)
|
$11.76 |
$11.76 |
$11.76 |
$51.30
|
|
Warde vitamin d (1 25 dihydroxy)
|
$45.36 |
$45.36 |
$45.36 |
$182.52
|
|
Warde vitamin e (alpha-tocopherol)
|
$16.24 |
$16.24 |
$16.24 |
$64.28
|
|
Warde zinc
|
$13.44 |
$13.44 |
$13.44 |
$67.20
|
|
Wbc automated
|
$20.16 |
$20.16 |
$20.16 |
$32.80
|
|
Western blot test
|
$52.91 |
$52.91 |
$52.91 |
$170.40
|
|
Whole blood for transfusion
|
$354.48 |
$354.48 |
$354.48 |
$400.68
|
|
Whole blood or red blood cells frozen/deglycerolized/washed leukocytes reduced each unit
|
$213.92 |
$213.92 |
$213.92 |
$511.20
|
|
Whole blood/red blood cells leukocytes reduced cmv negative each unit
|
$334.88 |
$334.88 |
$334.88 |
$432.00
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$282.24 |
$282.24 |
$282.24 |
$501.80
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$313.04 |
$313.04 |
$313.04 |
$558.97
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$147.84 |
$147.84 |
$147.84 |
$275.88
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$178.08 |
$178.08 |
$178.08 |
$370.00
|
|
Wrist X-ray
|
$180.88 |
$180.88 |
$180.88 |
$311.20
|
|
Xm archive tissue molec anal
|
$28.56 |
$28.56 |
$28.56 |
$48.00
|
|
Xpos opn axillary/sbclvn art w/cndt crtn
|
$2,342.48 |
$2,342.48 |
$2,342.48 |
$1,869.40
|
|
Xpos opn fmrl eprst aor uni add-on
|
$1,633.52 |
$1,633.52 |
$1,633.52 |
$2,234.27
|
|
X-ray abdomen 1 view
|
$87.92 |
$87.92 |
$87.92 |
$243.00
|
|
X-ray abdomen 2 views
|
$127.12 |
$127.12 |
$127.12 |
$281.50
|
|
X-ray abdomen >=3 views
|
$62.16 |
$62.16 |
$62.16 |
$309.38
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$104.72 |
$104.72 |
$104.72 |
$359.84
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$104.16 |
$104.16 |
$104.16 |
$246.42
|
|
X-ray ankle 2 views (both sides)
|
$119.28 |
$119.28 |
$119.28 |
$239.39
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$281.68 |
$281.68 |
$281.68 |
$718.20
|
|
X-ray bone age studies
|
$90.16 |
$90.16 |
$90.16 |
$227.08
|
|
X-ray bone length studies
|
$156.24 |
$156.24 |
$156.24 |
$258.70
|
|
X-ray bone survey complete
|
$117.04 |
$117.04 |
$117.04 |
$569.03
|
|
X-ray bone survey infant
|
$87.92 |
$87.92 |
$87.92 |
$362.40
|
|
X-ray cervical spine 2-3 views
|
$141.68 |
$141.68 |
$141.68 |
$307.30
|
|
X-ray cervical spine 4-5 views
|
$182.00 |
$182.00 |
$182.00 |
$439.14
|
|
X-ray cervical spine >= 6 views
|
$186.48 |
$186.48 |
$186.48 |
$478.69
|
|
X-ray clavicle complete (both sides)
|
$112.00 |
$112.00 |
$112.00 |
$277.00
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$287.84 |
$287.84 |
$287.84 |
$594.68
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$281.68 |
$281.68 |
$281.68 |
$785.86
|
|
X-ray elbow 2 views (both sides)
|
$116.48 |
$116.48 |
$116.48 |
$280.80
|
|
X-ray elbow >= 3 views (both sides)
|
$172.48 |
$172.48 |
$172.48 |
$325.88
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$151.76 |
$151.76 |
$151.76 |
$434.76
|
|
X-ray exam entire spi 4/5 vw
|
$246.96 |
$246.96 |
$246.96 |
$441.48
|
|
X-ray exam entire spi 6/> vw
|
$326.48 |
$326.48 |
$326.48 |
$562.90
|
|
X-ray exam of arm infant
|
$92.40 |
$92.40 |
$92.40 |
$238.26
|
|
X-ray exam of eye sockets
|
$174.72 |
$174.72 |
$174.72 |
$321.48
|
|
X-ray exam of femur 1
|
$86.24 |
$86.24 |
$86.24 |
$194.40
|
|
X-ray exam of mastoids
|
$220.08 |
$220.08 |
$220.08 |
$187.60
|
|
X-ray exam of sinuses
|
$50.40 |
$50.40 |
$50.40 |
$192.00
|
|
X-ray exam thorac spine4/>vw
|
$182.00 |
$182.00 |
$182.00 |
$365.00
|
|
X-ray eye detection foreign body (both sides)
|
$147.28 |
$147.28 |
$147.28 |
$227.80
|
|
X-ray facial bones complete > 3 views
|
$186.48 |
$186.48 |
$186.48 |
$336.00
|
|
X-ray femur >=2 views (both sides)
|
$151.76 |
$151.76 |
$151.76 |
$288.00
|
|
X-ray finger(s) >= 2 views (both sides)
|
$62.16 |
$62.16 |
$62.16 |
$233.55
|
|
X-ray foot 2 views (both sides)
|
$103.04 |
$103.04 |
$103.04 |
$270.40
|
|
X-ray forearm 2 views (both sides)
|
$120.40 |
$120.40 |
$120.40 |
$317.62
|
|
X-ray hand 2 views (both sides)
|
$75.04 |
$75.04 |
$75.04 |
$267.20
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$119.28 |
$119.28 |
$119.28 |
$243.10
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$268.80 |
$268.80 |
$268.80 |
$300.00
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$211.12 |
$211.12 |
$211.12 |
$313.45
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$268.80 |
$268.80 |
$268.80 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$281.68 |
$281.68 |
$281.68 |
$477.10
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$103.60 |
$103.60 |
$103.60 |
$186.60
|
|
X-ray humerus >= 2 views left
|
$122.08 |
$122.08 |
$122.08 |
$285.00
|
|
X-ray joint survey 1 view
|
$174.72 |
$174.72 |
$174.72 |
$211.00
|
|
X-ray knee 1-2 views (both sides)
|
$136.08 |
$136.08 |
$136.08 |
$271.70
|
|
X-ray knee 3 views (both sides)
|
$143.92 |
$143.92 |
$143.92 |
$319.24
|
|
X-ray knee ap standing bilateral
|
$109.20 |
$109.20 |
$109.20 |
$238.80
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$134.40 |
$134.40 |
$134.40 |
$227.92
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$75.60 |
$75.60 |
$75.60 |
$342.55
|
|
X-ray lumbosacral spine >= 4 views
|
$210.56 |
$210.56 |
$210.56 |
$475.04
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$166.32 |
$166.32 |
$166.32 |
$513.63
|
|
X-ray mandible complete > 4 views
|
$182.56 |
$182.56 |
$182.56 |
$320.90
|
|
X-ray mandible ltd <4 views
|
$123.20 |
$123.20 |
$123.20 |
$200.20
|
|
X-ray nasal bones complete > 3 views
|
$116.48 |
$116.48 |
$116.48 |
$260.52
|
|
X-ray neck soft tissue
|
$99.12 |
$99.12 |
$99.12 |
$221.10
|
|
X-ray nose to rectum for foreign body child
|
$32.48 |
$32.48 |
$32.48 |
$201.00
|
|
X-ray of mammary ducts
|
$223.44 |
$223.44 |
$223.44 |
$437.00
|
|
X-ray pelvis 1-2 views
|
$77.84 |
$77.84 |
$77.84 |
$242.58
|
|
X-ray pelvis complete > 3 views
|
$140.00 |
$140.00 |
$140.00 |
$295.75
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$226.80 |
$226.80 |
$226.80 |
$663.18
|
|
X-ray ribs 2 views left
|
$86.80 |
$86.80 |
$86.80 |
$281.45
|
|
X-ray ribs 3 views bilateral
|
$137.20 |
$137.20 |
$137.20 |
$361.20
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$99.68 |
$99.68 |
$99.68 |
$327.21
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$166.32 |
$166.32 |
$166.32 |
$463.45
|
|
X-ray sacroiliac joints >= 3 views
|
$90.16 |
$90.16 |
$90.16 |
$270.40
|
|
X-ray sacrum/coccyx >= 2 views
|
$98.00 |
$98.00 |
$98.00 |
$260.00
|
|
X-ray scapula complete (both sides)
|
$134.40 |
$134.40 |
$134.40 |
$264.80
|
|
X-ray shoulder 1 view (both sides)
|
$106.96 |
$106.96 |
$106.96 |
$242.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$186.48 |
$186.48 |
$186.48 |
$324.53
|
|
X-ray sinus tract/fistula/abscess
|
$124.32 |
$124.32 |
$124.32 |
$529.75
|
|
X-ray skull < 4 views
|
$146.72 |
$146.72 |
$146.72 |
$277.54
|
|
X-ray skull > 4 views complete
|
$201.04 |
$201.04 |
$201.04 |
$404.30
|
|
X-ray slg plne bdy sect without urogr
|
$248.08 |
$248.08 |
$248.08 |
$370.64
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$186.48 |
$186.48 |
$186.48 |
$511.38
|
|
X-ray spine single view
|
$49.84 |
$49.84 |
$49.84 |
$225.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$90.16 |
$90.16 |
$90.16 |
$236.88
|
|
X-ray sternum > 2 views
|
$90.16 |
$90.16 |
$90.16 |
$230.00
|
|
X-ray surgical specimen
|
$222.32 |
$222.32 |
$222.32 |
$457.47
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$125.44 |
$125.44 |
$125.44 |
$463.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$84.56 |
$84.56 |
$84.56 |
$276.00
|
|
X-ray thoracic spine 2 views
|
$102.48 |
$102.48 |
$102.48 |
$286.65
|