|
Wnd prep f/n/hf/g addl cm
|
$979.44 |
$979.44 |
$979.44 |
$865.80
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$399.84 |
$399.84 |
$399.84 |
$501.80
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$436.80 |
$436.80 |
$436.80 |
$558.97
|
|
Wrist X-ray
|
$115.50 |
$115.50 |
$115.50 |
$311.20
|
|
Xe133 xenon 10mci
|
$107.94 |
$107.94 |
$107.94 |
$299.00
|
|
X-ray abdomen 1 view
|
$102.90 |
$102.90 |
$102.90 |
$243.00
|
|
X-ray abdomen >=3 views
|
$148.68 |
$148.68 |
$148.68 |
$309.38
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$136.92 |
$136.92 |
$136.92 |
$246.42
|
|
X-ray ankle 2 views (both sides)
|
$106.68 |
$106.68 |
$106.68 |
$240.00
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$248.22 |
$248.22 |
$248.22 |
$734.43
|
|
X-ray bone age studies
|
$128.10 |
$128.10 |
$128.10 |
$227.08
|
|
X-ray bone length studies
|
$107.10 |
$107.10 |
$107.10 |
$258.70
|
|
X-ray bone survey complete
|
$181.44 |
$181.44 |
$181.44 |
$569.03
|
|
X-ray bone survey infant
|
$119.28 |
$119.28 |
$119.28 |
$362.40
|
|
X-ray cervical spine 2-3 views
|
$105.84 |
$105.84 |
$105.84 |
$308.40
|
|
X-ray cervical spine 4-5 views
|
$173.88 |
$173.88 |
$173.88 |
$439.14
|
|
X-ray cervical spine >= 6 views
|
$232.26 |
$232.26 |
$232.26 |
$479.05
|
|
X-ray clavicle complete (both sides)
|
$118.02 |
$118.02 |
$118.02 |
$277.00
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$305.76 |
$305.76 |
$305.76 |
$594.68
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$452.34 |
$452.34 |
$452.34 |
$785.86
|
|
X-ray elbow 2 views (both sides)
|
$100.38 |
$100.38 |
$100.38 |
$281.40
|
|
X-ray elbow >= 3 views (both sides)
|
$106.68 |
$106.68 |
$106.68 |
$325.88
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$118.86 |
$118.86 |
$118.86 |
$434.76
|
|
X-ray exam of arm infant
|
$97.02 |
$97.02 |
$97.02 |
$238.26
|
|
X-ray exam of eye sockets
|
$153.72 |
$153.72 |
$153.72 |
$321.48
|
|
X-ray exam of mastoids
|
$100.38 |
$100.38 |
$100.38 |
$187.60
|
|
X-ray exam of sinuses
|
$84.84 |
$84.84 |
$84.84 |
$192.00
|
|
X-ray exam thorac spine4/>vw
|
$194.04 |
$194.04 |
$194.04 |
$365.00
|
|
X-ray facial bones complete > 3 views
|
$157.92 |
$157.92 |
$157.92 |
$337.95
|
|
X-ray femur >=2 views (both sides)
|
$128.10 |
$128.10 |
$128.10 |
$290.44
|
|
X-ray finger(s) >= 2 views (both sides)
|
$60.90 |
$60.90 |
$60.90 |
$233.55
|
|
X-ray foot 2 views (both sides)
|
$100.38 |
$100.38 |
$100.38 |
$270.40
|
|
X-ray forearm 2 views (both sides)
|
$96.60 |
$96.60 |
$96.60 |
$317.62
|
|
X-ray hand 2 views (both sides)
|
$109.20 |
$109.20 |
$109.20 |
$270.00
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$93.24 |
$93.24 |
$93.24 |
$243.10
|
|
X-ray humerus >= 2 views left
|
$103.32 |
$103.32 |
$103.32 |
$285.00
|
|
X-ray knee 1-2 views (both sides)
|
$102.48 |
$102.48 |
$102.48 |
$271.70
|
|
X-ray knee ap standing bilateral
|
$95.34 |
$95.34 |
$95.34 |
$243.09
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$97.02 |
$97.02 |
$97.02 |
$227.92
|
|
X-ray lumbosacral spine >= 4 views
|
$223.02 |
$223.02 |
$223.02 |
$475.04
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$264.18 |
$264.18 |
$264.18 |
$513.63
|
|
X-ray mandible complete > 4 views
|
$154.14 |
$154.14 |
$154.14 |
$323.70
|
|
X-ray mandible ltd <4 views
|
$104.16 |
$104.16 |
$104.16 |
$200.20
|
|
X-ray nasal bones complete > 3 views
|
$104.16 |
$104.16 |
$104.16 |
$260.52
|
|
X-ray neck soft tissue
|
$87.36 |
$87.36 |
$87.36 |
$221.10
|
|
X-ray nose to rectum for foreign body child
|
$225.96 |
$225.96 |
$225.96 |
$201.00
|
|
X-ray pelvis 1-2 views
|
$118.86 |
$118.86 |
$118.86 |
$242.58
|
|
X-ray pelvis complete > 3 views
|
$125.58 |
$125.58 |
$125.58 |
$299.46
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$827.82 |
$827.82 |
$827.82 |
$663.18
|
|
X-ray ribs 2 views left
|
$139.02 |
$139.02 |
$139.02 |
$281.45
|
|
X-ray ribs 3 views bilateral
|
$157.50 |
$157.50 |
$157.50 |
$361.20
|
|
X-ray sacroiliac joints >= 3 views
|
$118.86 |
$118.86 |
$118.86 |
$270.40
|
|
X-ray sacrum/coccyx >= 2 views
|
$106.26 |
$106.26 |
$106.26 |
$260.65
|
|
X-ray scapula complete (both sides)
|
$106.26 |
$106.26 |
$106.26 |
$264.80
|
|
X-ray sella turcica
|
$77.70 |
$77.70 |
$77.70 |
$144.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$180.18 |
$180.18 |
$180.18 |
$324.53
|
|
X-ray sinus tract/fistula/abscess
|
$553.14 |
$553.14 |
$553.14 |
$539.50
|
|
X-ray skull < 4 views
|
$127.26 |
$127.26 |
$127.26 |
$277.54
|
|
X-ray skull > 4 views complete
|
$207.48 |
$207.48 |
$207.48 |
$404.30
|
|
X-ray slg plne bdy sect without urogr
|
$252.84 |
$252.84 |
$252.84 |
$370.64
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$193.62 |
$193.62 |
$193.62 |
$511.38
|
|
X-ray spine single view
|
$81.90 |
$81.90 |
$81.90 |
$225.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$145.74 |
$145.74 |
$145.74 |
$236.88
|
|
X-ray sternum > 2 views
|
$132.72 |
$132.72 |
$132.72 |
$230.00
|
|
X-ray surgical specimen
|
$331.80 |
$331.80 |
$331.80 |
$457.47
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$135.24 |
$135.24 |
$135.24 |
$276.00
|
|
X-ray thoracic spine 2 views
|
$115.50 |
$115.50 |
$115.50 |
$286.65
|
|
X-ray thoracic spine 3 views
|
$134.82 |
$134.82 |
$134.82 |
$343.00
|
|
X-ray thoracolumbar spine >=2 views
|
$71.82 |
$71.82 |
$71.82 |
$269.10
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$156.24 |
$156.24 |
$156.24 |
$211.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$203.70 |
$203.70 |
$203.70 |
$346.50
|
|
X-ray tibia/fibula 2 views (both sides)
|
$103.32 |
$103.32 |
$103.32 |
$306.47
|
|
X-ray toe(s) > 2 views (both sides)
|
$65.10 |
$65.10 |
$65.10 |
$225.00
|
|
X-ray wrist 2 views (both sides)
|
$102.48 |
$102.48 |
$102.48 |
$268.49
|
|
Xylose absorption test blood &/or urine
|
$38.01 |
$38.01 |
$38.01 |
$91.44
|
|
Yersinia antibody
|
$23.84 |
$23.84 |
$23.84 |
$79.20
|