|
Warde vitamin c (ascorbic acid)
|
$6.30 |
$40.32 |
$93.12 |
|
|
Warde vitamin d (1 25 dihydroxy)
|
$40.92 |
$157.32 |
$363.50 |
|
|
Warde vitamin e (alpha-tocopherol)
|
$11.00 |
$24.99 |
$53.55 |
|
|
Warde zinc
|
$9.46 |
$83.64 |
$138.23 |
|
|
Wbc automated
|
$5.20 |
$29.61 |
$48.96 |
|
|
Wedging of cast
|
$394.24 |
$394.24 |
$394.24 |
|
|
Western blot test
|
$44.10 |
$94.50 |
$238.97 |
|
|
Whole blood for transfusion
|
$334.19 |
$656.60 |
$662.97 |
|
|
Whole blood or red blood cells frozen/deglycerolized/washed leukocytes reduced each unit
|
$178.29 |
$448.04 |
$1,065.00 |
|
|
Whole blood/red blood cells leukocytes reduced cmv negative each unit
|
$240.24 |
$329.00 |
$335.57 |
|
|
Wnd prep f/n/hf/g addl cm
|
$280.14 |
$320.16 |
$600.30 |
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$192.72 |
$249.36 |
$467.55 |
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$78.54 |
$248.86 |
$486.90 |
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$45.98 |
$109.41 |
$188.16 |
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$80.40 |
$180.72 |
$360.18 |
|
|
Wrist endoscopy/surgery
|
$750.40 |
$750.40 |
$750.40 |
|
|
Wrist X-ray
|
$77.20 |
$105.60 |
$144.00 |
|
|
Xe133 xenon 10mci
|
$60.41 |
$72.49 |
$120.82 |
|
|
Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/<
|
$1,090.00 |
$1,307.25 |
$2,696.72 |
|
|
Xfer tis s/a/l 10 sq cm/<
|
$1,095.15 |
$1,095.15 |
$1,095.15 |
|
|
Xm archive tissue molec anal
|
$7.77 |
$15.17 |
$16.65 |
|
|
Xpos opn fmrl eprst aor uni add-on
|
$472.00 |
$590.00 |
$1,417.20 |
|
|
X-ray abdomen 1 view
|
$60.26 |
$109.83 |
$200.20 |
|
|
X-ray abdomen 2 views
|
$81.65 |
$126.28 |
$204.88 |
|
|
X-ray abdomen >=3 views
|
$78.54 |
$134.48 |
$214.83 |
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$79.20 |
$144.00 |
$375.27 |
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$57.42 |
$102.48 |
$166.40 |
|
|
X-ray ankle 2 views (both sides)
|
$57.40 |
$86.08 |
$144.00 |
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$223.08 |
$287.00 |
$405.60 |
|
|
X-ray assay calculus
|
$18.69 |
$59.04 |
$64.80 |
|
|
X-ray bone age studies
|
$56.60 |
$86.08 |
$264.15 |
|
|
X-ray bone length studies
|
$71.40 |
$89.28 |
$193.44 |
|
|
X-ray bone survey complete
|
$189.64 |
$226.75 |
$384.48 |
|
|
X-ray bone survey infant
|
$74.00 |
$144.96 |
$259.77 |
|
|
X-ray cervical spine 2-3 views
|
$71.40 |
$129.78 |
$236.70 |
|
|
X-ray cervical spine 4-5 views
|
$117.70 |
$146.79 |
$272.25 |
|
|
X-ray cervical spine >= 6 views
|
$35.42 |
$160.02 |
$283.95 |
|
|
X-ray clavicle complete (both sides)
|
$54.50 |
$94.50 |
$144.00 |
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$107.58 |
$175.04 |
$266.28 |
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$144.98 |
$263.60 |
$375.27 |
|
|
X-ray elbow 2 views (both sides)
|
$54.50 |
$90.90 |
$144.00 |
|
|
X-ray elbow >= 3 views (both sides)
|
$60.75 |
$94.71 |
$136.00 |
|
|
Xray endovasc thor ao repr
|
$1,574.32 |
$1,643.75 |
$2,862.40 |
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$79.20 |
$144.00 |
$200.97 |
|
|
X-ray exam entire spi 4/5 vw
|
$126.20 |
$151.44 |
$328.12 |
|
|
X-ray exam entire spi 6/> vw
|
$145.60 |
$174.72 |
$291.20 |
|
|
X-ray exam of arm infant
|
$56.60 |
$75.60 |
$144.00 |
|
|
X-ray exam of eye sockets
|
$49.94 |
$90.80 |
$137.55 |
|
|
X-ray exam of femur 1
|
$47.20 |
$85.26 |
$142.80 |
|
|
X-ray exam of jaw joint
|
$33.88 |
$39.79 |
$77.85 |
|
|
X-ray exam of mastoids
|
$175.48 |
$192.60 |
$255.99 |
|
|
X-ray exam of middle ear
|
$138.05 |
$138.05 |
$138.05 |
|
|
X-ray exam of penis
|
$266.24 |
$266.24 |
$266.24 |
|
|
X-ray exam of sinuses
|
$41.50 |
$79.20 |
$212.40 |
|
|
X-ray exam si joints
|
$38.20 |
$99.32 |
$133.14 |
|
|
X-ray exam thorac spine4/>vw
|
$79.20 |
$132.00 |
$286.00 |
|
|
X-ray eye detection foreign body (both sides)
|
$98.12 |
$109.40 |
$178.40 |
|
|
X-ray facial bones complete > 3 views
|
$60.75 |
$123.76 |
$144.00 |
|
|
X-ray fallopian tube
|
$90.93 |
$90.93 |
$90.93 |
|
|
X-ray femur >=2 views (both sides)
|
$85.20 |
$102.24 |
$231.40 |
|
|
X-ray finger(s) >= 2 views (both sides)
|
$50.80 |
$78.75 |
$144.00 |
|
|
X-ray foot 2 views (both sides)
|
$53.60 |
$86.08 |
$143.20 |
|
|
X-ray forearm 2 views (both sides)
|
$56.60 |
$105.60 |
$144.00 |
|
|
X-ray hand 2 views (both sides)
|
$54.50 |
$97.20 |
$264.15 |
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$38.60 |
$87.78 |
$144.00 |
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$113.80 |
$136.56 |
$153.60 |
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$66.88 |
$124.50 |
$222.30 |
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$113.80 |
$142.80 |
$306.00 |
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$115.06 |
$158.16 |
$305.28 |
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$52.60 |
$79.20 |
$144.00 |
|
|
X-ray humerus >= 2 views left
|
$56.60 |
$107.83 |
$143.20 |
|
|
X-ray joint survey 1 view
|
$51.03 |
$51.03 |
$81.73 |
|
|
X-ray knee 1-2 views (both sides)
|
$60.75 |
$96.76 |
$144.00 |
|
|
X-ray knee 3 views (both sides)
|
$71.40 |
$107.83 |
$143.20 |
|
|
X-ray knee ap standing bilateral
|
$59.20 |
$86.08 |
$178.40 |
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$61.20 |
$79.20 |
$231.40 |
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$57.40 |
$110.00 |
$144.00 |
|
|
X-ray lumbosacral spine >= 4 views
|
$80.30 |
$159.39 |
$213.20 |
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$113.74 |
$206.80 |
$482.85 |
|
|
X-ray mandible complete > 4 views
|
$63.80 |
$116.00 |
$153.90 |
|
|
X-ray mandible ltd <4 views
|
$18.26 |
$60.49 |
$209.04 |
|
|
X-ray nasal bones complete > 3 views
|
$60.75 |
$95.76 |
$153.90 |
|
|
X-ray neck soft tissue
|
$54.50 |
$93.20 |
$182.70 |
|
|
X-ray nose to rectum for foreign body child
|
$52.36 |
$88.00 |
$241.80 |
|
|
X-ray of mammary ducts
|
$243.12 |
$243.12 |
$243.12 |
|
|
X-ray optic foramina
|
$52.71 |
$52.71 |
$81.73 |
|
|
X-ray pelvis 1-2 views
|
$44.25 |
$111.60 |
$191.31 |
|
|
X-ray pelvis complete > 3 views
|
$77.20 |
$119.72 |
$160.16 |
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$123.00 |
$258.06 |
$469.20 |
|
|
X-ray ribs 2 views left
|
$66.00 |
$93.60 |
$202.80 |
|
|
X-ray ribs 3 views bilateral
|
$74.40 |
$124.23 |
$219.12 |
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$78.75 |
$124.23 |
$171.08 |
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$102.80 |
$148.05 |
$219.12 |
|
|
X-ray sacroiliac joints >= 3 views
|
$53.90 |
$98.00 |
$241.80 |
|
|
X-ray sacrum/coccyx >= 2 views
|
$54.50 |
$111.60 |
$149.94 |
|
|
X-ray scapula complete (both sides)
|
$50.00 |
$91.02 |
$241.80 |
|
|
X-ray sella turcica
|
$81.73 |
$81.73 |
$81.73 |
|
|
X-ray shoulder 1 view (both sides)
|
$34.75 |
$84.60 |
$144.00 |
|
|
X-ray sinuses paranasal complete > 3 views
|
$79.20 |
$123.76 |
$144.00 |
|
|
X-ray sinus tract/fistula/abscess
|
$241.08 |
$300.48 |
$558.40 |
|
