|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$979.90 |
$979.90 |
$979.90 |
$288.91
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$1,019.06 |
$1,019.06 |
$1,019.06 |
$436.15
|
|
Wrist X-ray
|
$526.65 |
$526.65 |
$526.65 |
$343.70
|
|
Xe133 xenon 10mci
|
$74.21 |
$74.21 |
$74.21 |
$299.00
|
|
X-ray abdomen 1 view
|
$322.06 |
$322.06 |
$322.06 |
$255.00
|
|
X-ray abdomen 2 views
|
$505.53 |
$505.53 |
$505.53 |
$312.36
|
|
X-ray abdomen >=3 views
|
$505.53 |
$505.53 |
$505.53 |
$332.15
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$608.65 |
$608.65 |
$608.65 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$185.53 |
$185.53 |
$185.53 |
$271.44
|
|
X-ray ankle 2 views (both sides)
|
$463.51 |
$463.51 |
$463.51 |
$283.00
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$624.84 |
$624.84 |
$624.84 |
$768.30
|
|
X-ray bone age studies
|
$143.50 |
$143.50 |
$143.50 |
$246.75
|
|
X-ray bone length studies
|
$207.87 |
$207.87 |
$207.87 |
$287.25
|
|
X-ray bone survey complete
|
$483.80 |
$483.80 |
$483.80 |
$666.60
|
|
X-ray bone survey infant
|
$525.83 |
$525.83 |
$525.83 |
$410.73
|
|
X-ray cervical spine 2-3 views
|
$374.95 |
$374.95 |
$374.95 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$506.15 |
$506.15 |
$506.15 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$633.66 |
$633.66 |
$633.66 |
$515.35
|
|
X-ray clavicle complete (both sides)
|
$387.86 |
$387.86 |
$387.86 |
$299.65
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$629.76 |
$629.76 |
$629.76 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$881.71 |
$881.71 |
$881.71 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$523.57 |
$523.57 |
$523.57 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$624.64 |
$624.64 |
$624.64 |
$342.00
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$520.70 |
$520.70 |
$520.70 |
$486.24
|
|
X-ray exam of eye sockets
|
$283.52 |
$283.52 |
$283.52 |
$349.05
|
|
X-ray exam of femur 1
|
$522.55 |
$522.55 |
$522.55 |
$232.36
|
|
X-ray exam of jaw joint
|
$389.71 |
$389.71 |
$389.71 |
$354.79
|
|
X-ray exam of mastoids
|
$137.56 |
$137.56 |
$137.56 |
$191.91
|
|
X-ray exam of middle ear
|
$242.93 |
$242.93 |
$242.93 |
$341.25
|
|
X-ray exam of penis
|
$1,072.36 |
$1,072.36 |
$1,072.36 |
$565.20
|
|
X-ray exam of sinuses
|
$181.63 |
$181.63 |
$181.63 |
$211.00
|
|
X-ray exam si joints
|
$365.72 |
$365.72 |
$365.72 |
$246.16
|
|
X-ray eye detection foreign body (both sides)
|
$194.55 |
$194.55 |
$194.55 |
$235.00
|
|
X-ray facial bones complete > 3 views
|
$290.69 |
$290.69 |
$290.69 |
$366.60
|
|
X-ray femur >=2 views (both sides)
|
$985.85 |
$985.85 |
$985.85 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$257.69 |
$257.69 |
$257.69 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$448.34 |
$448.34 |
$448.34 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$452.23 |
$452.23 |
$452.23 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$379.87 |
$379.87 |
$379.87 |
$316.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$369.82 |
$369.82 |
$369.82 |
$270.00
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$99.02 |
$99.02 |
$99.02 |
$370.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$504.92 |
$504.92 |
$504.92 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$504.92 |
$504.92 |
$504.92 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$581.59 |
$581.59 |
$581.59 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$268.35 |
$268.35 |
$268.35 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$287.41 |
$287.41 |
$287.41 |
$304.15
|
|
X-ray knee 1-2 views (both sides)
|
$421.69 |
$421.69 |
$421.69 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$516.81 |
$516.81 |
$516.81 |
$353.25
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$425.99 |
$425.99 |
$425.99 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$518.65 |
$518.65 |
$518.65 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$659.28 |
$659.28 |
$659.28 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$399.55 |
$399.55 |
$399.55 |
$352.83
|
|
X-ray nasal bones complete > 3 views
|
$246.00 |
$246.00 |
$246.00 |
$277.70
|
|
X-ray neck soft tissue
|
$335.18 |
$335.18 |
$335.18 |
$237.43
|
|
X-ray of mammary ducts
|
$327.59 |
$327.59 |
$327.59 |
$473.55
|
|
X-ray pelvis 1-2 views
|
$282.29 |
$282.29 |
$282.29 |
$270.84
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$527.06 |
$527.06 |
$527.06 |
$742.00
|
|
X-ray ribs 3 views bilateral
|
$372.90 |
$372.90 |
$372.90 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$362.03 |
$362.03 |
$362.03 |
$359.47
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$470.68 |
$470.68 |
$470.68 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$420.05 |
$420.05 |
$420.05 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$362.03 |
$362.03 |
$362.03 |
$285.60
|
|
X-ray scapula complete (both sides)
|
$502.66 |
$502.66 |
$502.66 |
$292.50
|
|
X-ray sella turcica
|
$117.47 |
$117.47 |
$117.47 |
$162.50
|
|
X-ray shoulder 1 view (both sides)
|
$387.04 |
$387.04 |
$387.04 |
$264.48
|
|
X-ray sinuses paranasal complete > 3 views
|
$226.94 |
$226.94 |
$226.94 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$407.34 |
$407.34 |
$407.34 |
$601.30
|
|
X-ray skull < 4 views
|
$322.88 |
$322.88 |
$322.88 |
$291.78
|
|
X-ray skull > 4 views complete
|
$406.93 |
$406.93 |
$406.93 |
$414.60
|
|
X-ray slg plne bdy sect without urogr
|
$271.83 |
$271.83 |
$271.83 |
$387.00
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$391.96 |
$391.96 |
$391.96 |
$557.70
|
|
X-ray small intestine follow-through study
|
$701.51 |
$701.51 |
$701.51 |
$504.14
|
|
X-ray spine single view
|
$268.35 |
$268.35 |
$268.35 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$412.26 |
$412.26 |
$412.26 |
$263.49
|
|
X-ray sternum > 2 views
|
$335.18 |
$335.18 |
$335.18 |
$269.75
|
|
X-ray surgical specimen
|
$381.30 |
$381.30 |
$381.30 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$499.59 |
$499.59 |
$499.59 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$304.84 |
$304.84 |
$304.84 |
$317.70
|
|
X-ray thoracic spine 3 views
|
$438.50 |
$438.50 |
$438.50 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$280.65 |
$280.65 |
$280.65 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$68.88 |
$68.88 |
$68.88 |
$385.80
|
|
X-ray tibia/fibula 2 views (both sides)
|
$575.03 |
$575.03 |
$575.03 |
$328.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$277.98 |
$277.98 |
$277.98 |
$264.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$477.04 |
$477.04 |
$477.04 |
$555.04
|
|
X-ray wrist 2 views (both sides)
|
$438.91 |
$438.91 |
$438.91 |
$290.40
|
|
Xwrap 1 sq cm
|
$3,877.17 |
$3,877.17 |
$3,877.17 |
$171.12
|
|
Yersinia antibody
|
$83.03 |
$83.03 |
$83.03 |
$66.95
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$32.39 |
$32.39 |
$32.39 |
$106.94
|
|
Zika virus dna/rna amp probe
|
$27.68 |
$27.68 |
$27.68 |
$175.00
|
|
Zika virus igm antibody
|
$18.45 |
$18.45 |
$18.45 |
$75.40
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$11.48 |
$11.48 |
$11.48 |
$121.56
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$541.00 |
$541.00 |
$541.00 |
$405.10
|