|
Wound therapy negative pressure per session <= 50 sq cm
|
$217.70 |
$217.70 |
$217.70 |
$558.97
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$301.06 |
$301.06 |
$301.06 |
$611.25
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$196.26 |
$196.26 |
$196.26 |
$288.91
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$212.45 |
$212.45 |
$212.45 |
$436.15
|
|
Wrist arthroscopy
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$3,839.54
|
|
Wrist arthroscopy/surgery
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$3,839.54
|
|
Wrist arthroscopy/surgery
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$3,839.54
|
|
Wrist arthroscopy/surgery
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$3,839.54
|
|
Wrist arthroscopy/surgery
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$3,839.54
|
|
Wrist arthroscopy/surgery
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$6,010.63
|
|
Wrist endoscopy/surgery
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,512.00
|
|
Xcapsl ctrc rmvl cplx w/ecp
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$4,760.49
|
|
Xcapsl ctrc rmvl cplx wo ecp
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$3,724.80
|
|
Xcapsl ctrc rmvl insj 1+
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$6,105.79
|
|
Xcapsl ctrc rmvl w/ecp
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$4,760.49
|
|
Xcpsl ctrc rmvl cplx insj 1+
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$6,076.38
|
|
Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/<
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,830.00
|
|
Xfer tis s/a/l 10 sq cm/<
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,623.24
|
|
X-linked intellectual dblt
|
$1,005.40 |
$1,005.40 |
$1,005.40 |
$1,005.40
|
|
X-linked intellectual dblt
|
$1,005.40 |
$1,005.40 |
$1,005.40 |
$914.00
|
|
Xm archive tissue molec anal
|
$31.72 |
$31.72 |
$31.72 |
$47.85
|
|
Xpos opn fmrl eprst aor uni add-on
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,160.89
|
|
X-ray abdomen 1 view
|
$95.39 |
$95.39 |
$95.39 |
$255.00
|
|
X-ray abdomen 2 views
|
$114.65 |
$114.65 |
$114.65 |
$312.36
|
|
X-ray abdomen >=3 views
|
$132.37 |
$132.37 |
$132.37 |
$332.15
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$165.63 |
$165.63 |
$165.63 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$159.50 |
$159.50 |
$159.50 |
$271.44
|
|
X-ray assay calculus
|
$13.77 |
$13.77 |
$13.77 |
$13.77
|
|
X-ray bone age studies
|
$63.23 |
$63.23 |
$63.23 |
$246.75
|
|
X-ray bone length studies
|
$100.86 |
$100.86 |
$100.86 |
$287.25
|
|
X-ray bone survey complete
|
$168.47 |
$168.47 |
$168.47 |
$666.60
|
|
X-ray bone survey infant
|
$170.00 |
$170.00 |
$170.00 |
$410.73
|
|
X-ray cervical spine 2-3 views
|
$117.49 |
$117.49 |
$117.49 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$182.26 |
$182.26 |
$182.26 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$202.60 |
$202.60 |
$202.60 |
$515.35
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$240.24 |
$240.24 |
$240.24 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$367.58 |
$367.58 |
$367.58 |
$820.15
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$239.36 |
$239.36 |
$239.36 |
$486.24
|
|
X-ray exam entire spi 4/5 vw
|
$189.48 |
$189.48 |
$189.48 |
$486.01
|
|
X-ray exam entire spi 6/> vw
|
$189.91 |
$189.91 |
$189.91 |
$575.76
|
|
X-ray exam of eye sockets
|
$139.81 |
$139.81 |
$139.81 |
$349.05
|
|
X-ray exam of jaw joint
|
$318.57 |
$318.57 |
$318.57 |
$192.39
|
|
X-ray exam thorac spine4/>vw
|
$140.68 |
$140.68 |
$140.68 |
$395.59
|
|
X-ray facial bones complete > 3 views
|
$117.27 |
$117.27 |
$117.27 |
$366.60
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$99.11 |
$99.11 |
$99.11 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$122.52 |
$122.52 |
$122.52 |
$409.24
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$106.11 |
$106.11 |
$106.11 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$172.41 |
$172.41 |
$172.41 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$186.41 |
$186.41 |
$186.41 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$117.27 |
$117.27 |
$117.27 |
$352.83
|
|
X-ray nasal bones complete > 3 views
|
$95.83 |
$95.83 |
$95.83 |
$277.70
|
|
X-ray neck soft tissue
|
$88.39 |
$88.39 |
$88.39 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$73.51 |
$73.51 |
$73.51 |
$225.96
|
|
X-ray pelvis 1-2 views
|
$108.08 |
$108.08 |
$108.08 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$119.90 |
$119.90 |
$119.90 |
$342.30
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$309.60 |
$309.60 |
$309.60 |
$742.00
|
|
X-ray ribs 3 views bilateral
|
$138.28 |
$138.28 |
$138.28 |
$394.34
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$182.26 |
$182.26 |
$182.26 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$105.02 |
$105.02 |
$105.02 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$117.49 |
$117.49 |
$117.49 |
$285.60
|
|
X-ray sinuses paranasal complete > 3 views
|
$98.89 |
$98.89 |
$98.89 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$251.18 |
$251.18 |
$251.18 |
$601.30
|
|
X-ray skull < 4 views
|
$110.93 |
$110.93 |
$110.93 |
$291.78
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$223.83 |
$223.83 |
$223.83 |
$557.70
|
|
X-ray small intestine follow-through study
|
$255.12 |
$255.12 |
$255.12 |
$504.14
|
|
X-ray spine single view
|
$69.14 |
$69.14 |
$69.14 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$170.44 |
$170.44 |
$170.44 |
$263.49
|
|
X-ray sternum > 2 views
|
$133.46 |
$133.46 |
$133.46 |
$269.75
|
|
X-ray surgical specimen
|
$176.79 |
$176.79 |
$176.79 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$227.98 |
$227.98 |
$227.98 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$106.77 |
$106.77 |
$106.77 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$117.27 |
$117.27 |
$117.27 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$127.77 |
$127.77 |
$127.77 |
$387.60
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$126.68 |
$126.68 |
$126.68 |
$385.80
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$250.74 |
$250.74 |
$250.74 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$229.30 |
$229.30 |
$229.30 |
$555.04
|
|
Xylose absorption test blood &/or urine
|
$14.20 |
$14.20 |
$14.20 |
$64.28
|
|
Yersinia antibody
|
$14.51 |
$14.51 |
$14.51 |
$66.95
|
|
Zika virus dna/rna amp probe
|
$56.44 |
$56.44 |
$56.44 |
$175.00
|
|
Zika virus igm antibody
|
$18.54 |
$18.54 |
$18.54 |
$75.40
|
|
Zoster vaccine-live inj
|
$99.00 |
$99.00 |
$99.00 |
$235.20
|
|
Zrsr2 gene common variants
|
$212.58 |
$212.58 |
$212.58 |
$193.25
|