|
Whole mitochondrial genome
|
$1,029.60 |
$1,029.60 |
$1,029.60 |
$1,524.90
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$132.74 |
$132.74 |
$132.74 |
$558.97
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$106.68 |
$106.68 |
$106.68 |
$611.25
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$74.94 |
$74.94 |
$74.94 |
$288.91
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$92.75 |
$92.75 |
$92.75 |
$436.15
|
|
Wrist arthroscopy
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,839.54
|
|
Wrist arthroscopy/surgery
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,839.54
|
|
Wrist arthroscopy/surgery
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,839.54
|
|
Wrist arthroscopy/surgery
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,839.54
|
|
Wrist arthroscopy/surgery
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,839.54
|
|
Wrist arthroscopy/surgery
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,010.63
|
|
Wrist endoscopy/surgery
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,512.00
|
|
Xcapsl ctrc rmvl cplx w/ecp
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$4,760.49
|
|
Xcapsl ctrc rmvl cplx wo ecp
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,724.80
|
|
Xcapsl ctrc rmvl insj 1+
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,105.79
|
|
Xcapsl ctrc rmvl w/ecp
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$4,760.49
|
|
Xcpsl ctrc rmvl cplx insj 1+
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,076.38
|
|
Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/<
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,830.00
|
|
Xfer tis s/a/l 10 sq cm/<
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$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
|
$7.35 |
$7.35 |
$7.35 |
$47.85
|
|
X-ray abdomen 1 view
|
$65.91 |
$65.91 |
$65.91 |
$255.00
|
|
X-ray abdomen 2 views
|
$69.27 |
$69.27 |
$69.27 |
$312.36
|
|
X-ray abdomen >=3 views
|
$73.91 |
$73.91 |
$73.91 |
$332.15
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$86.81 |
$86.81 |
$86.81 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$59.34 |
$59.34 |
$59.34 |
$271.44
|
|
X-ray assay calculus
|
$13.77 |
$13.77 |
$13.77 |
$13.77
|
|
X-ray bone age studies
|
$65.91 |
$65.91 |
$65.91 |
$246.75
|
|
X-ray bone length studies
|
$58.82 |
$58.82 |
$58.82 |
$287.25
|
|
X-ray bone survey complete
|
$131.32 |
$131.32 |
$131.32 |
$666.60
|
|
X-ray cervical spine 2-3 views
|
$91.33 |
$91.33 |
$91.33 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$133.51 |
$133.51 |
$133.51 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$155.18 |
$155.18 |
$155.18 |
$515.35
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$102.68 |
$102.68 |
$102.68 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$127.19 |
$127.19 |
$127.19 |
$820.15
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$115.32 |
$115.32 |
$115.32 |
$486.24
|
|
X-ray exam entire spi 4/5 vw
|
$65.27 |
$65.27 |
$65.27 |
$486.01
|
|
X-ray exam of eye sockets
|
$63.72 |
$63.72 |
$63.72 |
$349.05
|
|
X-ray exam of jaw joint
|
$187.05 |
$187.05 |
$187.05 |
$192.39
|
|
X-ray exam thorac spine4/>vw
|
$109.77 |
$109.77 |
$109.77 |
$395.59
|
|
X-ray facial bones complete > 3 views
|
$110.29 |
$110.29 |
$110.29 |
$366.60
|
|
X-ray fallopian tube
|
$55.08 |
$55.08 |
$55.08 |
$501.00
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$83.59 |
$83.59 |
$83.59 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$94.81 |
$94.81 |
$94.81 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$111.32 |
$111.32 |
$111.32 |
$508.00
|
|
X-ray knee ap standing bilateral
|
$46.82 |
$46.82 |
$46.82 |
$276.25
|
|
X-ray lumbosacral spine >= 4 views
|
$101.65 |
$101.65 |
$101.65 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$109.90 |
$109.90 |
$109.90 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$90.42 |
$90.42 |
$90.42 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$31.99 |
$31.99 |
$31.99 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$83.46 |
$83.46 |
$83.46 |
$277.70
|
|
X-ray neck soft tissue
|
$55.98 |
$55.98 |
$55.98 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$33.54 |
$33.54 |
$33.54 |
$225.96
|
|
X-ray pelvis 1-2 views
|
$80.23 |
$80.23 |
$80.23 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$84.23 |
$84.23 |
$84.23 |
$342.30
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$188.34 |
$188.34 |
$188.34 |
$742.00
|
|
X-ray ribs 3 views bilateral
|
$116.22 |
$116.22 |
$116.22 |
$394.34
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$131.06 |
$131.06 |
$131.06 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$52.11 |
$52.11 |
$52.11 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$87.84 |
$87.84 |
$87.84 |
$285.60
|
|
X-ray sinuses paranasal complete > 3 views
|
$55.85 |
$55.85 |
$55.85 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$138.93 |
$138.93 |
$138.93 |
$601.30
|
|
X-ray skull < 4 views
|
$54.69 |
$54.69 |
$54.69 |
$291.78
|
|
X-ray skull > 4 views complete
|
$101.26 |
$101.26 |
$101.26 |
$414.60
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$104.49 |
$104.49 |
$104.49 |
$557.70
|
|
X-ray small intestine follow-through study
|
$110.68 |
$110.68 |
$110.68 |
$504.14
|
|
X-ray spine single view
|
$61.27 |
$61.27 |
$61.27 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$84.88 |
$84.88 |
$84.88 |
$263.49
|
|
X-ray sternum > 2 views
|
$66.43 |
$66.43 |
$66.43 |
$269.75
|
|
X-ray surgical specimen
|
$130.41 |
$130.41 |
$130.41 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$110.42 |
$110.42 |
$110.42 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$67.08 |
$67.08 |
$67.08 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$101.65 |
$101.65 |
$101.65 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$104.49 |
$104.49 |
$104.49 |
$387.60
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$178.66 |
$178.66 |
$178.66 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$156.60 |
$156.60 |
$156.60 |
$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
|
|
Zrsr2 gene common variants
|
$212.58 |
$212.58 |
$212.58 |
$193.25
|