|
Wnd prep f/n/hf/g addl cm
|
$1,713.60 |
$1,713.60 |
$1,713.60 |
$811.00
|
|
Woman's shoe oxford brace
|
$159.87 |
$159.87 |
$159.87 |
$149.37
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$1,110.60 |
$1,110.60 |
$1,110.60 |
$554.01
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$1,167.00 |
$1,167.00 |
$1,167.00 |
$579.70
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$597.60 |
$597.60 |
$597.60 |
$284.70
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$715.20 |
$715.20 |
$715.20 |
$438.75
|
|
Wrist X-ray
|
$329.40 |
$329.40 |
$329.40 |
$342.80
|
|
Xcellistem, 1 mg
|
$5,285.18 |
$5,285.18 |
$5,285.18 |
$2,859.19
|
|
Xe133 xenon 10mci
|
$34.80 |
$34.80 |
$34.80 |
$207.00
|
|
Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/<
|
$19,587.52 |
$19,587.52 |
$19,587.52 |
$2,692.80
|
|
Xfer tis s/a/l 10 sq cm/<
|
$22,501.75 |
$22,501.75 |
$22,501.75 |
$2,837.09
|
|
X-ray abdomen 1 view
|
$264.00 |
$264.00 |
$264.00 |
$258.50
|
|
X-ray abdomen 2 views
|
$264.00 |
$264.00 |
$264.00 |
$316.47
|
|
X-ray abdomen >=3 views
|
$282.00 |
$282.00 |
$282.00 |
$342.50
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$626.40 |
$626.40 |
$626.40 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$294.00 |
$294.00 |
$294.00 |
$270.20
|
|
X-ray ankle 2 views (both sides)
|
$262.80 |
$262.80 |
$262.80 |
$282.50
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$730.20 |
$730.20 |
$730.20 |
$773.40
|
|
X-ray bone age studies
|
$248.40 |
$248.40 |
$248.40 |
$251.40
|
|
X-ray bone length studies
|
$364.80 |
$364.80 |
$364.80 |
$285.30
|
|
X-ray bone survey complete
|
$816.60 |
$816.60 |
$816.60 |
$660.00
|
|
X-ray bone survey infant
|
$354.00 |
$354.00 |
$354.00 |
$394.69
|
|
X-ray cervical spine 2-3 views
|
$382.80 |
$382.80 |
$382.80 |
$333.83
|
|
X-ray cervical spine 4-5 views
|
$552.60 |
$552.60 |
$552.60 |
$457.05
|
|
X-ray cervical spine >= 6 views
|
$702.60 |
$702.60 |
$702.60 |
$508.50
|
|
X-ray clavicle complete (both sides)
|
$251.40 |
$251.40 |
$251.40 |
$300.05
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$867.60 |
$867.60 |
$867.60 |
$657.03
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$1,260.60 |
$1,260.60 |
$1,260.60 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$271.80 |
$271.80 |
$271.80 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$364.20 |
$364.20 |
$364.20 |
$364.12
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$586.80 |
$586.80 |
$586.80 |
$483.50
|
|
X-ray exam entire spi 4/5 vw
|
$415.20 |
$415.20 |
$415.20 |
$441.48
|
|
X-ray exam entire spi 6/> vw
|
$499.20 |
$499.20 |
$499.20 |
$517.80
|
|
X-ray exam of arm infant
|
$259.80 |
$259.80 |
$259.80 |
$248.44
|
|
X-ray exam of eye sockets
|
$474.00 |
$474.00 |
$474.00 |
$328.35
|
|
X-ray exam of femur 1
|
$292.80 |
$292.80 |
$292.80 |
$240.00
|
|
X-ray exam of jaw joint
|
$885.60 |
$885.60 |
$885.60 |
$452.00
|
|
X-ray exam of salivary gland
|
$291.00 |
$291.00 |
$291.00 |
$162.60
|
|
X-ray exam of sinuses
|
$297.00 |
$297.00 |
$297.00 |
$214.50
|
|
X-ray exam si joints
|
$241.80 |
$241.80 |
$241.80 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$400.80 |
$400.80 |
$400.80 |
$387.40
|
|
X-ray eye detection foreign body (both sides)
|
$340.80 |
$340.80 |
$340.80 |
$238.29
|
|
X-ray facial bones complete > 3 views
|
$421.20 |
$421.20 |
$421.20 |
$381.75
|
|
X-ray femur >=2 views (both sides)
|
$292.80 |
$292.80 |
$292.80 |
$317.25
|
|
X-ray finger(s) >= 2 views (both sides)
|
$251.40 |
$251.40 |
$251.40 |
$241.05
|
|
X-ray foot 2 views (both sides)
|
$271.80 |
$271.80 |
$271.80 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$270.00 |
$270.00 |
$270.00 |
$322.20
|
|
X-ray hand 2 views (both sides)
|
$260.40 |
$260.40 |
$260.40 |
$291.20
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$266.40 |
$266.40 |
$266.40 |
$274.95
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$496.80 |
$496.80 |
$496.80 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$391.80 |
$391.80 |
$391.80 |
$374.40
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$496.80 |
$496.80 |
$496.80 |
$424.05
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$745.20 |
$745.20 |
$745.20 |
$505.60
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$294.00 |
$294.00 |
$294.00 |
$231.00
|
|
X-ray humerus >= 2 views left
|
$277.20 |
$277.20 |
$277.20 |
$309.31
|
|
X-ray joint survey 1 view
|
$479.40 |
$479.40 |
$479.40 |
$232.00
|
|
X-ray knee 1-2 views (both sides)
|
$285.00 |
$285.00 |
$285.00 |
$285.00
|
|
X-ray knee 3 views (both sides)
|
$363.60 |
$363.60 |
$363.60 |
$363.20
|
|
X-ray knee ap standing bilateral
|
$363.60 |
$363.60 |
$363.60 |
$252.50
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$282.00 |
$282.00 |
$282.00 |
$254.12
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$404.40 |
$404.40 |
$404.40 |
$369.15
|
|
X-ray lumbosacral spine >= 4 views
|
$519.00 |
$519.00 |
$519.00 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$568.20 |
$568.20 |
$568.20 |
$535.91
|
|
X-ray mandible complete > 4 views
|
$307.20 |
$307.20 |
$307.20 |
$361.61
|
|
X-ray mandible ltd <4 views
|
$231.60 |
$231.60 |
$231.60 |
$235.30
|
|
X-ray nasal bones complete > 3 views
|
$303.00 |
$303.00 |
$303.00 |
$274.65
|
|
X-ray neck soft tissue
|
$312.00 |
$312.00 |
$312.00 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$268.80 |
$268.80 |
$268.80 |
$225.60
|
|
X-ray optic foramina
|
$285.00 |
$285.00 |
$285.00 |
$188.40
|
|
X-ray pelvis 1-2 views
|
$306.60 |
$306.60 |
$306.60 |
$280.80
|
|
X-ray pelvis complete > 3 views
|
$310.80 |
$310.80 |
$310.80 |
$348.19
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$996.60 |
$996.60 |
$996.60 |
$755.50
|
|
X-ray ribs 2 views left
|
$325.20 |
$325.20 |
$325.20 |
$292.80
|
|
X-ray ribs 3 views bilateral
|
$393.60 |
$393.60 |
$393.60 |
$395.76
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$442.20 |
$442.20 |
$442.20 |
$356.20
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$632.40 |
$632.40 |
$632.40 |
$491.70
|
|
X-ray sacroiliac joints >= 3 views
|
$288.60 |
$288.60 |
$288.60 |
$312.75
|
|
X-ray sacrum/coccyx >= 2 views
|
$354.00 |
$354.00 |
$354.00 |
$288.80
|
|
X-ray scapula complete (both sides)
|
$271.80 |
$271.80 |
$271.80 |
$285.00
|
|
X-ray sella turcica
|
$231.60 |
$231.60 |
$231.60 |
$162.50
|
|
X-ray shoulder 1 view (both sides)
|
$241.80 |
$241.80 |
$241.80 |
$260.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$709.80 |
$709.80 |
$709.80 |
$345.60
|
|
X-ray sinus tract/fistula/abscess
|
$845.40 |
$845.40 |
$845.40 |
$606.89
|
|
X-ray skull < 4 views
|
$339.60 |
$339.60 |
$339.60 |
$292.50
|
|
X-ray skull > 4 views complete
|
$463.80 |
$463.80 |
$463.80 |
$417.50
|
|
X-ray slg plne bdy sect without urogr
|
$763.20 |
$763.20 |
$763.20 |
$399.82
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$734.40 |
$734.40 |
$734.40 |
$557.70
|
|
X-ray small intestine follow-through study
|
$1,178.40 |
$1,178.40 |
$1,178.40 |
$499.50
|
|
X-ray spine single view
|
$235.20 |
$235.20 |
$235.20 |
$251.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$335.40 |
$335.40 |
$335.40 |
$264.48
|
|
X-ray sternum > 2 views
|
$319.80 |
$319.80 |
$319.80 |
$274.65
|
|
X-ray surgical specimen
|
$378.60 |
$378.60 |
$378.60 |
$504.00
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$676.80 |
$676.80 |
$676.80 |
$523.25
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$345.60 |
$345.60 |
$345.60 |
$327.80
|
|
X-ray thoracic spine 2 views
|
$364.20 |
$364.20 |
$364.20 |
$320.45
|
|
X-ray thoracic spine 3 views
|
$381.60 |
$381.60 |
$381.60 |
$381.60
|
|
X-ray thoracolumbar spine >=2 views
|
$328.80 |
$328.80 |
$328.80 |
$282.50
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$252.00 |
$252.00 |
$252.00 |
$257.04
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$334.20 |
$334.20 |
$334.20 |
$352.95
|
|
X-ray tibia/fibula 2 views (both sides)
|
$279.00 |
$279.00 |
$279.00 |
$332.00
|
