|
Warde zinc
|
$57.81 |
$57.81 |
$57.81 |
$67.20
|
|
Western blot test
|
$235.78 |
$235.78 |
$235.78 |
$170.40
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$206.46 |
$206.46 |
$206.46 |
$275.88
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$249.66 |
$249.66 |
$249.66 |
$370.00
|
|
Wrist X-ray
|
$263.81 |
$263.81 |
$263.81 |
$311.20
|
|
Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/<
|
$2,004.20 |
$2,004.20 |
$2,004.20 |
$2,563.00
|
|
X-ray abdomen 1 view
|
$116.83 |
$116.83 |
$116.83 |
$243.00
|
|
X-ray abdomen 2 views
|
$158.73 |
$158.73 |
$158.73 |
$281.50
|
|
X-ray abdomen >=3 views
|
$158.73 |
$158.73 |
$158.73 |
$309.38
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$199.80 |
$199.80 |
$199.80 |
$359.84
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$117.94 |
$117.94 |
$117.94 |
$246.42
|
|
X-ray ankle 2 views (both sides)
|
$230.51 |
$230.51 |
$230.51 |
$240.00
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$267.14 |
$267.14 |
$267.14 |
$734.43
|
|
X-ray bone age studies
|
$170.57 |
$170.57 |
$170.57 |
$227.08
|
|
X-ray bone length studies
|
$150.41 |
$150.41 |
$150.41 |
$258.70
|
|
X-ray bone survey complete
|
$330.04 |
$330.04 |
$330.04 |
$569.03
|
|
X-ray bone survey infant
|
$158.36 |
$158.36 |
$158.36 |
$362.40
|
|
X-ray cervical spine 2-3 views
|
$148.46 |
$148.46 |
$148.46 |
$308.40
|
|
X-ray cervical spine 4-5 views
|
$184.82 |
$184.82 |
$184.82 |
$439.14
|
|
X-ray cervical spine >= 6 views
|
$217.93 |
$217.93 |
$217.93 |
$479.05
|
|
X-ray clavicle complete (both sides)
|
$242.35 |
$242.35 |
$242.35 |
$277.00
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$287.68 |
$287.68 |
$287.68 |
$594.68
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$340.40 |
$340.40 |
$340.40 |
$785.86
|
|
X-ray elbow 2 views (both sides)
|
$225.89 |
$225.89 |
$225.89 |
$281.40
|
|
X-ray elbow >= 3 views (both sides)
|
$238.28 |
$238.28 |
$238.28 |
$325.88
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$221.54 |
$221.54 |
$221.54 |
$434.76
|
|
X-ray exam entire spi 4/5 vw
|
$195.36 |
$195.36 |
$195.36 |
$441.48
|
|
X-ray exam of arm infant
|
$167.06 |
$167.06 |
$167.06 |
$238.26
|
|
X-ray exam of eye sockets
|
$74.93 |
$74.93 |
$74.93 |
$321.48
|
|
X-ray exam of femur 1
|
$110.54 |
$110.54 |
$110.54 |
$194.40
|
|
X-ray exam of jaw joint
|
$57.44 |
$57.44 |
$57.44 |
$179.54
|
|
X-ray exam of mastoids
|
$48.01 |
$48.01 |
$48.01 |
$187.60
|
|
X-ray exam of perineum
|
$160.95 |
$160.95 |
$160.95 |
$330.96
|
|
X-ray exam of salivary gland
|
$53.47 |
$53.47 |
$53.47 |
$124.24
|
|
X-ray exam of sinuses
|
$70.67 |
$70.67 |
$70.67 |
$192.00
|
|
X-ray exam si joints
|
$120.71 |
$120.71 |
$120.71 |
$198.38
|
|
X-ray exam thorac spine4/>vw
|
$175.01 |
$175.01 |
$175.01 |
$365.00
|
|
X-ray eye detection foreign body (both sides)
|
$45.70 |
$45.70 |
$45.70 |
$227.80
|
|
X-ray facial bones complete > 3 views
|
$95.18 |
$95.18 |
$95.18 |
$337.95
|
|
X-ray femur >=2 views (both sides)
|
$232.18 |
$232.18 |
$232.18 |
$290.44
|
|
X-ray finger(s) >= 2 views (both sides)
|
$240.32 |
$240.32 |
$240.32 |
$233.55
|
|
X-ray foot 2 views (both sides)
|
$232.18 |
$232.18 |
$232.18 |
$270.40
|
|
X-ray forearm 2 views (both sides)
|
$235.32 |
$235.32 |
$235.32 |
$317.62
|
|
X-ray hand 2 views (both sides)
|
$240.32 |
$240.32 |
$240.32 |
$270.00
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$220.15 |
$220.15 |
$220.15 |
$243.10
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$161.69 |
$161.69 |
$161.69 |
$300.00
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$107.67 |
$107.67 |
$107.67 |
$313.45
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$159.19 |
$159.19 |
$159.19 |
$376.80
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$100.27 |
$100.27 |
$100.27 |
$187.20
|
|
X-ray humerus >= 2 views left
|
$124.23 |
$124.23 |
$124.23 |
$285.00
|
|
X-ray joint survey 1 view
|
$284.16 |
$284.16 |
$284.16 |
$211.00
|
|
X-ray knee 1-2 views (both sides)
|
$207.20 |
$207.20 |
$207.20 |
$271.70
|
|
X-ray knee 3 views (both sides)
|
$243.65 |
$243.65 |
$243.65 |
$319.24
|
|
X-ray knee ap standing bilateral
|
$89.82 |
$89.82 |
$89.82 |
$243.09
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$227.92 |
$227.92 |
$227.92 |
$227.92
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$192.03 |
$192.03 |
$192.03 |
$345.15
|
|
X-ray lumbosacral spine >= 4 views
|
$227.00 |
$227.00 |
$227.00 |
$475.04
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$266.22 |
$266.22 |
$266.22 |
$513.63
|
|
X-ray mandible complete > 4 views
|
$113.31 |
$113.31 |
$113.31 |
$323.70
|
|
X-ray mandible ltd <4 views
|
$81.12 |
$81.12 |
$81.12 |
$200.20
|
|
X-ray nasal bones complete > 3 views
|
$95.37 |
$95.37 |
$95.37 |
$260.52
|
|
X-ray neck soft tissue
|
$109.15 |
$109.15 |
$109.15 |
$221.10
|
|
X-ray nose to rectum for foreign body child
|
$66.51 |
$66.51 |
$66.51 |
$201.00
|
|
X-ray of mammary ducts
|
$233.56 |
$233.56 |
$233.56 |
$437.00
|
|
X-ray pelvis 1-2 views
|
$116.00 |
$116.00 |
$116.00 |
$242.58
|
|
X-ray pelvis complete > 3 views
|
$127.74 |
$127.74 |
$127.74 |
$299.46
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$289.25 |
$289.25 |
$289.25 |
$663.18
|
|
X-ray ribs 2 views left
|
$172.88 |
$172.88 |
$172.88 |
$281.45
|
|
X-ray ribs 3 views bilateral
|
$197.49 |
$197.49 |
$197.49 |
$361.20
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$206.74 |
$206.74 |
$206.74 |
$327.21
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$225.61 |
$225.61 |
$225.61 |
$466.80
|
|
X-ray sacroiliac joints >= 3 views
|
$129.04 |
$129.04 |
$129.04 |
$270.40
|
|
X-ray sacrum/coccyx >= 2 views
|
$124.32 |
$124.32 |
$124.32 |
$260.65
|
|
X-ray scapula complete (both sides)
|
$259.56 |
$259.56 |
$259.56 |
$264.80
|
|
X-ray shoulder 1 view (both sides)
|
$224.04 |
$224.04 |
$224.04 |
$242.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$95.37 |
$95.37 |
$95.37 |
$324.53
|
|
X-ray sinus tract/fistula/abscess
|
$245.22 |
$245.22 |
$245.22 |
$539.50
|
|
X-ray skull < 4 views
|
$95.37 |
$95.37 |
$95.37 |
$277.54
|
|
X-ray skull > 4 views complete
|
$115.35 |
$115.35 |
$115.35 |
$404.30
|
|
X-ray slg plne bdy sect without urogr
|
$240.59 |
$240.59 |
$240.59 |
$370.64
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$172.14 |
$172.14 |
$172.14 |
$511.38
|
|
X-ray small intestine follow-through study
|
$90.37 |
$90.37 |
$90.37 |
$470.16
|
|
X-ray spine single view
|
$120.99 |
$120.99 |
$120.99 |
$225.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$125.80 |
$125.80 |
$125.80 |
$236.88
|
|
X-ray sternum > 2 views
|
$114.33 |
$114.33 |
$114.33 |
$230.00
|
|
X-ray surgical specimen
|
$209.61 |
$209.61 |
$209.61 |
$457.47
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$240.41 |
$240.41 |
$240.41 |
$463.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$101.47 |
$101.47 |
$101.47 |
$276.00
|
|
X-ray thoracic spine 2 views
|
$148.46 |
$148.46 |
$148.46 |
$286.65
|
|
X-ray thoracic spine 3 views
|
$172.24 |
$172.24 |
$172.24 |
$343.00
|
|
X-ray thoracolumbar spine >=2 views
|
$141.43 |
$141.43 |
$141.43 |
$269.10
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$143.38 |
$143.38 |
$143.38 |
$211.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$148.46 |
$148.46 |
$148.46 |
$346.50
|
|
X-ray tibia/fibula 2 views (both sides)
|
$232.18 |
$232.18 |
$232.18 |
$306.47
|
|
X-ray toe(s) > 2 views (both sides)
|
$200.91 |
$200.91 |
$200.91 |
$225.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$321.62 |
$321.62 |
$321.62 |
$590.20
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$299.98 |
$299.98 |
$299.98 |
$497.93
|
|
X-ray wrist 2 views (both sides)
|
$246.42 |
$246.42 |
$246.42 |
$268.49
|
|
Ziconotide injection
|
$2,571.72 |
$2,571.72 |
$2,571.72 |
$4,530.00
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$54.54 |
$54.54 |
$54.54 |
$90.15
|