|
Wnd prep f/n/hf/g addl cm
|
$65.26 |
$65.26 |
$65.26 |
$811.00
|
|
Wound Cleaning and Dead Tissue Removal (up to 20 sq cm)
|
$558.70 |
$558.70 |
$558.70 |
$351.60
|
|
Wound closure by adhesive
|
$31.98 |
$31.98 |
$31.98 |
$138.25
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$1,123.32 |
$1,123.32 |
$1,123.32 |
$574.80
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$17.68 |
$17.68 |
$17.68 |
$594.00
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$17.94 |
$17.94 |
$17.94 |
$284.70
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$19.50 |
$19.50 |
$19.50 |
$438.91
|
|
Wrist arthroscopy
|
$338.00 |
$338.00 |
$338.00 |
$3,839.54
|
|
Wrist arthroscopy/surgery
|
$361.14 |
$361.14 |
$361.14 |
$3,839.54
|
|
Wrist arthroscopy/surgery
|
$371.54 |
$371.54 |
$371.54 |
$3,839.54
|
|
Wrist arthroscopy/surgery
|
$433.68 |
$433.68 |
$433.68 |
$4,022.93
|
|
Wrist arthroscopy/surgery
|
$387.40 |
$387.40 |
$387.40 |
$3,986.00
|
|
Wrist arthroscopy/surgery
|
$402.74 |
$402.74 |
$402.74 |
$8,412.89
|
|
Wrist endoscopy/surgery
|
$380.38 |
$380.38 |
$380.38 |
$3,452.80
|
|
Wrist X-ray
|
$425.50 |
$425.50 |
$425.50 |
$350.40
|
|
Wrist X-ray (2 views, both wrists)
|
$340.40 |
$340.40 |
$340.40 |
$290.40
|
|
Xcapsl ctrc rmvl cplx wo ecp
|
$532.48 |
$532.48 |
$532.48 |
$3,786.00
|
|
Xcapsl ctrc rmvl insj 1+
|
$489.06 |
$489.06 |
$489.06 |
$7,316.99
|
|
Xcpsl ctrc rmvl cplx insj 1+
|
$611.52 |
$611.52 |
$611.52 |
$8,652.80
|
|
Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/<
|
$455.26 |
$455.26 |
$455.26 |
$2,830.00
|
|
Xfer tis s/a/l 10 sq cm/<
|
$413.66 |
$413.66 |
$413.66 |
$2,838.00
|
|
Xm archive tissue molec anal
|
$68.82 |
$68.82 |
$68.82 |
$48.38
|
|
Xpos opn axillary/sbclvn art w/cndt crtn
|
$266.50 |
$266.50 |
$266.50 |
$3,143.58
|
|
Xpos opn fmrl eprst aor uni add-on
|
$8,746.06 |
$8,746.06 |
$8,746.06 |
$1,825.60
|
|
X-ray abdomen >=3 views
|
$411.44 |
$411.44 |
$411.44 |
$341.90
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$1,380.84 |
$1,380.84 |
$1,380.84 |
$789.36
|
|
X-ray assay calculus
|
$9.88 |
$9.88 |
$9.88 |
$33.60
|
|
X-ray bone length studies
|
$411.44 |
$411.44 |
$411.44 |
$285.30
|
|
X-ray bone survey infant
|
$411.44 |
$411.44 |
$411.44 |
$391.38
|
|
X-ray consultation
|
$22.62 |
$22.62 |
$22.62 |
$40.88
|
|
Xray endovasc thor ao repr
|
$6,152.36 |
$6,152.36 |
$6,152.36 |
$1,734.00
|
|
Xray endovasc thor ao repr
|
$6,152.36 |
$6,152.36 |
$6,152.36 |
$1,622.18
|
|
X-ray exam entire spi 4/5 vw
|
$513.56 |
$513.56 |
$513.56 |
$441.48
|
|
X-ray exam entire spi 6/> vw
|
$513.56 |
$513.56 |
$513.56 |
$517.80
|
|
X-ray exam of arm infant
|
$411.44 |
$411.44 |
$411.44 |
$248.50
|
|
X-ray exam of femur 1
|
$340.40 |
$340.40 |
$340.40 |
$236.40
|
|
X-ray exam of jaw joint
|
$6.24 |
$6.24 |
$6.24 |
$201.75
|
|
X-ray exam of jaw joint
|
$934.62 |
$934.62 |
$934.62 |
$452.00
|
|
X-ray exam of mastoids
|
$6.24 |
$6.24 |
$6.24 |
$193.41
|
|
X-ray exam of middle ear
|
$2,120.10 |
$2,120.10 |
$2,120.10 |
$349.35
|
|
X-ray exam of penis
|
$39.00 |
$39.00 |
$39.00 |
$593.46
|
|
X-ray exam of perineum
|
$934.62 |
$934.62 |
$934.62 |
$588.00
|
|
X-ray exam of salivary gland
|
$340.40 |
$340.40 |
$340.40 |
$162.60
|
|
X-ray exam of tear duct
|
$934.62 |
$934.62 |
$934.62 |
$467.50
|
|
X-ray exam of teeth
|
$3.64 |
$3.64 |
$3.64 |
$138.40
|
|
X-ray exam of teeth
|
$5.98 |
$5.98 |
$5.98 |
$385.39
|
|
X-ray exam si joints
|
$411.44 |
$411.44 |
$411.44 |
$247.80
|
|
X-ray exam thorac spine4/>vw
|
$513.56 |
$513.56 |
$513.56 |
$395.00
|
|
X-ray eye detection foreign body (both sides)
|
$340.40 |
$340.40 |
$340.40 |
$237.78
|
|
X-ray fallopian tube
|
$734.08 |
$734.08 |
$734.08 |
$565.40
|
|
X-ray head for orthodontia
|
$6.24 |
$6.24 |
$6.24 |
$158.50
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$411.44 |
$411.44 |
$411.44 |
$372.64
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$513.56 |
$513.56 |
$513.56 |
$500.28
|
|
X-ray joint survey 1 view
|
$411.44 |
$411.44 |
$411.44 |
$232.00
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$340.40 |
$340.40 |
$340.40 |
$251.74
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$411.44 |
$411.44 |
$411.44 |
$364.75
|
|
X-ray male genital tract
|
$13.00 |
$13.00 |
$13.00 |
$603.50
|
|
X-ray mandible ltd <4 views
|
$340.40 |
$340.40 |
$340.40 |
$238.00
|
|
X-ray measurement of pelvis
|
$12.48 |
$12.48 |
$12.48 |
$157.39
|
|
X-ray nose to rectum for foreign body child
|
$340.40 |
$340.40 |
$340.40 |
$229.00
|
|
X-ray of mammary ducts
|
$15.34 |
$15.34 |
$15.34 |
$568.26
|
|
X-ray optic foramina
|
$7.80 |
$7.80 |
$7.80 |
$188.40
|
|
Xray place dist ext thor ao
|
$6,152.36 |
$6,152.36 |
$6,152.36 |
$1,203.95
|
|
Xray place prox ext thor ao
|
$4,817.40 |
$4,817.40 |
$4,817.40 |
$1,005.84
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$1,380.84 |
$1,380.84 |
$1,380.84 |
$769.50
|
|
X-ray ribs 2 views left
|
$340.40 |
$340.40 |
$340.40 |
$291.61
|
|
X-ray sella turcica
|
$340.40 |
$340.40 |
$340.40 |
$162.50
|
|
X-ray sinus tract/fistula/abscess
|
$2,120.10 |
$2,120.10 |
$2,120.10 |
$636.30
|
|
X-ray slg plne bdy sect without urogr
|
$20.02 |
$20.02 |
$20.02 |
$398.75
|
|
X-ray small intestine follow-through study
|
$963.48 |
$963.48 |
$963.48 |
$504.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$425.50 |
$425.50 |
$425.50 |
$267.50
|
|
X-ray surgical specimen
|
$2,120.10 |
$2,120.10 |
$2,120.10 |
$521.28
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$340.40 |
$340.40 |
$340.40 |
$257.04
|
|
X-ray xm phrnx&/crv esoph c+
|
$20.28 |
$20.28 |
$20.28 |
$362.98
|
|
Xtrnl ecg rec up to 48 hrs
|
$49.92 |
$49.92 |
$49.92 |
$232.98
|
|
Xylose absorption test blood &/or urine
|
$9.88 |
$9.88 |
$9.88 |
$99.89
|
|
Yersinia antibody
|
$10.40 |
$10.40 |
$10.40 |
$55.80
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$26.57 |
$26.57 |
$26.57 |
$83.25
|
|
Zika virus dna/rna amp probe
|
$324.86 |
$324.86 |
$324.86 |
$181.08
|
|
Zika virus igm antibody
|
$106.56 |
$106.56 |
$106.56 |
$85.00
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$58.63 |
$58.63 |
$58.63 |
$123.21
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$273.00 |
$273.00 |
$273.00 |
$416.81
|