|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$125.00 |
$125.00 |
$125.00 |
$284.70
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$309.50 |
$309.50 |
$309.50 |
$438.75
|
|
Wrist X-ray
|
$237.00 |
$237.00 |
$237.00 |
$342.80
|
|
X-ray abdomen 1 view
|
$264.00 |
$264.00 |
$264.00 |
$258.50
|
|
X-ray abdomen 2 views
|
$292.50 |
$292.50 |
$292.50 |
$316.47
|
|
X-ray abdomen >=3 views
|
$277.00 |
$277.00 |
$277.00 |
$342.50
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$458.00 |
$458.00 |
$458.00 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$276.00 |
$276.00 |
$276.00 |
$270.20
|
|
X-ray ankle 2 views (both sides)
|
$221.50 |
$221.50 |
$221.50 |
$282.50
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$397.00 |
$397.00 |
$397.00 |
$773.40
|
|
X-ray bone age studies
|
$145.50 |
$145.50 |
$145.50 |
$251.40
|
|
X-ray bone length studies
|
$189.50 |
$189.50 |
$189.50 |
$285.30
|
|
X-ray bone survey complete
|
$508.50 |
$508.50 |
$508.50 |
$660.00
|
|
X-ray bone survey infant
|
$184.50 |
$184.50 |
$184.50 |
$394.69
|
|
X-ray cervical spine 2-3 views
|
$180.00 |
$180.00 |
$180.00 |
$333.83
|
|
X-ray cervical spine 4-5 views
|
$339.50 |
$339.50 |
$339.50 |
$457.05
|
|
X-ray cervical spine >= 6 views
|
$367.50 |
$367.50 |
$367.50 |
$508.50
|
|
X-ray clavicle complete (both sides)
|
$346.00 |
$346.00 |
$346.00 |
$300.05
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$576.50 |
$576.50 |
$576.50 |
$657.03
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$682.50 |
$682.50 |
$682.50 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$194.00 |
$194.00 |
$194.00 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$352.00 |
$352.00 |
$352.00 |
$364.12
|
|
Xray endovasc thor ao repr
|
$1,893.50 |
$1,893.50 |
$1,893.50 |
$1,734.00
|
|
Xray endovasc thor ao repr
|
$1,894.00 |
$1,894.00 |
$1,894.00 |
$1,622.18
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$325.50 |
$325.50 |
$325.50 |
$483.50
|
|
X-ray exam entire spi 4/5 vw
|
$416.00 |
$416.00 |
$416.00 |
$441.48
|
|
X-ray exam entire spi 6/> vw
|
$416.00 |
$416.00 |
$416.00 |
$517.80
|
|
X-ray exam of arm infant
|
$156.50 |
$156.50 |
$156.50 |
$248.44
|
|
X-ray exam of eye sockets
|
$191.50 |
$191.50 |
$191.50 |
$328.35
|
|
X-ray exam of jaw joint
|
$179.50 |
$179.50 |
$179.50 |
$188.40
|
|
X-ray exam of mastoids
|
$194.00 |
$194.00 |
$194.00 |
$193.41
|
|
X-ray exam of salivary gland
|
$71.50 |
$71.50 |
$71.50 |
$162.60
|
|
X-ray exam of sinuses
|
$84.00 |
$84.00 |
$84.00 |
$214.50
|
|
X-ray exam of teeth
|
$173.00 |
$173.00 |
$173.00 |
$328.08
|
|
X-ray exam si joints
|
$145.50 |
$145.50 |
$145.50 |
$246.16
|
|
X-ray eye detection foreign body (both sides)
|
$153.50 |
$153.50 |
$153.50 |
$238.29
|
|
X-ray facial bones complete > 3 views
|
$325.50 |
$325.50 |
$325.50 |
$381.75
|
|
X-ray femur >=2 views (both sides)
|
$225.00 |
$225.00 |
$225.00 |
$317.25
|
|
X-ray finger(s) >= 2 views (both sides)
|
$352.00 |
$352.00 |
$352.00 |
$241.05
|
|
X-ray foot 2 views (both sides)
|
$192.50 |
$192.50 |
$192.50 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$232.00 |
$232.00 |
$232.00 |
$322.20
|
|
X-ray hand 2 views (both sides)
|
$346.00 |
$346.00 |
$346.00 |
$291.20
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$457.50 |
$457.50 |
$457.50 |
$274.95
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$323.50 |
$323.50 |
$323.50 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$220.50 |
$220.50 |
$220.50 |
$374.40
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$220.50 |
$220.50 |
$220.50 |
$424.05
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$440.50 |
$440.50 |
$440.50 |
$505.60
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$183.00 |
$183.00 |
$183.00 |
$231.00
|
|
X-ray humerus >= 2 views left
|
$237.00 |
$237.00 |
$237.00 |
$309.31
|
|
X-ray knee 1-2 views (both sides)
|
$245.00 |
$245.00 |
$245.00 |
$285.00
|
|
X-ray knee 3 views (both sides)
|
$436.00 |
$436.00 |
$436.00 |
$363.20
|
|
X-ray knee ap standing bilateral
|
$101.00 |
$101.00 |
$101.00 |
$252.50
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$132.00 |
$132.00 |
$132.00 |
$254.12
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$145.50 |
$145.50 |
$145.50 |
$369.15
|
|
X-ray lumbosacral spine >= 4 views
|
$333.50 |
$333.50 |
$333.50 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$175.00 |
$175.00 |
$175.00 |
$535.91
|
|
X-ray mandible complete > 4 views
|
$296.00 |
$296.00 |
$296.00 |
$361.61
|
|
X-ray mandible ltd <4 views
|
$253.00 |
$253.00 |
$253.00 |
$235.30
|
|
X-ray nasal bones complete > 3 views
|
$242.50 |
$242.50 |
$242.50 |
$274.65
|
|
X-ray neck soft tissue
|
$173.50 |
$173.50 |
$173.50 |
$237.43
|
|
X-ray of mammary ducts
|
$289.50 |
$289.50 |
$289.50 |
$568.26
|
|
X-ray pelvis 1-2 views
|
$145.50 |
$145.50 |
$145.50 |
$280.80
|
|
X-ray pelvis complete > 3 views
|
$194.00 |
$194.00 |
$194.00 |
$348.19
|
|
Xray place dist ext thor ao
|
$947.00 |
$947.00 |
$947.00 |
$1,194.70
|
|
Xray place prox ext thor ao
|
$947.00 |
$947.00 |
$947.00 |
$1,005.84
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$751.00 |
$751.00 |
$751.00 |
$755.50
|
|
X-ray ribs 2 views left
|
$272.00 |
$272.00 |
$272.00 |
$292.80
|
|
X-ray ribs 3 views bilateral
|
$145.50 |
$145.50 |
$145.50 |
$395.76
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$289.50 |
$289.50 |
$289.50 |
$356.20
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$271.00 |
$271.00 |
$271.00 |
$491.70
|
|
X-ray sacroiliac joints >= 3 views
|
$169.00 |
$169.00 |
$169.00 |
$312.75
|
|
X-ray sacrum/coccyx >= 2 views
|
$227.00 |
$227.00 |
$227.00 |
$288.80
|
|
X-ray scapula complete (both sides)
|
$432.50 |
$432.50 |
$432.50 |
$285.00
|
|
X-ray shoulder 1 view (both sides)
|
$170.00 |
$170.00 |
$170.00 |
$260.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$288.50 |
$288.50 |
$288.50 |
$345.60
|
|
X-ray sinus tract/fistula/abscess
|
$591.00 |
$591.00 |
$591.00 |
$606.89
|
|
X-ray skull < 4 views
|
$256.50 |
$256.50 |
$256.50 |
$292.50
|
|
X-ray skull > 4 views complete
|
$292.50 |
$292.50 |
$292.50 |
$417.50
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$457.50 |
$457.50 |
$457.50 |
$557.70
|
|
X-ray small intestine follow-through study
|
$260.50 |
$260.50 |
$260.50 |
$499.50
|
|
X-ray spine single view
|
$90.50 |
$90.50 |
$90.50 |
$251.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$131.50 |
$131.50 |
$131.50 |
$264.48
|
|
X-ray sternum > 2 views
|
$188.00 |
$188.00 |
$188.00 |
$274.65
|
|
X-ray surgical specimen
|
$496.00 |
$496.00 |
$496.00 |
$504.00
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$325.50 |
$325.50 |
$325.50 |
$523.25
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$179.50 |
$179.50 |
$179.50 |
$327.80
|
|
X-ray thoracic spine 2 views
|
$282.50 |
$282.50 |
$282.50 |
$320.45
|
|
X-ray thoracic spine 3 views
|
$282.50 |
$282.50 |
$282.50 |
$381.60
|
|
X-ray thoracolumbar spine >=2 views
|
$585.50 |
$585.50 |
$585.50 |
$282.50
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$208.00 |
$208.00 |
$208.00 |
$257.04
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$219.00 |
$219.00 |
$219.00 |
$352.95
|
|
X-ray tibia/fibula 2 views (both sides)
|
$197.00 |
$197.00 |
$197.00 |
$332.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$339.50 |
$339.50 |
$339.50 |
$258.50
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$325.50 |
$325.50 |
$325.50 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$325.50 |
$325.50 |
$325.50 |
$603.20
|
|
X-ray wrist 2 views (both sides)
|
$237.00 |
$237.00 |
$237.00 |
$290.40
|
|
X-ray xm phrnx&/crv esoph c+
|
$229.50 |
$229.50 |
$229.50 |
$354.00
|
