|
Warde vitamin a
|
$60.49 |
$60.49 |
$60.49 |
$58.80
|
|
Warde vitamin b-1 (thiamine)
|
$51.06 |
$51.06 |
$51.06 |
$82.04
|
|
Warde vitamin b6 (pyridoxine)
|
$100.74 |
$100.74 |
$100.74 |
$116.20
|
|
Warde vitamin c (ascorbic acid)
|
$39.56 |
$39.56 |
$39.56 |
$50.00
|
|
Warde vitamin d (1 25 dihydroxy)
|
$51.06 |
$51.06 |
$51.06 |
$138.50
|
|
Warde vitamin e (alpha-tocopherol)
|
$12.65 |
$12.65 |
$12.65 |
$59.25
|
|
Warde zinc
|
$46.46 |
$46.46 |
$46.46 |
$62.50
|
|
Wbc automated
|
$17.48 |
$17.48 |
$17.48 |
$32.35
|
|
Western blot test
|
$14.72 |
$14.72 |
$14.72 |
$150.00
|
|
Whole blood/red blood cells leukocytes reduced cmv negative each unit
|
$269.79 |
$269.79 |
$269.79 |
$491.04
|
|
Wnd prep f/n/hf/g addl cm
|
$306.82 |
$306.82 |
$306.82 |
$811.00
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$238.97 |
$238.97 |
$238.97 |
$554.01
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$248.86 |
$248.86 |
$248.86 |
$579.70
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$78.66 |
$78.66 |
$78.66 |
$284.70
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$136.62 |
$136.62 |
$136.62 |
$438.75
|
|
Wrist X-ray
|
$100.05 |
$100.05 |
$100.05 |
$342.80
|
|
Xe133 xenon 10mci
|
$69.47 |
$69.47 |
$69.47 |
$207.00
|
|
Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/<
|
$1,201.52 |
$1,201.52 |
$1,201.52 |
$2,692.80
|
|
X-ray abdomen 1 view
|
$89.70 |
$89.70 |
$89.70 |
$258.50
|
|
X-ray abdomen 2 views
|
$107.18 |
$107.18 |
$107.18 |
$316.47
|
|
X-ray abdomen >=3 views
|
$136.85 |
$136.85 |
$136.85 |
$342.50
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$148.35 |
$148.35 |
$148.35 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$111.78 |
$111.78 |
$111.78 |
$270.20
|
|
X-ray ankle 2 views (both sides)
|
$93.38 |
$93.38 |
$93.38 |
$282.50
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$304.75 |
$304.75 |
$304.75 |
$773.40
|
|
X-ray bone survey complete
|
$229.31 |
$229.31 |
$229.31 |
$660.00
|
|
X-ray bone survey infant
|
$125.12 |
$125.12 |
$125.12 |
$394.69
|
|
X-ray cervical spine 2-3 views
|
$112.24 |
$112.24 |
$112.24 |
$333.83
|
|
X-ray cervical spine 4-5 views
|
$136.16 |
$136.16 |
$136.16 |
$457.05
|
|
X-ray cervical spine >= 6 views
|
$173.65 |
$173.65 |
$173.65 |
$508.50
|
|
X-ray clavicle complete (both sides)
|
$103.04 |
$103.04 |
$103.04 |
$300.05
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$199.64 |
$199.64 |
$199.64 |
$657.03
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$230.00 |
$230.00 |
$230.00 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$100.05 |
$100.05 |
$100.05 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$106.49 |
$106.49 |
$106.49 |
$364.12
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$165.60 |
$165.60 |
$165.60 |
$483.50
|
|
X-ray exam entire spi 4/5 vw
|
$145.13 |
$145.13 |
$145.13 |
$441.48
|
|
X-ray exam entire spi 6/> vw
|
$167.44 |
$167.44 |
$167.44 |
$517.80
|
|
X-ray exam of arm infant
|
$68.08 |
$68.08 |
$68.08 |
$248.44
|
|
X-ray exam of eye sockets
|
$132.94 |
$132.94 |
$132.94 |
$328.35
|
|
X-ray exam of femur 1
|
$54.28 |
$54.28 |
$54.28 |
$240.00
|
|
X-ray exam of jaw joint
|
$34.50 |
$34.50 |
$34.50 |
$188.40
|
|
X-ray exam of sinuses
|
$55.89 |
$55.89 |
$55.89 |
$214.50
|
|
X-ray exam si joints
|
$97.75 |
$97.75 |
$97.75 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$154.33 |
$154.33 |
$154.33 |
$387.40
|
|
X-ray facial bones complete > 3 views
|
$180.55 |
$180.55 |
$180.55 |
$381.75
|
|
X-ray femur >=2 views (both sides)
|
$97.98 |
$97.98 |
$97.98 |
$317.25
|
|
X-ray finger(s) >= 2 views (both sides)
|
$78.66 |
$78.66 |
$78.66 |
$241.05
|
|
X-ray foot 2 views (both sides)
|
$91.54 |
$91.54 |
$91.54 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$89.24 |
$89.24 |
$89.24 |
$322.20
|
|
X-ray hand 2 views (both sides)
|
$47.61 |
$47.61 |
$47.61 |
$291.20
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$100.05 |
$100.05 |
$100.05 |
$274.95
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$130.87 |
$130.87 |
$130.87 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$114.54 |
$114.54 |
$114.54 |
$374.40
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$130.87 |
$130.87 |
$130.87 |
$424.05
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$151.57 |
$151.57 |
$151.57 |
$505.60
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$60.49 |
$60.49 |
$60.49 |
$231.00
|
|
X-ray humerus >= 2 views left
|
$106.49 |
$106.49 |
$106.49 |
$309.31
|
|
X-ray knee 1-2 views (both sides)
|
$99.59 |
$99.59 |
$99.59 |
$285.00
|
|
X-ray knee 3 views (both sides)
|
$112.24 |
$112.24 |
$112.24 |
$363.20
|
|
X-ray knee ap standing bilateral
|
$68.08 |
$68.08 |
$68.08 |
$252.50
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$73.83 |
$73.83 |
$73.83 |
$254.12
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$137.08 |
$137.08 |
$137.08 |
$369.15
|
|
X-ray lumbosacral spine >= 4 views
|
$173.65 |
$173.65 |
$173.65 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$159.16 |
$159.16 |
$159.16 |
$535.91
|
|
X-ray mandible complete > 4 views
|
$136.16 |
$136.16 |
$136.16 |
$361.61
|
|
X-ray mandible ltd <4 views
|
$89.24 |
$89.24 |
$89.24 |
$235.30
|
|
X-ray nasal bones complete > 3 views
|
$100.97 |
$100.97 |
$100.97 |
$274.65
|
|
X-ray neck soft tissue
|
$85.56 |
$85.56 |
$85.56 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$101.20 |
$101.20 |
$101.20 |
$225.60
|
|
X-ray pelvis 1-2 views
|
$89.93 |
$89.93 |
$89.93 |
$280.80
|
|
X-ray pelvis complete > 3 views
|
$126.50 |
$126.50 |
$126.50 |
$348.19
|
|
X-ray ribs 2 views left
|
$114.31 |
$114.31 |
$114.31 |
$292.80
|
|
X-ray ribs 3 views bilateral
|
$141.68 |
$141.68 |
$141.68 |
$395.76
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$173.65 |
$173.65 |
$173.65 |
$356.20
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$232.53 |
$232.53 |
$232.53 |
$491.70
|
|
X-ray sacroiliac joints >= 3 views
|
$131.56 |
$131.56 |
$131.56 |
$312.75
|
|
X-ray sacrum/coccyx >= 2 views
|
$97.75 |
$97.75 |
$97.75 |
$288.80
|
|
X-ray scapula complete (both sides)
|
$107.18 |
$107.18 |
$107.18 |
$285.00
|
|
X-ray shoulder 1 view (both sides)
|
$47.61 |
$47.61 |
$47.61 |
$260.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$126.50 |
$126.50 |
$126.50 |
$345.60
|
|
X-ray sinus tract/fistula/abscess
|
$166.52 |
$166.52 |
$166.52 |
$606.89
|
|
X-ray skull < 4 views
|
$111.78 |
$111.78 |
$111.78 |
$292.50
|
|
X-ray skull > 4 views complete
|
$148.35 |
$148.35 |
$148.35 |
$417.50
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$269.79 |
$269.79 |
$269.79 |
$557.70
|
|
X-ray small intestine follow-through study
|
$160.54 |
$160.54 |
$160.54 |
$499.50
|
|
X-ray spine single view
|
$84.41 |
$84.41 |
$84.41 |
$251.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$85.56 |
$85.56 |
$85.56 |
$264.48
|
|
X-ray sternum > 2 views
|
$123.51 |
$123.51 |
$123.51 |
$274.65
|
|
X-ray surgical specimen
|
$345.92 |
$345.92 |
$345.92 |
$504.00
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$186.53 |
$186.53 |
$186.53 |
$523.25
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$136.16 |
$136.16 |
$136.16 |
$327.80
|
|
X-ray thoracic spine 2 views
|
$127.65 |
$127.65 |
$127.65 |
$320.45
|
|
X-ray thoracic spine 3 views
|
$137.08 |
$137.08 |
$137.08 |
$381.60
|
|
X-ray thoracolumbar spine >=2 views
|
$106.49 |
$106.49 |
$106.49 |
$282.50
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$91.31 |
$91.31 |
$91.31 |
$257.04
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$101.20 |
$101.20 |
$101.20 |
$352.95
|
|
X-ray tibia/fibula 2 views (both sides)
|
$99.82 |
$99.82 |
$99.82 |
$332.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$69.00 |
$69.00 |
$69.00 |
$258.50
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$383.18 |
$383.18 |
$383.18 |
$657.77
|