|
Wilate injection
|
$4.58 |
$4.58 |
$4.58 |
$4.58
|
|
Wnd prep f/n/hf/g addl cm
|
$560.85 |
$560.85 |
$560.85 |
$811.00
|
|
Wound pouch each
|
$111.89 |
$111.89 |
$111.89 |
$57.00
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$718.50 |
$718.50 |
$718.50 |
$554.01
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$718.50 |
$718.50 |
$718.50 |
$579.70
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$306.75 |
$306.75 |
$306.75 |
$284.70
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$532.35 |
$532.35 |
$532.35 |
$438.75
|
|
Wrist X-ray
|
$502.05 |
$502.05 |
$502.05 |
$342.80
|
|
Xcellistem, 1 mg
|
$5.62 |
$5.62 |
$5.62 |
$2,859.19
|
|
Xe133 xenon 10mci
|
$67.65 |
$67.65 |
$67.65 |
$207.00
|
|
Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/<
|
$2,105.40 |
$2,105.40 |
$2,105.40 |
$2,692.80
|
|
X-linked intellectual dblt
|
$369.00 |
$369.00 |
$369.00 |
$1,258.40
|
|
X-ray abdomen 1 view
|
$339.15 |
$339.15 |
$339.15 |
$258.50
|
|
X-ray abdomen 2 views
|
$404.40 |
$404.40 |
$404.40 |
$316.47
|
|
X-ray abdomen >=3 views
|
$404.40 |
$404.40 |
$404.40 |
$342.50
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$339.15 |
$339.15 |
$339.15 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$257.10 |
$257.10 |
$257.10 |
$270.20
|
|
X-ray ankle 2 views (both sides)
|
$317.85 |
$317.85 |
$317.85 |
$282.50
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$594.30 |
$594.30 |
$594.30 |
$773.40
|
|
X-ray bone age studies
|
$376.35 |
$376.35 |
$376.35 |
$251.40
|
|
X-ray bone length studies
|
$285.30 |
$285.30 |
$285.30 |
$285.30
|
|
X-ray bone survey complete
|
$578.10 |
$578.10 |
$578.10 |
$660.00
|
|
X-ray bone survey infant
|
$374.85 |
$374.85 |
$374.85 |
$394.69
|
|
X-ray cervical spine 2-3 views
|
$364.80 |
$364.80 |
$364.80 |
$333.83
|
|
X-ray cervical spine 4-5 views
|
$545.55 |
$545.55 |
$545.55 |
$457.05
|
|
X-ray cervical spine >= 6 views
|
$508.50 |
$508.50 |
$508.50 |
$508.50
|
|
X-ray clavicle complete (both sides)
|
$371.85 |
$371.85 |
$371.85 |
$300.05
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$742.20 |
$742.20 |
$742.20 |
$657.03
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$785.55 |
$785.55 |
$785.55 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$351.00 |
$351.00 |
$351.00 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$383.10 |
$383.10 |
$383.10 |
$364.12
|
|
Xray endovasc thor ao repr
|
$1,480.05 |
$1,480.05 |
$1,480.05 |
$1,734.00
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$425.55 |
$425.55 |
$425.55 |
$483.50
|
|
X-ray exam entire spi 4/5 vw
|
$362.55 |
$362.55 |
$362.55 |
$441.48
|
|
X-ray exam entire spi 6/> vw
|
$383.10 |
$383.10 |
$383.10 |
$517.80
|
|
X-ray exam of arm infant
|
$215.70 |
$215.70 |
$215.70 |
$248.44
|
|
X-ray exam of eye sockets
|
$328.35 |
$328.35 |
$328.35 |
$328.35
|
|
X-ray exam of femur 1
|
$317.85 |
$317.85 |
$317.85 |
$240.00
|
|
X-ray exam of middle ear
|
$328.20 |
$328.20 |
$328.20 |
$345.66
|
|
X-ray exam of sinuses
|
$208.50 |
$208.50 |
$208.50 |
$214.50
|
|
X-ray facial bones complete > 3 views
|
$381.75 |
$381.75 |
$381.75 |
$381.75
|
|
X-ray fallopian tube
|
$757.35 |
$757.35 |
$757.35 |
$532.38
|
|
X-ray femur >=2 views (both sides)
|
$351.00 |
$351.00 |
$351.00 |
$317.25
|
|
X-ray finger(s) >= 2 views (both sides)
|
$241.05 |
$241.05 |
$241.05 |
$241.05
|
|
X-ray foot 2 views (both sides)
|
$333.00 |
$333.00 |
$333.00 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$404.40 |
$404.40 |
$404.40 |
$322.20
|
|
X-ray hand 2 views (both sides)
|
$294.90 |
$294.90 |
$294.90 |
$291.20
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$289.65 |
$289.65 |
$289.65 |
$274.95
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$491.70 |
$491.70 |
$491.70 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$491.70 |
$491.70 |
$491.70 |
$374.40
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$507.75 |
$507.75 |
$507.75 |
$424.05
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$515.25 |
$515.25 |
$515.25 |
$505.60
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$360.30 |
$360.30 |
$360.30 |
$231.00
|
|
X-ray humerus >= 2 views left
|
$351.00 |
$351.00 |
$351.00 |
$309.31
|
|
X-ray knee 1-2 views (both sides)
|
$383.10 |
$383.10 |
$383.10 |
$285.00
|
|
X-ray knee 3 views (both sides)
|
$404.40 |
$404.40 |
$404.40 |
$363.20
|
|
X-ray knee ap standing bilateral
|
$491.70 |
$491.70 |
$491.70 |
$252.50
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$302.55 |
$302.55 |
$302.55 |
$254.12
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$425.55 |
$425.55 |
$425.55 |
$369.15
|
|
X-ray lumbosacral spine >= 4 views
|
$652.50 |
$652.50 |
$652.50 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$425.55 |
$425.55 |
$425.55 |
$535.91
|
|
X-ray mandible complete > 4 views
|
$411.30 |
$411.30 |
$411.30 |
$361.61
|
|
X-ray mandible ltd <4 views
|
$322.35 |
$322.35 |
$322.35 |
$235.30
|
|
X-ray nasal bones complete > 3 views
|
$274.65 |
$274.65 |
$274.65 |
$274.65
|
|
X-ray neck soft tissue
|
$175.80 |
$175.80 |
$175.80 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$415.80 |
$415.80 |
$415.80 |
$225.60
|
|
X-ray of mammary ducts
|
$621.75 |
$621.75 |
$621.75 |
$568.26
|
|
X-ray pelvis 1-2 views
|
$371.85 |
$371.85 |
$371.85 |
$280.80
|
|
X-ray pelvis complete > 3 views
|
$404.40 |
$404.40 |
$404.40 |
$348.19
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$622.35 |
$622.35 |
$622.35 |
$755.50
|
|
X-ray ribs 2 views left
|
$280.65 |
$280.65 |
$280.65 |
$292.80
|
|
X-ray ribs 3 views bilateral
|
$436.80 |
$436.80 |
$436.80 |
$395.76
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$294.90 |
$294.90 |
$294.90 |
$356.20
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$491.70 |
$491.70 |
$491.70 |
$491.70
|
|
X-ray sacroiliac joints >= 3 views
|
$230.55 |
$230.55 |
$230.55 |
$312.75
|
|
X-ray sacrum/coccyx >= 2 views
|
$307.05 |
$307.05 |
$307.05 |
$288.80
|
|
X-ray scapula complete (both sides)
|
$270.00 |
$270.00 |
$270.00 |
$285.00
|
|
X-ray sella turcica
|
$156.75 |
$156.75 |
$156.75 |
$162.50
|
|
X-ray shoulder 1 view (both sides)
|
$307.05 |
$307.05 |
$307.05 |
$260.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$404.40 |
$404.40 |
$404.40 |
$345.60
|
|
X-ray sinus tract/fistula/abscess
|
$404.40 |
$404.40 |
$404.40 |
$606.89
|
|
X-ray skull < 4 views
|
$351.00 |
$351.00 |
$351.00 |
$292.50
|
|
X-ray skull > 4 views complete
|
$525.00 |
$525.00 |
$525.00 |
$417.50
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$639.60 |
$639.60 |
$639.60 |
$557.70
|
|
X-ray small intestine follow-through study
|
$459.60 |
$459.60 |
$459.60 |
$499.50
|
|
X-ray spine single view
|
$328.35 |
$328.35 |
$328.35 |
$251.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$285.15 |
$285.15 |
$285.15 |
$264.48
|
|
X-ray sternum > 2 views
|
$274.65 |
$274.65 |
$274.65 |
$274.65
|
|
X-ray surgical specimen
|
$653.40 |
$653.40 |
$653.40 |
$504.00
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$601.05 |
$601.05 |
$601.05 |
$523.25
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$406.80 |
$406.80 |
$406.80 |
$327.80
|
|
X-ray thoracic spine 2 views
|
$404.40 |
$404.40 |
$404.40 |
$320.45
|
|
X-ray thoracic spine 3 views
|
$371.85 |
$371.85 |
$371.85 |
$381.60
|
|
X-ray thoracolumbar spine >=2 views
|
$371.85 |
$371.85 |
$371.85 |
$282.50
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$264.00 |
$264.00 |
$264.00 |
$257.04
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$300.60 |
$300.60 |
$300.60 |
$352.95
|
|
X-ray tibia/fibula 2 views (both sides)
|
$345.75 |
$345.75 |
$345.75 |
$332.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$313.35 |
$313.35 |
$313.35 |
$258.50
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$643.95 |
$643.95 |
$643.95 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$643.95 |
$643.95 |
$643.95 |
$603.20
|