|
Wound therapy negative pressure per session <= 50 sq cm
|
$425.52 |
$425.52 |
$827.40 |
$558.97
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$500.67 |
$500.67 |
$973.53 |
$611.25
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$239.13 |
$262.71 |
$510.83 |
$288.91
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$294.75 |
$294.75 |
$573.13 |
$436.15
|
|
Wrist X-ray
|
$610.92 |
$610.92 |
$763.88 |
$343.70
|
|
X-ray abdomen 1 view
|
$343.17 |
$343.17 |
$667.28 |
$255.00
|
|
X-ray abdomen 2 views
|
$421.65 |
$421.65 |
$819.88 |
$312.36
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$434.70 |
$434.70 |
$845.25 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$246.42 |
$246.42 |
$479.15 |
$271.44
|
|
X-ray ankle 2 views (both sides)
|
$462.15 |
$462.15 |
$577.85 |
$283.00
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$1,070.13 |
$1,248.84 |
$1,248.84 |
$768.30
|
|
X-ray bone age studies
|
$87.39 |
$87.39 |
$795.55 |
$246.75
|
|
X-ray bone length studies
|
$102.06 |
$164.43 |
$319.73 |
$287.25
|
|
X-ray bone survey complete
|
$678.96 |
$678.96 |
$1,320.20 |
$666.60
|
|
X-ray bone survey infant
|
$165.60 |
$165.60 |
$469.00 |
$410.73
|
|
X-ray cervical spine 2-3 views
|
$352.62 |
$352.62 |
$685.65 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$532.26 |
$532.26 |
$1,034.95 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$574.02 |
$574.02 |
$1,116.15 |
$515.35
|
|
X-ray clavicle complete (both sides)
|
$567.27 |
$567.27 |
$709.10 |
$299.65
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$342.36 |
$342.36 |
$665.70 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$511.02 |
$511.02 |
$993.65 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$487.98 |
$487.98 |
$610.05 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$647.46 |
$647.46 |
$809.73 |
$342.00
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$298.98 |
$298.98 |
$581.35 |
$486.24
|
|
X-ray exam entire spi 4/5 vw
|
$410.76 |
$410.76 |
$798.70 |
$486.01
|
|
X-ray exam entire spi 6/> vw
|
$410.76 |
$410.76 |
$798.70 |
$575.76
|
|
X-ray exam of arm infant
|
$275.04 |
$275.04 |
$534.80 |
$248.82
|
|
X-ray exam of eye sockets
|
$321.48 |
$321.48 |
$625.10 |
$349.05
|
|
X-ray exam of femur 1
|
$130.32 |
$130.32 |
$253.40 |
$232.36
|
|
X-ray exam of jaw joint
|
$206.64 |
$206.64 |
$272.48 |
$192.39
|
|
X-ray exam of jaw joint
|
$537.75 |
$537.75 |
$779.63 |
$354.79
|
|
X-ray exam of mastoids
|
$272.48 |
$272.48 |
$272.48 |
$191.91
|
|
X-ray exam of perineum
|
$420.93 |
$420.93 |
$610.75 |
$420.93
|
|
X-ray exam of sinuses
|
$87.39 |
$87.39 |
$404.08 |
$211.00
|
|
X-ray exam si joints
|
$118.17 |
$118.17 |
$252.70 |
$246.16
|
|
X-ray eye detection foreign body (both sides)
|
$183.23 |
$206.64 |
$206.64 |
$235.00
|
|
X-ray facial bones complete > 3 views
|
$294.03 |
$294.03 |
$571.73 |
$366.60
|
|
X-ray fallopian tube
|
$455.31 |
$455.31 |
$751.98 |
$501.00
|
|
X-ray femur >=2 views (both sides)
|
$130.32 |
$130.32 |
$253.40 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$233.55 |
$233.55 |
$454.13 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$511.38 |
$511.38 |
$994.35 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$562.32 |
$562.32 |
$703.15 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$522.27 |
$522.27 |
$1,015.53 |
$316.50
|
|
X-ray head for orthodontia
|
$94.23 |
$94.23 |
$198.10 |
$104.19
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$476.46 |
$476.46 |
$595.88 |
$270.00
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$215.19 |
$215.19 |
$418.43 |
$370.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$215.19 |
$215.19 |
$418.43 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$215.19 |
$215.19 |
$418.43 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$410.76 |
$410.76 |
$798.70 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$130.32 |
$130.32 |
$253.40 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$543.69 |
$543.69 |
$679.88 |
$304.15
|
|
X-ray joint survey 1 view
|
$261.18 |
$261.18 |
$507.85 |
$211.00
|
|
X-ray knee 1-2 views (both sides)
|
$553.41 |
$553.41 |
$691.95 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$610.92 |
$610.92 |
$763.88 |
$353.25
|
|
X-ray knee ap standing bilateral
|
$297.72 |
$297.72 |
$578.90 |
$276.25
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$330.03 |
$330.03 |
$412.65 |
$249.13
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$433.26 |
$433.26 |
$493.33 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$514.71 |
$514.71 |
$1,000.83 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$585.36 |
$585.36 |
$1,138.20 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$256.05 |
$256.05 |
$497.88 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$113.22 |
$113.22 |
$332.15 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$306.18 |
$306.18 |
$595.35 |
$277.70
|
|
X-ray neck soft tissue
|
$309.24 |
$309.24 |
$601.30 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$192.60 |
$192.60 |
$374.50 |
$225.96
|
|
X-ray of mammary ducts
|
$535.50 |
$535.50 |
$535.50 |
$473.55
|
|
X-ray optic foramina
|
$151.20 |
$151.20 |
$294.00 |
$171.00
|
|
X-ray pelvis 1-2 views
|
$313.47 |
$313.47 |
$609.53 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$501.03 |
$501.03 |
$974.23 |
$342.30
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$559.89 |
$559.89 |
$1,088.68 |
$742.00
|
|
X-ray ribs 2 views left
|
$356.22 |
$356.22 |
$692.65 |
$296.32
|
|
X-ray ribs 3 views bilateral
|
$303.93 |
$303.93 |
$590.98 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$219.42 |
$219.42 |
$517.83 |
$359.47
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$468.18 |
$468.18 |
$910.35 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$199.26 |
$199.26 |
$387.45 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$78.30 |
$78.30 |
$341.25 |
$285.60
|
|
X-ray scapula complete (both sides)
|
$556.38 |
$556.38 |
$695.63 |
$292.50
|
|
X-ray sella turcica
|
$94.23 |
$94.23 |
$212.45 |
$162.50
|
|
X-ray shoulder 1 view (both sides)
|
$426.60 |
$426.60 |
$533.58 |
$264.48
|
|
X-ray sinuses paranasal complete > 3 views
|
$209.70 |
$209.70 |
$493.33 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$383.85 |
$383.85 |
$746.38 |
$601.30
|
|
X-ray skull < 4 views
|
$147.42 |
$147.42 |
$416.50 |
$291.78
|
|
X-ray skull > 4 views complete
|
$331.38 |
$331.38 |
$654.15 |
$414.60
|
|
X-ray slg plne bdy sect without urogr
|
$151.20 |
$151.20 |
$219.10 |
$387.00
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$410.76 |
$410.76 |
$798.70 |
$557.70
|
|
X-ray small intestine follow-through study
|
$470.16 |
$470.16 |
$470.16 |
$504.14
|
|
X-ray spine single view
|
$232.92 |
$232.92 |
$452.90 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$194.31 |
$194.31 |
$377.83 |
$263.49
|
|
X-ray sternum > 2 views
|
$314.82 |
$314.82 |
$612.15 |
$269.75
|
|
X-ray surgical specimen
|
$209.16 |
$209.16 |
$406.70 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$583.65 |
$583.65 |
$1,538.25 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$179.37 |
$179.37 |
$348.78 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$293.40 |
$293.40 |
$570.50 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$430.29 |
$430.29 |
$836.68 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$258.12 |
$258.12 |
$501.90 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$113.40 |
$113.40 |
$220.50 |
$256.85
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$215.19 |
$215.19 |
$418.43 |
$385.80
|
|
X-ray tibia/fibula 2 views (both sides)
|
$454.95 |
$454.95 |
$568.75 |
$328.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$225.00 |
$225.00 |
$437.50 |
$264.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$342.45 |
$342.45 |
$665.88 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$342.45 |
$342.45 |
$665.88 |
$555.04
|