|
Warde zinc
|
$142.67 |
$142.67 |
$142.67 |
$62.50
|
|
Wbc automated
|
$75.99 |
$75.99 |
$75.99 |
$32.80
|
|
Wound closure by adhesive
|
$286.11 |
$286.11 |
$286.11 |
$153.40
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$1,636.61 |
$1,636.61 |
$1,636.61 |
$558.97
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$2,572.84 |
$2,572.84 |
$2,572.84 |
$611.25
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$272.67 |
$272.67 |
$272.67 |
$288.91
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$412.94 |
$412.94 |
$412.94 |
$436.15
|
|
Wrist X-ray
|
$641.67 |
$641.67 |
$641.67 |
$343.70
|
|
X-ray abdomen 1 view
|
$586.00 |
$586.00 |
$586.00 |
$255.00
|
|
X-ray abdomen 2 views
|
$725.84 |
$725.84 |
$725.84 |
$312.36
|
|
X-ray abdomen >=3 views
|
$839.88 |
$839.88 |
$839.88 |
$332.15
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$903.66 |
$903.66 |
$903.66 |
$418.63
|
|
X-ray ankle 2 views (both sides)
|
$626.05 |
$626.05 |
$626.05 |
$283.00
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$870.40 |
$870.40 |
$870.40 |
$768.30
|
|
X-ray bone age studies
|
$620.45 |
$620.45 |
$620.45 |
$246.75
|
|
X-ray bone survey complete
|
$1,338.29 |
$1,338.29 |
$1,338.29 |
$666.60
|
|
X-ray bone survey infant
|
$651.64 |
$651.64 |
$651.64 |
$410.73
|
|
X-ray cervical spine 2-3 views
|
$849.59 |
$849.59 |
$849.59 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$968.88 |
$968.88 |
$968.88 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$1,209.38 |
$1,209.38 |
$1,209.38 |
$515.35
|
|
X-ray clavicle complete (both sides)
|
$454.75 |
$454.75 |
$454.75 |
$299.65
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$1,305.68 |
$1,305.68 |
$1,305.68 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$1,373.00 |
$1,373.00 |
$1,373.00 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$495.03 |
$495.03 |
$495.03 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$613.10 |
$613.10 |
$613.10 |
$342.00
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$768.22 |
$768.22 |
$768.22 |
$486.24
|
|
X-ray exam entire spi 4/5 vw
|
$380.47 |
$380.47 |
$380.47 |
$486.01
|
|
X-ray exam entire spi 6/> vw
|
$565.79 |
$565.79 |
$565.79 |
$575.76
|
|
X-ray exam of arm infant
|
$592.26 |
$592.26 |
$592.26 |
$248.82
|
|
X-ray exam of eye sockets
|
$609.59 |
$609.59 |
$609.59 |
$349.05
|
|
X-ray exam of femur 1
|
$551.45 |
$551.45 |
$551.45 |
$232.36
|
|
X-ray exam of jaw joint
|
$1,016.39 |
$1,016.39 |
$1,016.39 |
$192.39
|
|
X-ray exam of sinuses
|
$814.52 |
$814.52 |
$814.52 |
$211.00
|
|
X-ray exam of teeth
|
$1,328.20 |
$1,328.20 |
$1,328.20 |
$286.04
|
|
X-ray exam si joints
|
$561.30 |
$561.30 |
$561.30 |
$246.16
|
|
X-ray facial bones complete > 3 views
|
$751.12 |
$751.12 |
$751.12 |
$366.60
|
|
X-ray femur >=2 views (both sides)
|
$551.45 |
$551.45 |
$551.45 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$508.72 |
$508.72 |
$508.72 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$603.99 |
$603.99 |
$603.99 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$576.10 |
$576.10 |
$576.10 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$581.92 |
$581.92 |
$581.92 |
$316.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$427.84 |
$427.84 |
$427.84 |
$270.00
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$932.96 |
$932.96 |
$932.96 |
$370.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$576.67 |
$576.67 |
$576.67 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$561.30 |
$561.30 |
$561.30 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$1,385.29 |
$1,385.29 |
$1,385.29 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$414.79 |
$414.79 |
$414.79 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$561.54 |
$561.54 |
$561.54 |
$304.15
|
|
X-ray knee 1-2 views (both sides)
|
$519.37 |
$519.37 |
$519.37 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$613.10 |
$613.10 |
$613.10 |
$353.25
|
|
X-ray knee ap standing bilateral
|
$804.56 |
$804.56 |
$804.56 |
$276.25
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$431.62 |
$431.62 |
$431.62 |
$249.13
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$495.22 |
$495.22 |
$495.22 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$1,014.59 |
$1,014.59 |
$1,014.59 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$1,136.86 |
$1,136.86 |
$1,136.86 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$773.19 |
$773.19 |
$773.19 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$456.85 |
$456.85 |
$456.85 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$469.46 |
$469.46 |
$469.46 |
$277.70
|
|
X-ray neck soft tissue
|
$391.99 |
$391.99 |
$391.99 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$427.79 |
$427.79 |
$427.79 |
$225.96
|
|
X-ray pelvis 1-2 views
|
$495.73 |
$495.73 |
$495.73 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$558.44 |
$558.44 |
$558.44 |
$342.30
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$1,030.83 |
$1,030.83 |
$1,030.83 |
$742.00
|
|
X-ray ribs 2 views left
|
$700.34 |
$700.34 |
$700.34 |
$296.32
|
|
X-ray ribs 3 views bilateral
|
$711.53 |
$711.53 |
$711.53 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$823.47 |
$823.47 |
$823.47 |
$359.47
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$732.90 |
$732.90 |
$732.90 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$576.49 |
$576.49 |
$576.49 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$713.28 |
$713.28 |
$713.28 |
$285.60
|
|
X-ray scapula complete (both sides)
|
$454.75 |
$454.75 |
$454.75 |
$292.50
|
|
X-ray shoulder 1 view (both sides)
|
$474.71 |
$474.71 |
$474.71 |
$264.48
|
|
X-ray sinuses paranasal complete > 3 views
|
$967.65 |
$967.65 |
$967.65 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$1,677.54 |
$1,677.54 |
$1,677.54 |
$601.30
|
|
X-ray skull < 4 views
|
$433.02 |
$433.02 |
$433.02 |
$291.78
|
|
X-ray skull > 4 views complete
|
$918.60 |
$918.60 |
$918.60 |
$414.60
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$1,664.46 |
$1,664.46 |
$1,664.46 |
$557.70
|
|
X-ray small intestine follow-through study
|
$2,019.70 |
$2,019.70 |
$2,019.70 |
$504.14
|
|
X-ray spine single view
|
$531.12 |
$531.12 |
$531.12 |
$252.60
|
|
X-ray sternum > 2 views
|
$445.64 |
$445.64 |
$445.64 |
$269.75
|
|
X-ray surgical specimen
|
$419.73 |
$419.73 |
$419.73 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$910.22 |
$910.22 |
$910.22 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$786.16 |
$786.16 |
$786.16 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$562.32 |
$562.32 |
$562.32 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$849.59 |
$849.59 |
$849.59 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$329.66 |
$329.66 |
$329.66 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$565.79 |
$565.79 |
$565.79 |
$385.80
|
|
X-ray tibia/fibula 2 views (both sides)
|
$584.93 |
$584.93 |
$584.93 |
$328.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$470.95 |
$470.95 |
$470.95 |
$264.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$2,019.70 |
$2,019.70 |
$2,019.70 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$2,019.70 |
$2,019.70 |
$2,019.70 |
$555.04
|
|
X-ray wrist 2 views (both sides)
|
$536.73 |
$536.73 |
$536.73 |
$290.40
|
|
X-ray xm phrnx&/crv esoph c+
|
$1,176.41 |
$1,176.41 |
$1,176.41 |
$324.20
|
|
Yersinia antibody
|
$158.71 |
$158.71 |
$158.71 |
$66.95
|
|
Zika virus igm antibody
|
$202.76 |
$202.76 |
$202.76 |
$75.40
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$296.06 |
$296.06 |
$296.06 |
$346.14
|