|
Warde pancreatic elastase fecal quantitative
|
$79.80 |
$79.80 |
$79.80 |
$94.25
|
|
Warde protein c antigen
|
$118.80 |
$118.80 |
$118.80 |
$93.43
|
|
Warde sex hormone binding globulin
|
$72.00 |
$72.00 |
$72.00 |
$82.08
|
|
Warde somatomedin
|
$106.20 |
$106.20 |
$106.20 |
$113.58
|
|
Warde t3 (triiodothyronine) reverse
|
$186.60 |
$186.60 |
$186.60 |
$69.50
|
|
Warde thyroid stimulating immunoglobulins
|
$333.00 |
$333.00 |
$333.00 |
$178.53
|
|
Warde topiramate therapeutic drug level
|
$143.40 |
$143.40 |
$143.40 |
$71.20
|
|
Warde virus isolation tissue culture innoculation presumptive id herpes simplex
|
$264.60 |
$264.60 |
$264.60 |
$129.54
|
|
Warde viscosity
|
$85.20 |
$85.20 |
$85.20 |
$49.47
|
|
Warde vitamin a
|
$152.40 |
$152.40 |
$152.40 |
$58.80
|
|
Warde vitamin b-1 (thiamine)
|
$181.20 |
$181.20 |
$181.20 |
$82.04
|
|
Warde vitamin b6 (pyridoxine)
|
$140.40 |
$140.40 |
$140.40 |
$116.20
|
|
Warde vitamin d (1 25 dihydroxy)
|
$193.20 |
$193.20 |
$193.20 |
$138.50
|
|
Warde zinc
|
$120.00 |
$120.00 |
$120.00 |
$62.50
|
|
Wbc automated
|
$73.80 |
$73.80 |
$73.80 |
$32.35
|
|
Wedging of cast
|
$237.00 |
$237.00 |
$237.00 |
$314.28
|
|
Whfo electric custom fitted
|
$14,399.88 |
$14,399.88 |
$14,399.88 |
$5,209.82
|
|
Whfo nontorsion joint prefab
|
$889.49 |
$889.49 |
$889.49 |
$224.01
|
|
Whfo w/joint(s) custom fab
|
$1,937.83 |
$1,937.83 |
$1,937.83 |
$465.50
|
|
Who nontorsion jnts pre cst
|
$2,267.75 |
$2,267.75 |
$2,267.75 |
$706.80
|
|
Who nontorsion jnts pre ots
|
$2,267.75 |
$2,267.75 |
$2,267.75 |
$1,144.66
|
|
Wilate injection
|
$10,080.00 |
$10,080.00 |
$10,080.00 |
$4.58
|
|
Woman's shoe oxford brace
|
$316.72 |
$316.72 |
$316.72 |
$149.37
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$649.20 |
$649.20 |
$649.20 |
$554.01
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$264.00 |
$264.00 |
$264.00 |
$284.70
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$307.80 |
$307.80 |
$307.80 |
$438.75
|
|
Wrist arthroscopy/surgery
|
$15,227.89 |
$15,227.89 |
$15,227.89 |
$3,839.54
|
|
Wrist endoscopy/surgery
|
$8,505.68 |
$8,505.68 |
$8,505.68 |
$3,452.80
|
|
Wrist X-ray
|
$662.40 |
$662.40 |
$662.40 |
$342.80
|
|
Xcapsl ctrc rmvl cplx wo ecp
|
$13,754.00 |
$13,754.00 |
$13,754.00 |
$3,724.80
|
|
Xcapsl ctrc rmvl insj 1+
|
$25,026.66 |
$25,026.66 |
$25,026.66 |
$6,311.00
|
|
Xcellistem, 1 mg
|
$10,470.79 |
$10,470.79 |
$10,470.79 |
$2,859.19
|
|
Xcpsl ctrc rmvl cplx insj 1+
|
$27,704.98 |
$27,704.98 |
$27,704.98 |
$7,316.99
|
|
Xe133 xenon 10mci
|
$114.60 |
$114.60 |
$114.60 |
$207.00
|
|
Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/<
|
$1,439.40 |
$1,439.40 |
$1,439.40 |
$2,692.80
|
|
X-ray abdomen 1 view
|
$640.80 |
$640.80 |
$640.80 |
$258.50
|
|
X-ray abdomen 2 views
|
$553.80 |
$553.80 |
$553.80 |
$316.47
|
|
X-ray abdomen >=3 views
|
$722.40 |
$722.40 |
$722.40 |
$342.50
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$871.20 |
$871.20 |
$871.20 |
$418.63
|
|
X-ray ankle 2 views (both sides)
|
$578.40 |
$578.40 |
$578.40 |
$282.50
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$1,365.60 |
$1,365.60 |
$1,365.60 |
$773.40
|
|
X-ray bone age studies
|
$737.40 |
$737.40 |
$737.40 |
$251.40
|
|
X-ray bone survey complete
|
$2,170.20 |
$2,170.20 |
$2,170.20 |
$660.00
|
|
X-ray cervical spine 2-3 views
|
$591.60 |
$591.60 |
$591.60 |
$333.83
|
|
X-ray cervical spine 4-5 views
|
$1,011.60 |
$1,011.60 |
$1,011.60 |
$457.05
|
|
X-ray cervical spine >= 6 views
|
$1,012.80 |
$1,012.80 |
$1,012.80 |
$508.50
|
|
X-ray clavicle complete (both sides)
|
$775.20 |
$775.20 |
$775.20 |
$300.05
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$1,495.80 |
$1,495.80 |
$1,495.80 |
$657.03
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$2,462.40 |
$2,462.40 |
$2,462.40 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$357.60 |
$357.60 |
$357.60 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$762.60 |
$762.60 |
$762.60 |
$364.12
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$1,231.80 |
$1,231.80 |
$1,231.80 |
$483.50
|
|
X-ray exam entire spi 4/5 vw
|
$481.80 |
$481.80 |
$481.80 |
$441.48
|
|
X-ray exam entire spi 6/> vw
|
$523.20 |
$523.20 |
$523.20 |
$517.80
|
|
X-ray exam of arm infant
|
$804.00 |
$804.00 |
$804.00 |
$248.44
|
|
X-ray exam of femur 1
|
$640.20 |
$640.20 |
$640.20 |
$240.00
|
|
X-ray exam of sinuses
|
$666.00 |
$666.00 |
$666.00 |
$214.50
|
|
X-ray exam si joints
|
$568.20 |
$568.20 |
$568.20 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$165.60 |
$165.60 |
$165.60 |
$387.40
|
|
X-ray eye detection foreign body (both sides)
|
$502.20 |
$502.20 |
$502.20 |
$238.29
|
|
X-ray facial bones complete > 3 views
|
$664.20 |
$664.20 |
$664.20 |
$381.75
|
|
X-ray femur >=2 views (both sides)
|
$776.40 |
$776.40 |
$776.40 |
$317.25
|
|
X-ray finger(s) >= 2 views (both sides)
|
$614.40 |
$614.40 |
$614.40 |
$241.05
|
|
X-ray foot 2 views (both sides)
|
$385.80 |
$385.80 |
$385.80 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$496.20 |
$496.20 |
$496.20 |
$322.20
|
|
X-ray hand 2 views (both sides)
|
$481.20 |
$481.20 |
$481.20 |
$291.20
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$543.60 |
$543.60 |
$543.60 |
$274.95
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$822.60 |
$822.60 |
$822.60 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$1,144.80 |
$1,144.80 |
$1,144.80 |
$374.40
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$1,163.40 |
$1,163.40 |
$1,163.40 |
$424.05
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$744.00 |
$744.00 |
$744.00 |
$505.60
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$329.40 |
$329.40 |
$329.40 |
$231.00
|
|
X-ray humerus >= 2 views left
|
$594.60 |
$594.60 |
$594.60 |
$309.31
|
|
X-ray knee 1-2 views (both sides)
|
$445.80 |
$445.80 |
$445.80 |
$285.00
|
|
X-ray knee 3 views (both sides)
|
$645.00 |
$645.00 |
$645.00 |
$363.20
|
|
X-ray knee ap standing bilateral
|
$75.00 |
$75.00 |
$75.00 |
$252.50
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$718.80 |
$718.80 |
$718.80 |
$254.12
|
|
X-ray lumbosacral spine >= 4 views
|
$1,033.80 |
$1,033.80 |
$1,033.80 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$780.60 |
$780.60 |
$780.60 |
$535.91
|
|
X-ray mandible complete > 4 views
|
$863.40 |
$863.40 |
$863.40 |
$361.61
|
|
X-ray mandible ltd <4 views
|
$166.80 |
$166.80 |
$166.80 |
$235.30
|
|
X-ray nasal bones complete > 3 views
|
$511.80 |
$511.80 |
$511.80 |
$274.65
|
|
X-ray neck soft tissue
|
$647.40 |
$647.40 |
$647.40 |
$237.43
|
|
X-ray pelvis 1-2 views
|
$603.60 |
$603.60 |
$603.60 |
$280.80
|
|
X-ray pelvis complete > 3 views
|
$542.40 |
$542.40 |
$542.40 |
$348.19
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$2,035.80 |
$2,035.80 |
$2,035.80 |
$755.50
|
|
X-ray ribs 2 views left
|
$448.80 |
$448.80 |
$448.80 |
$292.80
|
|
X-ray ribs 3 views bilateral
|
$600.00 |
$600.00 |
$600.00 |
$395.76
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$924.00 |
$924.00 |
$924.00 |
$356.20
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$696.60 |
$696.60 |
$696.60 |
$491.70
|
|
X-ray sacroiliac joints >= 3 views
|
$576.60 |
$576.60 |
$576.60 |
$312.75
|
|
X-ray sacrum/coccyx >= 2 views
|
$776.40 |
$776.40 |
$776.40 |
$288.80
|
|
X-ray scapula complete (both sides)
|
$803.40 |
$803.40 |
$803.40 |
$285.00
|
|
X-ray shoulder 1 view (both sides)
|
$508.20 |
$508.20 |
$508.20 |
$260.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$995.40 |
$995.40 |
$995.40 |
$345.60
|
|
X-ray sinus tract/fistula/abscess
|
$833.40 |
$833.40 |
$833.40 |
$606.89
|
|
X-ray skull < 4 views
|
$642.00 |
$642.00 |
$642.00 |
$292.50
|
|
X-ray skull > 4 views complete
|
$847.20 |
$847.20 |
$847.20 |
$417.50
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$1,458.00 |
$1,458.00 |
$1,458.00 |
$557.70
|
|
X-ray small intestine follow-through study
|
$2,362.80 |
$2,362.80 |
$2,362.80 |
$499.50
|
