|
Western blot test
|
$174.00 |
$174.00 |
$174.00 |
$150.00
|
|
Whfo electric custom fitted
|
$12,829.43 |
$12,829.43 |
$12,829.43 |
$5,209.82
|
|
Whfo nontorsion joint prefab
|
$792.49 |
$792.49 |
$792.49 |
$224.01
|
|
Whfo w/joint(s) custom fab
|
$1,726.49 |
$1,726.49 |
$1,726.49 |
$465.50
|
|
Who nontorsion jnts pre cst
|
$2,020.43 |
$2,020.43 |
$2,020.43 |
$706.80
|
|
Who nontorsion jnts pre ots
|
$2,020.43 |
$2,020.43 |
$2,020.43 |
$1,144.66
|
|
Woman's shoe oxford brace
|
$282.18 |
$282.18 |
$282.18 |
$149.37
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$775.20 |
$775.20 |
$775.20 |
$554.01
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$513.00 |
$513.00 |
$513.00 |
$284.70
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$1,095.60 |
$1,095.60 |
$1,095.60 |
$438.75
|
|
Wrist endoscopy/surgery
|
$8,808.59 |
$8,808.59 |
$8,808.59 |
$3,452.80
|
|
Wrist X-ray
|
$447.60 |
$447.60 |
$447.60 |
$342.80
|
|
Xcapsl ctrc rmvl cplx wo ecp
|
$14,002.18 |
$14,002.18 |
$14,002.18 |
$3,724.80
|
|
Xcellistem, 1 mg
|
$9,328.85 |
$9,328.85 |
$9,328.85 |
$2,859.19
|
|
Xe133 xenon 10mci
|
$69.60 |
$69.60 |
$69.60 |
$207.00
|
|
Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/<
|
$61,286.45 |
$61,286.45 |
$61,286.45 |
$2,692.80
|
|
Xm archive tissue molec anal
|
$60.60 |
$60.60 |
$60.60 |
$49.84
|
|
X-ray abdomen 1 view
|
$388.20 |
$388.20 |
$388.20 |
$258.50
|
|
X-ray abdomen 2 views
|
$327.60 |
$327.60 |
$327.60 |
$316.47
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$708.60 |
$708.60 |
$708.60 |
$418.63
|
|
X-ray ankle 2 views (both sides)
|
$422.40 |
$422.40 |
$422.40 |
$282.50
|
|
X-ray bone age studies
|
$394.80 |
$394.80 |
$394.80 |
$251.40
|
|
X-ray bone survey complete
|
$1,675.20 |
$1,675.20 |
$1,675.20 |
$660.00
|
|
X-ray bone survey infant
|
$405.60 |
$405.60 |
$405.60 |
$394.69
|
|
X-ray cervical spine 2-3 views
|
$803.40 |
$803.40 |
$803.40 |
$333.83
|
|
X-ray cervical spine 4-5 views
|
$1,170.00 |
$1,170.00 |
$1,170.00 |
$457.05
|
|
X-ray cervical spine >= 6 views
|
$1,330.20 |
$1,330.20 |
$1,330.20 |
$508.50
|
|
X-ray clavicle complete (both sides)
|
$558.00 |
$558.00 |
$558.00 |
$300.05
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$871.20 |
$871.20 |
$871.20 |
$657.03
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$1,045.80 |
$1,045.80 |
$1,045.80 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$411.00 |
$411.00 |
$411.00 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$422.40 |
$422.40 |
$422.40 |
$364.12
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$820.20 |
$820.20 |
$820.20 |
$483.50
|
|
X-ray exam of arm infant
|
$246.00 |
$246.00 |
$246.00 |
$248.44
|
|
X-ray exam of eye sockets
|
$517.80 |
$517.80 |
$517.80 |
$328.35
|
|
X-ray exam of femur 1
|
$343.20 |
$343.20 |
$343.20 |
$240.00
|
|
X-ray exam thorac spine4/>vw
|
$511.20 |
$511.20 |
$511.20 |
$387.40
|
|
X-ray eye detection foreign body (both sides)
|
$454.80 |
$454.80 |
$454.80 |
$238.29
|
|
X-ray facial bones complete > 3 views
|
$527.40 |
$527.40 |
$527.40 |
$381.75
|
|
X-ray femur >=2 views (both sides)
|
$519.00 |
$519.00 |
$519.00 |
$317.25
|
|
X-ray finger(s) >= 2 views (both sides)
|
$287.40 |
$287.40 |
$287.40 |
$241.05
|
|
X-ray foot 2 views (both sides)
|
$384.60 |
$384.60 |
$384.60 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$355.80 |
$355.80 |
$355.80 |
$322.20
|
|
X-ray hand 2 views (both sides)
|
$414.60 |
$414.60 |
$414.60 |
$291.20
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$480.00 |
$480.00 |
$480.00 |
$274.95
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$615.60 |
$615.60 |
$615.60 |
$374.40
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$615.60 |
$615.60 |
$615.60 |
$424.05
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$343.80 |
$343.80 |
$343.80 |
$231.00
|
|
X-ray humerus >= 2 views left
|
$348.60 |
$348.60 |
$348.60 |
$309.31
|
|
X-ray knee 1-2 views (both sides)
|
$461.40 |
$461.40 |
$461.40 |
$285.00
|
|
X-ray knee 3 views (both sides)
|
$467.40 |
$467.40 |
$467.40 |
$363.20
|
|
X-ray lumbosacral spine >= 4 views
|
$1,325.40 |
$1,325.40 |
$1,325.40 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$1,333.80 |
$1,333.80 |
$1,333.80 |
$535.91
|
|
X-ray mandible complete > 4 views
|
$553.20 |
$553.20 |
$553.20 |
$361.61
|
|
X-ray nasal bones complete > 3 views
|
$369.60 |
$369.60 |
$369.60 |
$274.65
|
|
X-ray neck soft tissue
|
$440.40 |
$440.40 |
$440.40 |
$237.43
|
|
X-ray pelvis 1-2 views
|
$462.60 |
$462.60 |
$462.60 |
$280.80
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$743.40 |
$743.40 |
$743.40 |
$755.50
|
|
X-ray ribs 2 views left
|
$329.40 |
$329.40 |
$329.40 |
$292.80
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$523.80 |
$523.80 |
$523.80 |
$356.20
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$577.20 |
$577.20 |
$577.20 |
$491.70
|
|
X-ray sacrum/coccyx >= 2 views
|
$412.20 |
$412.20 |
$412.20 |
$288.80
|
|
X-ray scapula complete (both sides)
|
$519.60 |
$519.60 |
$519.60 |
$285.00
|
|
X-ray shoulder 1 view (both sides)
|
$388.20 |
$388.20 |
$388.20 |
$260.00
|
|
X-ray sinus tract/fistula/abscess
|
$815.40 |
$815.40 |
$815.40 |
$606.89
|
|
X-ray skull < 4 views
|
$405.60 |
$405.60 |
$405.60 |
$292.50
|
|
X-ray skull > 4 views complete
|
$793.80 |
$793.80 |
$793.80 |
$417.50
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$944.40 |
$944.40 |
$944.40 |
$557.70
|
|
X-ray small intestine follow-through study
|
$609.60 |
$609.60 |
$609.60 |
$499.50
|
|
X-ray spine single view
|
$408.00 |
$408.00 |
$408.00 |
$251.00
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$420.60 |
$420.60 |
$420.60 |
$523.25
|
|
X-ray thoracic spine 2 views
|
$625.20 |
$625.20 |
$625.20 |
$320.45
|
|
X-ray thoracic spine 3 views
|
$768.00 |
$768.00 |
$768.00 |
$381.60
|
|
X-ray tibia/fibula 2 views (both sides)
|
$441.00 |
$441.00 |
$441.00 |
$332.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$389.40 |
$389.40 |
$389.40 |
$258.50
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$1,009.80 |
$1,009.80 |
$1,009.80 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$918.00 |
$918.00 |
$918.00 |
$603.20
|
|
X-ray wrist 2 views (both sides)
|
$407.40 |
$407.40 |
$407.40 |
$290.40
|
|
Yttrium y-90 ibritumomab ther
|
$2,194.80 |
$2,194.80 |
$2,194.80 |
$55,035.00
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$209.36 |
$209.36 |
$209.36 |
$93.06
|
|
Zika virus dna/rna amp probe
|
$286.80 |
$286.80 |
$286.80 |
$185.00
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$152.52 |
$152.52 |
$152.52 |
$452.69
|
