|
Western blot test
|
$124.00 |
$124.00 |
$124.00 |
$150.00
|
|
Wet mounts/ w preparations
|
$35.00 |
$35.00 |
$35.00 |
$36.80
|
|
Whfo nontorsion joint prefab
|
$114.37 |
$114.37 |
$114.37 |
$224.01
|
|
Whfo w/joint(s) custom fab
|
$218.38 |
$218.38 |
$218.38 |
$465.50
|
|
Whole blood for transfusion
|
$948.00 |
$948.00 |
$948.00 |
$497.00
|
|
Wound pouch each
|
$17.08 |
$17.08 |
$17.08 |
$57.00
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$894.00 |
$894.00 |
$894.00 |
$554.01
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$894.00 |
$894.00 |
$894.00 |
$579.70
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$487.50 |
$487.50 |
$487.50 |
$284.70
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$894.00 |
$894.00 |
$894.00 |
$438.75
|
|
Wrist X-ray
|
$214.00 |
$214.00 |
$214.00 |
$342.80
|
|
Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/<
|
$2,209.50 |
$2,209.50 |
$2,209.50 |
$2,692.80
|
|
Xfer tis s/a/l 10 sq cm/<
|
$5,420.00 |
$5,420.00 |
$5,420.00 |
$2,837.09
|
|
X-ray abdomen 1 view
|
$167.00 |
$167.00 |
$167.00 |
$258.50
|
|
X-ray abdomen 2 views
|
$265.00 |
$265.00 |
$265.00 |
$316.47
|
|
X-ray abdomen >=3 views
|
$273.50 |
$273.50 |
$273.50 |
$342.50
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$494.50 |
$494.50 |
$494.50 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$303.50 |
$303.50 |
$303.50 |
$270.20
|
|
X-ray ankle 2 views (both sides)
|
$184.50 |
$184.50 |
$184.50 |
$282.50
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$578.00 |
$578.00 |
$578.00 |
$773.40
|
|
X-ray bone age studies
|
$118.50 |
$118.50 |
$118.50 |
$251.40
|
|
X-ray bone length studies
|
$115.50 |
$115.50 |
$115.50 |
$285.30
|
|
X-ray bone survey complete
|
$882.50 |
$882.50 |
$882.50 |
$660.00
|
|
X-ray bone survey infant
|
$201.50 |
$201.50 |
$201.50 |
$394.69
|
|
X-ray cervical spine 2-3 views
|
$226.50 |
$226.50 |
$226.50 |
$333.83
|
|
X-ray cervical spine 4-5 views
|
$437.00 |
$437.00 |
$437.00 |
$457.05
|
|
X-ray cervical spine >= 6 views
|
$588.00 |
$588.00 |
$588.00 |
$508.50
|
|
X-ray clavicle complete (both sides)
|
$244.00 |
$244.00 |
$244.00 |
$300.05
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$482.50 |
$482.50 |
$482.50 |
$657.03
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$1,146.00 |
$1,146.00 |
$1,146.00 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$200.00 |
$200.00 |
$200.00 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$246.50 |
$246.50 |
$246.50 |
$364.12
|
|
Xray endovasc thor ao repr
|
$2,080.50 |
$2,080.50 |
$2,080.50 |
$1,734.00
|
|
Xray endovasc thor ao repr
|
$1,568.00 |
$1,568.00 |
$1,568.00 |
$1,622.18
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$467.00 |
$467.00 |
$467.00 |
$483.50
|
|
X-ray exam entire spi 4/5 vw
|
$307.00 |
$307.00 |
$307.00 |
$441.48
|
|
X-ray exam entire spi 6/> vw
|
$353.00 |
$353.00 |
$353.00 |
$517.80
|
|
X-ray exam of arm infant
|
$120.00 |
$120.00 |
$120.00 |
$248.44
|
|
X-ray exam of eye sockets
|
$524.50 |
$524.50 |
$524.50 |
$328.35
|
|
X-ray exam of femur 1
|
$373.50 |
$373.50 |
$373.50 |
$240.00
|
|
X-ray exam of jaw joint
|
$336.00 |
$336.00 |
$336.00 |
$188.40
|
|
X-ray exam of mastoids
|
$138.00 |
$138.00 |
$138.00 |
$193.41
|
|
X-ray exam of sinuses
|
$424.50 |
$424.50 |
$424.50 |
$214.50
|
|
X-ray exam of tear duct
|
$375.50 |
$375.50 |
$375.50 |
$467.50
|
|
X-ray exam of teeth
|
$66.00 |
$66.00 |
$66.00 |
$119.66
|
|
X-ray exam of teeth
|
$147.50 |
$147.50 |
$147.50 |
$328.08
|
|
X-ray exam si joints
|
$218.00 |
$218.00 |
$218.00 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$579.00 |
$579.00 |
$579.00 |
$387.40
|
|
X-ray eye detection foreign body (both sides)
|
$186.00 |
$186.00 |
$186.00 |
$238.29
|
|
X-ray facial bones complete > 3 views
|
$322.00 |
$322.00 |
$322.00 |
$381.75
|
|
X-ray femur >=2 views (both sides)
|
$129.50 |
$129.50 |
$129.50 |
$317.25
|
|
X-ray finger(s) >= 2 views (both sides)
|
$143.00 |
$143.00 |
$143.00 |
$241.05
|
|
X-ray foot 2 views (both sides)
|
$186.00 |
$186.00 |
$186.00 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$214.00 |
$214.00 |
$214.00 |
$322.20
|
|
X-ray hand 2 views (both sides)
|
$129.00 |
$129.00 |
$129.00 |
$291.20
|
|
X-ray head for orthodontia
|
$141.50 |
$141.50 |
$141.50 |
$158.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$247.00 |
$247.00 |
$247.00 |
$274.95
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$334.50 |
$334.50 |
$334.50 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$237.50 |
$237.50 |
$237.50 |
$374.40
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$351.50 |
$351.50 |
$351.50 |
$424.05
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$410.50 |
$410.50 |
$410.50 |
$505.60
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$172.50 |
$172.50 |
$172.50 |
$231.00
|
|
X-ray humerus >= 2 views left
|
$220.50 |
$220.50 |
$220.50 |
$309.31
|
|
X-ray joint survey 1 view
|
$343.50 |
$343.50 |
$343.50 |
$232.00
|
|
X-ray knee 1-2 views (both sides)
|
$185.50 |
$185.50 |
$185.50 |
$285.00
|
|
X-ray knee 3 views (both sides)
|
$329.50 |
$329.50 |
$329.50 |
$363.20
|
|
X-ray knee ap standing bilateral
|
$170.00 |
$170.00 |
$170.00 |
$252.50
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$127.00 |
$127.00 |
$127.00 |
$254.12
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$561.00 |
$561.00 |
$561.00 |
$369.15
|
|
X-ray lumbosacral spine >= 4 views
|
$312.50 |
$312.50 |
$312.50 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$482.50 |
$482.50 |
$482.50 |
$535.91
|
|
X-ray male genital tract
|
$617.00 |
$617.00 |
$617.00 |
$603.50
|
|
X-ray mandible complete > 4 views
|
$404.00 |
$404.00 |
$404.00 |
$361.61
|
|
X-ray mandible ltd <4 views
|
$283.00 |
$283.00 |
$283.00 |
$235.30
|
|
X-ray nasal bones complete > 3 views
|
$293.00 |
$293.00 |
$293.00 |
$274.65
|
|
X-ray neck soft tissue
|
$438.00 |
$438.00 |
$438.00 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$229.00 |
$229.00 |
$229.00 |
$225.60
|
|
X-ray of mammary ducts
|
$651.50 |
$651.50 |
$651.50 |
$568.26
|
|
X-ray pelvis 1-2 views
|
$322.50 |
$322.50 |
$322.50 |
$280.80
|
|
X-ray pelvis complete > 3 views
|
$427.00 |
$427.00 |
$427.00 |
$348.19
|
|
Xray place dist ext thor ao
|
$1,041.50 |
$1,041.50 |
$1,041.50 |
$1,194.70
|
|
Xray place prox ext thor ao
|
$984.50 |
$984.50 |
$984.50 |
$1,005.84
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$362.50 |
$362.50 |
$362.50 |
$755.50
|
|
X-ray ribs 2 views left
|
$264.50 |
$264.50 |
$264.50 |
$292.80
|
|
X-ray ribs 3 views bilateral
|
$545.50 |
$545.50 |
$545.50 |
$395.76
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$274.50 |
$274.50 |
$274.50 |
$356.20
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$693.50 |
$693.50 |
$693.50 |
$491.70
|
|
X-ray sacroiliac joints >= 3 views
|
$413.50 |
$413.50 |
$413.50 |
$312.75
|
|
X-ray sacrum/coccyx >= 2 views
|
$234.00 |
$234.00 |
$234.00 |
$288.80
|
|
X-ray scapula complete (both sides)
|
$381.50 |
$381.50 |
$381.50 |
$285.00
|
|
X-ray sella turcica
|
$141.50 |
$141.50 |
$141.50 |
$162.50
|
|
X-ray shoulder 1 view (both sides)
|
$198.00 |
$198.00 |
$198.00 |
$260.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$790.50 |
$790.50 |
$790.50 |
$345.60
|
|
X-ray sinus tract/fistula/abscess
|
$334.50 |
$334.50 |
$334.50 |
$606.89
|
|
X-ray skull < 4 views
|
$520.50 |
$520.50 |
$520.50 |
$292.50
|
|
X-ray skull > 4 views complete
|
$693.00 |
$693.00 |
$693.00 |
$417.50
|
|
X-ray slg plne bdy sect without urogr
|
$158.50 |
$158.50 |
$158.50 |
$399.82
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$569.00 |
$569.00 |
$569.00 |
$557.70
|
|
X-ray small intestine follow-through study
|
$510.50 |
$510.50 |
$510.50 |
$499.50
|
|
X-ray spine single view
|
$146.50 |
$146.50 |
$146.50 |
$251.00
|
