|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$220.00 |
$220.00 |
$220.00 |
$284.70
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$330.00 |
$330.00 |
$330.00 |
$438.75
|
|
Wrist X-ray
|
$780.00 |
$780.00 |
$780.00 |
$342.80
|
|
Xe133 xenon 10mci
|
$65.00 |
$65.00 |
$65.00 |
$207.00
|
|
Xpos opn axillary/sbclvn art w/cndt crtn
|
$3,025.00 |
$3,025.00 |
$3,025.00 |
$3,025.00
|
|
Xpos opn fmrl eprst aor uni add-on
|
$3,295.00 |
$3,295.00 |
$3,295.00 |
$2,087.40
|
|
X-ray abdomen 1 view
|
$262.50 |
$262.50 |
$262.50 |
$258.50
|
|
X-ray abdomen 2 views
|
$325.00 |
$325.00 |
$325.00 |
$316.47
|
|
X-ray abdomen >=3 views
|
$390.00 |
$390.00 |
$390.00 |
$342.50
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$452.50 |
$452.50 |
$452.50 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$295.00 |
$295.00 |
$295.00 |
$270.20
|
|
X-ray ankle 2 views (both sides)
|
$530.00 |
$530.00 |
$530.00 |
$282.50
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$965.00 |
$965.00 |
$965.00 |
$773.40
|
|
X-ray bone age studies
|
$292.50 |
$292.50 |
$292.50 |
$251.40
|
|
X-ray bone length studies
|
$350.00 |
$350.00 |
$350.00 |
$285.30
|
|
X-ray bone survey complete
|
$885.00 |
$885.00 |
$885.00 |
$660.00
|
|
X-ray bone survey infant
|
$525.00 |
$525.00 |
$525.00 |
$394.69
|
|
X-ray cervical spine 2-3 views
|
$350.00 |
$350.00 |
$350.00 |
$333.83
|
|
X-ray cervical spine 4-5 views
|
$510.00 |
$510.00 |
$510.00 |
$457.05
|
|
X-ray cervical spine >= 6 views
|
$580.00 |
$580.00 |
$580.00 |
$508.50
|
|
X-ray clavicle complete (both sides)
|
$575.00 |
$575.00 |
$575.00 |
$300.05
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$472.50 |
$472.50 |
$472.50 |
$657.03
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$615.00 |
$615.00 |
$615.00 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$475.00 |
$475.00 |
$475.00 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$595.00 |
$595.00 |
$595.00 |
$364.12
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$505.00 |
$505.00 |
$505.00 |
$483.50
|
|
X-ray exam entire spi 4/5 vw
|
$565.00 |
$565.00 |
$565.00 |
$441.48
|
|
X-ray exam entire spi 6/> vw
|
$845.00 |
$845.00 |
$845.00 |
$517.80
|
|
X-ray exam of arm infant
|
$220.00 |
$220.00 |
$220.00 |
$248.44
|
|
X-ray exam of eye sockets
|
$327.50 |
$327.50 |
$327.50 |
$328.35
|
|
X-ray exam of femur 1
|
$470.00 |
$470.00 |
$470.00 |
$240.00
|
|
X-ray exam of jaw joint
|
$260.00 |
$260.00 |
$260.00 |
$188.40
|
|
X-ray exam of sinuses
|
$282.50 |
$282.50 |
$282.50 |
$214.50
|
|
X-ray exam si joints
|
$252.50 |
$252.50 |
$252.50 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$462.50 |
$462.50 |
$462.50 |
$387.40
|
|
X-ray eye detection foreign body (both sides)
|
$275.00 |
$275.00 |
$275.00 |
$238.29
|
|
X-ray facial bones complete > 3 views
|
$402.50 |
$402.50 |
$402.50 |
$381.75
|
|
X-ray femur >=2 views (both sides)
|
$695.00 |
$695.00 |
$695.00 |
$317.25
|
|
X-ray finger(s) >= 2 views (both sides)
|
$545.00 |
$545.00 |
$545.00 |
$241.05
|
|
X-ray foot 2 views (both sides)
|
$465.00 |
$465.00 |
$465.00 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$560.00 |
$560.00 |
$560.00 |
$322.20
|
|
X-ray hand 2 views (both sides)
|
$470.00 |
$470.00 |
$470.00 |
$291.20
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$510.00 |
$510.00 |
$510.00 |
$274.95
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$432.50 |
$432.50 |
$432.50 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$432.50 |
$432.50 |
$432.50 |
$374.40
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$515.00 |
$515.00 |
$515.00 |
$424.05
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$655.00 |
$655.00 |
$655.00 |
$505.60
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$287.50 |
$287.50 |
$287.50 |
$231.00
|
|
X-ray humerus >= 2 views left
|
$590.00 |
$590.00 |
$590.00 |
$309.31
|
|
X-ray joint survey 1 view
|
$295.00 |
$295.00 |
$295.00 |
$232.00
|
|
X-ray knee 1-2 views (both sides)
|
$390.00 |
$390.00 |
$390.00 |
$285.00
|
|
X-ray knee 3 views (both sides)
|
$460.00 |
$460.00 |
$460.00 |
$363.20
|
|
X-ray knee ap standing bilateral
|
$252.50 |
$252.50 |
$252.50 |
$252.50
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$590.00 |
$590.00 |
$590.00 |
$254.12
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$395.00 |
$395.00 |
$395.00 |
$369.15
|
|
X-ray lumbosacral spine >= 4 views
|
$535.00 |
$535.00 |
$535.00 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$550.00 |
$550.00 |
$550.00 |
$535.91
|
|
X-ray mandible complete > 4 views
|
$392.50 |
$392.50 |
$392.50 |
$361.61
|
|
X-ray mandible ltd <4 views
|
$292.50 |
$292.50 |
$292.50 |
$235.30
|
|
X-ray nasal bones complete > 3 views
|
$332.50 |
$332.50 |
$332.50 |
$274.65
|
|
X-ray neck soft tissue
|
$280.00 |
$280.00 |
$280.00 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$147.50 |
$147.50 |
$147.50 |
$225.60
|
|
X-ray of mammary ducts
|
$342.50 |
$342.50 |
$342.50 |
$568.26
|
|
X-ray pelvis 1-2 views
|
$270.00 |
$270.00 |
$270.00 |
$280.80
|
|
X-ray pelvis complete > 3 views
|
$360.00 |
$360.00 |
$360.00 |
$348.19
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$925.00 |
$925.00 |
$925.00 |
$755.50
|
|
X-ray ribs 2 views left
|
$310.00 |
$310.00 |
$310.00 |
$292.80
|
|
X-ray ribs 3 views bilateral
|
$467.50 |
$467.50 |
$467.50 |
$395.76
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$467.50 |
$467.50 |
$467.50 |
$356.20
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$545.00 |
$545.00 |
$545.00 |
$491.70
|
|
X-ray sacroiliac joints >= 3 views
|
$322.50 |
$322.50 |
$322.50 |
$312.75
|
|
X-ray sacrum/coccyx >= 2 views
|
$332.50 |
$332.50 |
$332.50 |
$288.80
|
|
X-ray scapula complete (both sides)
|
$285.00 |
$285.00 |
$285.00 |
$285.00
|
|
X-ray shoulder 1 view (both sides)
|
$255.00 |
$255.00 |
$255.00 |
$260.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$425.00 |
$425.00 |
$425.00 |
$345.60
|
|
X-ray sinus tract/fistula/abscess
|
$417.50 |
$417.50 |
$417.50 |
$606.89
|
|
X-ray skull < 4 views
|
$280.00 |
$280.00 |
$280.00 |
$292.50
|
|
X-ray skull > 4 views complete
|
$417.50 |
$417.50 |
$417.50 |
$417.50
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$530.00 |
$530.00 |
$530.00 |
$557.70
|
|
X-ray small intestine follow-through study
|
$352.50 |
$352.50 |
$352.50 |
$499.50
|
|
X-ray spine single view
|
$290.00 |
$290.00 |
$290.00 |
$251.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$267.50 |
$267.50 |
$267.50 |
$264.48
|
|
X-ray sternum > 2 views
|
$290.00 |
$290.00 |
$290.00 |
$274.65
|
|
X-ray surgical specimen
|
$375.00 |
$375.00 |
$375.00 |
$504.00
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$437.50 |
$437.50 |
$437.50 |
$523.25
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$390.00 |
$390.00 |
$390.00 |
$327.80
|
|
X-ray thoracic spine 2 views
|
$350.00 |
$350.00 |
$350.00 |
$320.45
|
|
X-ray thoracic spine 3 views
|
$402.50 |
$402.50 |
$402.50 |
$381.60
|
|
X-ray thoracolumbar spine >=2 views
|
$380.00 |
$380.00 |
$380.00 |
$282.50
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$247.50 |
$247.50 |
$247.50 |
$257.04
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$375.00 |
$375.00 |
$375.00 |
$352.95
|
|
X-ray tibia/fibula 2 views (both sides)
|
$590.00 |
$590.00 |
$590.00 |
$332.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$530.00 |
$530.00 |
$530.00 |
$258.50
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$705.00 |
$705.00 |
$705.00 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$655.00 |
$655.00 |
$655.00 |
$603.20
|
|
X-ray wrist 2 views (both sides)
|
$675.00 |
$675.00 |
$675.00 |
$290.40
|
|
Ziconotide injection
|
$37.88 |
$37.88 |
$37.88 |
$7,216.02
|
|
Zika virus dna/rna amp probe
|
$212.50 |
$212.50 |
$212.50 |
$185.00
|
|
Zika virus igm antibody
|
$170.00 |
$170.00 |
$170.00 |
$85.00
|
