"This file reflects the overall contractual discount we provide to the various insurers. The rate listed is based on our accounting system and not specific to the code listed. We recommend you utilize the price estimator found at MyBellin Health for the more accurate information about what your insurance will pay and your out-of-pocket costs. If you already have a MyBellin Health account, please log in and select ?Estimates? on the billing page. If you don?t yet have a MyBellin Health account, please select the ?Guest Estimate? icon on the right hand column of the screen. "
" To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 C.F. R. ยง 180.50 and the information encoded in this machine readable file is true, accurate and complete as of the
10/18/2023"
In this file there are the following tabs:
Hospital Most Common - 300 of the most commonly chargeed items at Western Wisconsin Health
FSCH - Full List of All Active Fee Schedule Pricing
Hospital Most Common Field Definitions:
Internal ID - The unique number assigned to a specific charge code
Procedure Description - The description assigned to the internal ID
Price - The charge amount set for that specific charge code
Cash Discount Price - The amount due for the charge code with the cash discount
Minimum Contracted Rate - The lowest contracted rate for the payers listed
Maximum Contracted Rate - The highest contracted rate for the payers listed
The list of payers and their contracted rate
FSCH Field Definitions
Fee Schedule - what area the specific charge lies in
CPT Code - The CPT assigned based on national CPT guidelines
"Base Charge - Often used with Anesthesia, base charge for administration, then a unit charge for each unit utilized"
Unit Charge - charge per each quantity of one.
Internal ID Procedure Description Price Cash Discounted Price Minimum Contracted Rate Maximum Contracted Rate Medicare Blue Cross HealthPartners Medica Preferred One Group Health Coop of Eau Claire United Healthcare PMAP Medicaid Blue Cross MA United Healthcare Cigna
20553 INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES $290.00 $261.00 $116.00 $232.00 $162.40 $203.00 $185.60 $232.00 $226.20 $130.50 $118.90 $121.80 $116.00 $217.50 $188.50
23350 INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG $701.00 $630.90 $280.40 $560.80 $392.56 $490.70 $448.64 $560.80 $546.78 $315.45 $287.41 $294.42 $280.40 $525.75 $455.65
27093 INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA $732.00 $658.80 $292.80 $585.60 $409.92 $512.40 $468.48 $585.60 $570.96 $329.40 $300.12 $307.44 $292.80 $549.00 $475.80
27096 INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA $716.00 $644.40 $286.40 $572.80 $400.96 $501.20 $458.24 $572.80 $558.48 $322.20 $293.56 $300.72 $286.40 $537.00 $465.40
29826 ARTHROSCOPY SHOULDER W/CORACOACRM LIGMNT RELEASE " $1,482.00 " " $1,333.80 " $592.80 " $1,185.60 " $829.92 " $1,037.40 " $948.48 " $1,185.60 " " $1,155.96 " $666.90 $607.62 $622.44 $592.80 " $1,111.50 " $963.30
29881 Arthroscopic Meniscectomy Knee " $3,041.00 " " $2,736.90 " " $1,216.40 " " $2,432.80 " " $1,702.96 " " $2,128.70 " " $1,946.24 " " $2,432.80 " " $2,371.98 " " $1,368.45 " " $1,246.81 " " $1,277.22 " " $1,216.40 " " $2,280.75 " " $1,976.65 "
42820 TONSILLECTOMY & ADENOIDECTOMY " $1,696.00 " " $1,526.40 " $678.40 " $1,356.80 " $949.76 " $1,187.20 " " $1,085.44 " " $1,356.80 " " $1,322.88 " $763.20 $695.36 $712.32 $678.40 " $1,272.00 " " $1,102.40 "
43235 EGD ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC " $1,273.00 " " $1,145.70 " $509.20 " $1,018.40 " $712.88 $891.10 $814.72 " $1,018.40 " $992.94 $572.85 $521.93 $534.66 $509.20 $954.75 $827.45
43239 EGD TRANSORAL BIOPSY SINGLE/MULTIPLE " $1,516.00 " " $1,364.40 " $606.40 " $1,212.80 " $848.96 " $1,061.20 " $970.24 " $1,212.80 " " $1,182.48 " $682.20 $621.56 $636.72 $606.40 " $1,137.00 " $985.40
43248 EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS " $1,130.00 " " $1,017.00 " $452.00 $904.00 $632.80 $791.00 $723.20 $904.00 $881.40 $508.50 $463.30 $474.60 $452.00 $847.50 $734.50
43249 EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM " $2,426.00 " " $2,183.40 " $970.40 " $1,940.80 " " $1,358.56 " " $1,698.20 " " $1,552.64 " " $1,940.80 " " $1,892.28 " " $1,091.70 " $994.66 " $1,018.92 " $970.40 " $1,819.50 " " $1,576.90 "
43251 EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH " $1,250.00 " " $1,125.00 " $500.00 " $1,000.00 " $700.00 $875.00 $800.00 " $1,000.00 " $975.00 $562.50 $512.50 $525.00 $500.00 $937.50 $812.50
43281 LAPS R PARAESPHGL HRNA INCL FUNDPLSTY W/O MESH " $7,788.00 " " $7,009.20 " " $3,115.20 " " $6,230.40 " " $4,361.28 " " $5,451.60 " " $4,984.32 " " $6,230.40 " " $6,074.64 " " $3,504.60 " " $3,193.08 " " $3,270.96 " " $3,115.20 " " $5,841.00 " " $5,062.20 "
45330 SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD $504.00 $453.60 $201.60 $403.20 $282.24 $352.80 $322.56 $403.20 $393.12 $226.80 $206.64 $211.68 $201.60 $378.00 $327.60
45378 COLONOSCOPY " $1,767.00 " " $1,590.30 " $706.80 " $1,413.60 " $989.52 " $1,236.90 " " $1,130.88 " " $1,413.60 " " $1,378.26 " $795.15 $724.47 $742.14 $706.80 " $1,325.25 " " $1,148.55 "
45380 COLONOSCOPY W/BIOPSY " $1,638.00 " " $1,474.20 " $655.20 " $1,310.40 " $917.28 " $1,146.60 " " $1,048.32 " " $1,310.40 " " $1,277.64 " $737.10 $671.58 $687.96 $655.20 " $1,228.50 " " $1,064.70 "
45385 Colonoscopy with Polypectomy " $2,484.00 " " $2,235.60 " $993.60 " $1,987.20 " " $1,391.04 " " $1,738.80 " " $1,589.76 " " $1,987.20 " " $1,937.52 " " $1,117.80 " " $1,018.44 " " $1,043.28 " $993.60 " $1,863.00 " " $1,614.60 "
47562 Laparoscopic Cholecystectomy " $3,008.00 " " $2,707.20 " " $1,203.20 " " $2,406.40 " " $1,684.48 " " $2,105.60 " " $1,925.12 " " $2,406.40 " " $2,346.24 " " $1,353.60 " " $1,233.28 " " $1,263.36 " " $1,203.20 " " $2,256.00 " " $1,955.20 "
47563 LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY " $3,144.00 " " $2,829.60 " " $1,257.60 " " $2,515.20 " " $1,760.64 " " $2,200.80 " " $2,012.16 " " $2,515.20 " " $2,452.32 " " $1,414.80 " " $1,289.04 " " $1,320.48 " " $1,257.60 " " $2,358.00 " " $2,043.60 "
49083 ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE $959.00 $863.10 $383.60 $767.20 $537.04 $671.30 $613.76 $767.20 $748.02 $431.55 $393.19 $402.78 $383.60 $719.25 $623.35
49452 REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS " $1,655.00 " " $1,489.50 " $662.00 " $1,324.00 " $926.80 " $1,158.50 " " $1,059.20 " " $1,324.00 " " $1,290.90 " $744.75 $678.55 $695.10 $662.00 " $1,241.25 " " $1,075.75 "
49505 R 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE " $2,513.00 " " $2,261.70 " " $1,005.20 " " $2,010.40 " " $1,407.28 " " $1,759.10 " " $1,608.32 " " $2,010.40 " " $1,960.14 " " $1,130.85 " " $1,030.33 " " $1,055.46 " " $1,005.20 " " $1,884.75 " " $1,633.45 "
49560 REPAIR FIRST ABDOMINAL WALL HERNIA " $3,175.00 " " $2,857.50 " " $1,270.00 " " $2,540.00 " " $1,778.00 " " $2,222.50 " " $2,032.00 " " $2,540.00 " " $2,476.50 " " $1,428.75 " " $1,301.75 " " $1,333.50 " " $1,270.00 " " $2,381.25 " " $2,063.75 "
49561 R 1ST INCAL/VNT HERNIA INCARCERATED " $3,955.00 " " $3,559.50 " " $1,582.00 " " $3,164.00 " " $2,214.80 " " $2,768.50 " " $2,531.20 " " $3,164.00 " " $3,084.90 " " $1,779.75 " " $1,621.55 " " $1,661.10 " " $1,582.00 " " $2,966.25 " " $2,570.75 "
49568 IMPLANT MESH OPN HERNIA R/DEBRIDEMENT CLOSURE " $1,269.00 " " $1,142.10 " $507.60 " $1,015.20 " $710.64 $888.30 $812.16 " $1,015.20 " $989.82 $571.05 $520.29 $532.98 $507.60 $951.75 $824.85
49585 R UMBILICAL HRNA 5 YRS/> REDUCIBLE " $2,532.00 " " $2,278.80 " " $1,012.80 " " $2,025.60 " " $1,417.92 " " $1,772.40 " " $1,620.48 " " $2,025.60 " " $1,974.96 " " $1,139.40 " " $1,038.12 " " $1,063.44 " " $1,012.80 " " $1,899.00 " " $1,645.80 "
49587 R UMBILICAL HERNIA AGE 5 YRS/> INCARCERATED " $2,292.00 " " $2,062.80 " $916.80 " $1,833.60 " " $1,283.52 " " $1,604.40 " " $1,466.88 " " $1,833.60 " " $1,787.76 " " $1,031.40 " $939.72 $962.64 $916.80 " $1,719.00 " " $1,489.80 "
49650 LAPAROSCOPY SURG R INITIAL INGUINAL HERNIA " $1,708.00 " " $1,537.20 " $683.20 " $1,366.40 " $956.48 " $1,195.60 " " $1,093.12 " " $1,366.40 " " $1,332.24 " $768.60 $700.28 $717.36 $683.20 " $1,281.00 " " $1,110.20 "
58262 VAG HYST 250 GM/< W/RMVL TUBE&/OVARY " $5,016.00 " " $4,514.40 " " $2,006.40 " " $4,012.80 " " $2,808.96 " " $3,511.20 " " $3,210.24 " " $4,012.80 " " $3,912.48 " " $2,257.20 " " $2,056.56 " " $2,106.72 " " $2,006.40 " " $3,762.00 " " $3,260.40 "
58291 VAG HYST > 250 GM RMVL TUBE&/OVARY " $6,099.00 " " $5,489.10 " " $2,439.60 " " $4,879.20 " " $3,415.44 " " $4,269.30 " " $3,903.36 " " $4,879.20 " " $4,757.22 " " $2,744.55 " " $2,500.59 " " $2,561.58 " " $2,439.60 " " $4,574.25 " " $3,964.35 "
58552 LAPS W/VAG HYSTERECT 250 GM/&RMVL TUBE&/OVARIES " $4,430.00 " " $3,987.00 " " $1,772.00 " " $3,544.00 " " $2,480.80 " " $3,101.00 " " $2,835.20 " " $3,544.00 " " $3,455.40 " " $1,993.50 " " $1,816.30 " " $1,860.60 " " $1,772.00 " " $3,322.50 " " $2,879.50 "
58661 LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES " $3,817.00 " " $3,435.30 " " $1,526.80 " " $3,053.60 " " $2,137.52 " " $2,671.90 " " $2,442.88 " " $3,053.60 " " $2,977.26 " " $1,717.65 " " $1,564.97 " " $1,603.14 " " $1,526.80 " " $2,862.75 " " $2,481.05 "
58662 LAPS FULG/EXC OVARY VISCERA/PERITONEAL SURFACE " $3,428.00 " " $3,085.20 " " $1,371.20 " " $2,742.40 " " $1,919.68 " " $2,399.60 " " $2,193.92 " " $2,742.40 " " $2,673.84 " " $1,542.60 " " $1,405.48 " " $1,439.76 " " $1,371.20 " " $2,571.00 " " $2,228.20 "
59025 FETAL NONSTRESS TEST $298.00 $268.20 $119.20 $238.40 $166.88 $208.60 $190.72 $238.40 $232.44 $134.10 $122.18 $125.16 $119.20 $223.50 $193.70
59151 LAPS TX ECTOPIC EG W/SALPING&/OOPHORECTOMY " $3,754.00 " " $3,378.60 " " $1,501.60 " " $3,003.20 " " $2,102.24 " " $2,627.80 " " $2,402.56 " " $3,003.20 " " $2,928.12 " " $1,689.30 " " $1,539.14 " " $1,576.68 " " $1,501.60 " " $2,815.50 " " $2,440.10 "
59412 EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS " $1,275.00 " " $1,147.50 " $510.00 " $1,020.00 " $714.00 $892.50 $816.00 " $1,020.00 " $994.50 $573.75 $522.75 $535.50 $510.00 $956.25 $828.75
62321 NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN $974.00 $876.60 $389.60 $779.20 $545.44 $681.80 $623.36 $779.20 $759.72 $438.30 $399.34 $409.08 $389.60 $730.50 $633.10
64450 INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH $353.00 $317.70 $141.20 $282.40 $197.68 $247.10 $225.92 $282.40 $275.34 $158.85 $144.73 $148.26 $141.20 $264.75 $229.45
64454 INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG " $2,754.00 " " $2,478.60 " " $1,101.60 " " $2,203.20 " " $1,542.24 " " $1,927.80 " " $1,762.56 " " $2,203.20 " " $2,148.12 " " $1,239.30 " " $1,129.14 " " $1,156.68 " " $1,101.60 " " $2,065.50 " " $1,790.10 "
64483 NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL " $1,422.00 " " $1,279.80 " $568.80 " $1,137.60 " $796.32 $995.40 $910.08 " $1,137.60 " " $1,109.16 " $639.90 $583.02 $597.24 $568.80 " $1,066.50 " $924.30
64484 NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LV $812.00 $730.80 $324.80 $649.60 $454.72 $568.40 $519.68 $649.60 $633.36 $365.40 $332.92 $341.04 $324.80 $609.00 $527.80
64493 NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL " $1,332.00 " " $1,198.80 " $532.80 " $1,065.60 " $745.92 $932.40 $852.48 " $1,065.60 " " $1,038.96 " $599.40 $546.12 $559.44 $532.80 $999.00 $865.80
64494 NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL $414.00 $372.60 $165.60 $331.20 $231.84 $289.80 $264.96 $331.20 $322.92 $186.30 $169.74 $173.88 $165.60 $310.50 $269.10
64495 NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL $398.00 $358.20 $159.20 $318.40 $222.88 $278.60 $254.72 $318.40 $310.44 $179.10 $163.18 $167.16 $159.20 $298.50 $258.70
64624 DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG " $4,729.00 " " $4,256.10 " " $1,891.60 " " $3,783.20 " " $2,648.24 " " $3,310.30 " " $3,026.56 " " $3,783.20 " " $3,688.62 " " $2,128.05 " " $1,938.89 " " $1,986.18 " " $1,891.60 " " $3,546.75 " " $3,073.85 "
64721 NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE " $2,817.00 " " $2,535.30 " " $1,126.80 " " $2,253.60 " " $1,577.52 " " $1,971.90 " " $1,802.88 " " $2,253.60 " " $2,197.26 " " $1,267.65 " " $1,154.97 " " $1,183.14 " " $1,126.80 " " $2,112.75 " " $1,831.05 "
66982 Extracapsular Cataract Extraction Intraocular Lens Implant " $4,005.00 " " $3,604.50 " " $1,602.00 " " $3,204.00 " " $2,242.80 " " $2,803.50 " " $2,563.20 " " $3,204.00 " " $3,123.90 " " $1,802.25 " " $1,642.05 " " $1,682.10 " " $1,602.00 " " $3,003.75 " " $2,603.25 "
66984 CATARACT REMOVAL INSERTION OF LENS " $3,085.00 " " $2,776.50 " " $1,234.00 " " $2,468.00 " " $1,727.60 " " $2,159.50 " " $1,974.40 " " $2,468.00 " " $2,406.30 " " $1,388.25 " " $1,264.85 " " $1,295.70 " " $1,234.00 " " $2,313.75 " " $2,005.25 "
70160 RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS $174.00 $156.60 $69.60 $139.20 $97.44 $121.80 $111.36 $139.20 $135.72 $78.30 $71.34 $73.08 $69.60 $130.50 $113.10
70450 CT HEAD/BRAIN Without CONTRAST MATERIAL " $1,991.00 " " $1,791.90 " $796.40 " $1,592.80 " " $1,114.96 " " $1,393.70 " " $1,274.24 " " $1,592.80 " " $1,552.98 " $895.95 $816.31 $836.22 $796.40 " $1,493.25 " " $1,294.15 "
70480 CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL " $1,383.00 " " $1,244.70 " $553.20 " $1,106.40 " $774.48 $968.10 $885.12 " $1,106.40 " " $1,078.74 " $622.35 $567.03 $580.86 $553.20 " $1,037.25 " $898.95
70486 CT MAXILLOFACIAL W/O CONTRAST MATERIAL $974.00 $876.60 $389.60 $779.20 $545.44 $681.80 $623.36 $779.20 $759.72 $438.30 $399.34 $409.08 $389.60 $730.50 $633.10
70491 CT SOFT TISSUE NECK W/CONTRAST MATERIAL " $2,730.00 " " $2,457.00 " " $1,092.00 " " $2,184.00 " " $1,528.80 " " $1,911.00 " " $1,747.20 " " $2,184.00 " " $2,129.40 " " $1,228.50 " " $1,119.30 " " $1,146.60 " " $1,092.00 " " $2,047.50 " " $1,774.50 "
70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST " $3,408.00 " " $3,067.20 " " $1,363.20 " " $2,726.40 " " $1,908.48 " " $2,385.60 " " $2,181.12 " " $2,726.40 " " $2,658.24 " " $1,533.60 " " $1,397.28 " " $1,431.36 " " $1,363.20 " " $2,556.00 " " $2,215.20 "
70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST " $3,516.00 " " $3,164.40 " " $1,406.40 " " $2,812.80 " " $1,968.96 " " $2,461.20 " " $2,250.24 " " $2,812.80 " " $2,742.48 " " $1,582.20 " " $1,441.56 " " $1,476.72 " " $1,406.40 " " $2,637.00 " " $2,285.40 "
70544 MRA HEAD W/O CONTRST MATERIAL " $3,688.00 " " $3,319.20 " " $1,475.20 " " $2,950.40 " " $2,065.28 " " $2,581.60 " " $2,360.32 " " $2,950.40 " " $2,876.64 " " $1,659.60 " " $1,512.08 " " $1,548.96 " " $1,475.20 " " $2,766.00 " " $2,397.20 "
70549 MRA NECK W/O &W/CONTRAST MATERIAL " $5,832.00 " " $5,248.80 " " $2,332.80 " " $4,665.60 " " $3,265.92 " " $4,082.40 " " $3,732.48 " " $4,665.60 " " $4,548.96 " " $2,624.40 " " $2,391.12 " " $2,449.44 " " $2,332.80 " " $4,374.00 " " $3,790.80 "
70551 MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL " $2,922.00 " " $2,629.80 " " $1,168.80 " " $2,337.60 " " $1,636.32 " " $2,045.40 " " $1,870.08 " " $2,337.60 " " $2,279.16 " " $1,314.90 " " $1,198.02 " " $1,227.24 " " $1,168.80 " " $2,191.50 " " $1,899.30 "
70553 MRI BRAIN BRAIN STEM WITH AND WITHOUT CONTRAST MATERIAL " $4,860.00 " " $4,374.00 " " $1,944.00 " " $3,888.00 " " $2,721.60 " " $3,402.00 " " $3,110.40 " " $3,888.00 " " $3,790.80 " " $2,187.00 " " $1,992.60 " " $2,041.20 " " $1,944.00 " " $3,645.00 " " $3,159.00 "
71045 RADIOLOGIC EXAM CHEST SINGLE VIEW $200.00 $180.00 $80.00 $160.00 $112.00 $140.00 $128.00 $160.00 $156.00 $90.00 $82.00 $84.00 $80.00 $150.00 $130.00
71046 Chest xray $286.00 $257.40 $114.40 $228.80 $160.16 $200.20 $183.04 $228.80 $223.08 $128.70 $117.26 $120.12 $114.40 $214.50 $185.90
71100 RADEX RIBS UNILATERAL 2 VIEWS $273.00 $245.70 $109.20 $218.40 $152.88 $191.10 $174.72 $218.40 $212.94 $122.85 $111.93 $114.66 $109.20 $204.75 $177.45
71101 RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS $319.00 $287.10 $127.60 $255.20 $178.64 $223.30 $204.16 $255.20 $248.82 $143.55 $130.79 $133.98 $127.60 $239.25 $207.35
71250 CT THORAX W/O CONTRAST MATERIAL " $2,828.00 " " $2,545.20 " " $1,131.20 " " $2,262.40 " " $1,583.68 " " $1,979.60 " " $1,809.92 " " $2,262.40 " " $2,205.84 " " $1,272.60 " " $1,159.48 " " $1,187.76 " " $1,131.20 " " $2,121.00 " " $1,838.20 "
71260 CT THORAX W/CONTRAST MATERIAL " $2,951.00 " " $2,655.90 " " $1,180.40 " " $2,360.80 " " $1,652.56 " " $2,065.70 " " $1,888.64 " " $2,360.80 " " $2,301.78 " " $1,327.95 " " $1,209.91 " " $1,239.42 " " $1,180.40 " " $2,213.25 " " $1,918.15 "
71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST " $3,299.00 " " $2,969.10 " " $1,319.60 " " $2,639.20 " " $1,847.44 " " $2,309.30 " " $2,111.36 " " $2,639.20 " " $2,573.22 " " $1,484.55 " " $1,352.59 " " $1,385.58 " " $1,319.60 " " $2,474.25 " " $2,144.35 "
72040 RADEX SPINE CERVICAL 2 OR 3 VIEWS $184.00 $165.60 $73.60 $147.20 $103.04 $128.80 $117.76 $147.20 $143.52 $82.80 $75.44 $77.28 $73.60 $138.00 $119.60
72070 RADEX SPINE THORACIC 2 VIEWS $141.00 $126.90 $56.40 $112.80 $78.96 $98.70 $90.24 $112.80 $109.98 $63.45 $57.81 $59.22 $56.40 $105.75 $91.65
72082 RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW $237.00 $213.30 $94.80 $189.60 $132.72 $165.90 $151.68 $189.60 $184.86 $106.65 $97.17 $99.54 $94.80 $177.75 $154.05
72100 RADEX SPINE LUMBOSACRAL 2/3 VIEWS $193.00 $173.70 $77.20 $154.40 $108.08 $135.10 $123.52 $154.40 $150.54 $86.85 $79.13 $81.06 $77.20 $144.75 $125.45
72110 RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS $271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
72125 CT CERVICAL SPINE W/O CONTRAST MATERIAL " $1,868.00 " " $1,681.20 " $747.20 " $1,494.40 " " $1,046.08 " " $1,307.60 " " $1,195.52 " " $1,494.40 " " $1,457.04 " $840.60 $765.88 $784.56 $747.20 " $1,401.00 " " $1,214.20 "
72128 CT THORACIC SPINE W/O CONTRAST MATERIAL " $1,866.00 " " $1,679.40 " $746.40 " $1,492.80 " " $1,044.96 " " $1,306.20 " " $1,194.24 " " $1,492.80 " " $1,455.48 " $839.70 $765.06 $783.72 $746.40 " $1,399.50 " " $1,212.90 "
72131 CT LUMBAR SPINE W/O CONTRAST MATERIAL " $1,866.00 " " $1,679.40 " $746.40 " $1,492.80 " " $1,044.96 " " $1,306.20 " " $1,194.24 " " $1,492.80 " " $1,455.48 " $839.70 $765.06 $783.72 $746.40 " $1,399.50 " " $1,212.90 "
72141 MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL " $2,770.00 " " $2,493.00 " " $1,108.00 " " $2,216.00 " " $1,551.20 " " $1,939.00 " " $1,772.80 " " $2,216.00 " " $2,160.60 " " $1,246.50 " " $1,135.70 " " $1,163.40 " " $1,108.00 " " $2,077.50 " " $1,800.50 "
72146 MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL " $3,201.00 " " $2,880.90 " " $1,280.40 " " $2,560.80 " " $1,792.56 " " $2,240.70 " " $2,048.64 " " $2,560.80 " " $2,496.78 " " $1,440.45 " " $1,312.41 " " $1,344.42 " " $1,280.40 " " $2,400.75 " " $2,080.65 "
72148 MRI Lumbar Spinal " $2,870.00 " " $2,583.00 " " $1,148.00 " " $2,296.00 " " $1,607.20 " " $2,009.00 " " $1,836.80 " " $2,296.00 " " $2,238.60 " " $1,291.50 " " $1,176.70 " " $1,205.40 " " $1,148.00 " " $2,152.50 " " $1,865.50 "
72156 MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL " $4,209.00 " " $3,788.10 " " $1,683.60 " " $3,367.20 " " $2,357.04 " " $2,946.30 " " $2,693.76 " " $3,367.20 " " $3,283.02 " " $1,894.05 " " $1,725.69 " " $1,767.78 " " $1,683.60 " " $3,156.75 " " $2,735.85 "
72158 MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL " $5,424.00 " " $4,881.60 " " $2,169.60 " " $4,339.20 " " $3,037.44 " " $3,796.80 " " $3,471.36 " " $4,339.20 " " $4,230.72 " " $2,440.80 " " $2,223.84 " " $2,278.08 " " $2,169.60 " " $4,068.00 " " $3,525.60 "
72170 RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS $145.00 $130.50 $58.00 $116.00 $81.20 $101.50 $92.80 $116.00 $113.10 $65.25 $59.45 $60.90 $58.00 $108.75 $94.25
72192 CT PELVIS W/O CONTRAST MATERIAL " $1,335.00 " " $1,201.50 " $534.00 " $1,068.00 " $747.60 $934.50 $854.40 " $1,068.00 " " $1,041.30 " $600.75 $547.35 $560.70 $534.00 " $1,001.25 " $867.75
72193 CT PELVIS WITH CONTRAST MATERIAL " $1,519.00 " " $1,367.10 " $607.60 " $1,215.20 " $850.64 " $1,063.30 " $972.16 " $1,215.20 " " $1,184.82 " $683.55 $622.79 $637.98 $607.60 " $1,139.25 " $987.35
72195 MRI PELVIS W/O CONTRAST MATERIAL " $2,560.00 " " $2,304.00 " " $1,024.00 " " $2,048.00 " " $1,433.60 " " $1,792.00 " " $1,638.40 " " $2,048.00 " " $1,996.80 " " $1,152.00 " " $1,049.60 " " $1,075.20 " " $1,024.00 " " $1,920.00 " " $1,664.00 "
72197 MRI PELVIS W/O & W/CONTRAST MATERIAL " $4,328.00 " " $3,895.20 " " $1,731.20 " " $3,462.40 " " $2,423.68 " " $3,029.60 " " $2,769.92 " " $3,462.40 " " $3,375.84 " " $1,947.60 " " $1,774.48 " " $1,817.76 " " $1,731.20 " " $3,246.00 " " $2,813.20 "
72220 RADEX SACRUM & COCCYX MINIMUM 2 VIEWS $306.00 $275.40 $122.40 $244.80 $171.36 $214.20 $195.84 $244.80 $238.68 $137.70 $125.46 $128.52 $122.40 $229.50 $198.90
73000 RADEX CLAVICLE COMPLETE $229.00 $206.10 $91.60 $183.20 $128.24 $160.30 $146.56 $183.20 $178.62 $103.05 $93.89 $96.18 $91.60 $171.75 $148.85
73030 RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS $272.00 $244.80 $108.80 $217.60 $152.32 $190.40 $174.08 $217.60 $212.16 $122.40 $111.52 $114.24 $108.80 $204.00 $176.80
73060 RADEX HUMERUS MINIMUM 2 VIEWS $273.00 $245.70 $109.20 $218.40 $152.88 $191.10 $174.72 $218.40 $212.94 $122.85 $111.93 $114.66 $109.20 $204.75 $177.45
73070 RADEX ELBOW 2 VIEWS $133.00 $119.70 $53.20 $106.40 $74.48 $93.10 $85.12 $106.40 $103.74 $59.85 $54.53 $55.86 $53.20 $99.75 $86.45
73080 RADEX ELBOW COMPLETE MINIMUM 3 VIEWS $244.00 $219.60 $97.60 $195.20 $136.64 $170.80 $156.16 $195.20 $190.32 $109.80 $100.04 $102.48 $97.60 $183.00 $158.60
73090 RADEX FOREARM 2 VIEWS $231.00 $207.90 $92.40 $184.80 $129.36 $161.70 $147.84 $184.80 $180.18 $103.95 $94.71 $97.02 $92.40 $173.25 $150.15
73100 RADEX WRIST 2 VIEWS $176.00 $158.40 $70.40 $140.80 $98.56 $123.20 $112.64 $140.80 $137.28 $79.20 $72.16 $73.92 $70.40 $132.00 $114.40
73110 RADEX WRIST COMPLETE MINIMUM 3 VIEWS $250.00 $225.00 $100.00 $200.00 $140.00 $175.00 $160.00 $200.00 $195.00 $112.50 $102.50 $105.00 $100.00 $187.50 $162.50
73120 RADEX HAND 2 VIEWS $136.00 $122.40 $54.40 $108.80 $76.16 $95.20 $87.04 $108.80 $106.08 $61.20 $55.76 $57.12 $54.40 $102.00 $88.40
73130 RADEX HAND MINIMUM 3 VIEWS $258.00 $232.20 $103.20 $206.40 $144.48 $180.60 $165.12 $206.40 $201.24 $116.10 $105.78 $108.36 $103.20 $193.50 $167.70
73140 RADEX FINGR MINIMUM 2 VIEWS $202.00 $181.80 $80.80 $161.60 $113.12 $141.40 $129.28 $161.60 $157.56 $90.90 $82.82 $84.84 $80.80 $151.50 $131.30
73200 CT UPPER EXTREMITY W/O CONTRAST MATERIAL " $1,355.00 " " $1,219.50 " $542.00 " $1,084.00 " $758.80 $948.50 $867.20 " $1,084.00 " " $1,056.90 " $609.75 $555.55 $569.10 $542.00 " $1,016.25 " $880.75
73220 MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS " $5,152.00 " " $4,636.80 " " $2,060.80 " " $4,121.60 " " $2,885.12 " " $3,606.40 " " $3,297.28 " " $4,121.60 " " $4,018.56 " " $2,318.40 " " $2,112.32 " " $2,163.84 " " $2,060.80 " " $3,864.00 " " $3,348.80 "
73221 MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL " $2,895.00 " " $2,605.50 " " $1,158.00 " " $2,316.00 " " $1,621.20 " " $2,026.50 " " $1,852.80 " " $2,316.00 " " $2,258.10 " " $1,302.75 " " $1,186.95 " " $1,215.90 " " $1,158.00 " " $2,171.25 " " $1,881.75 "
73222 MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL " $3,840.00 " " $3,456.00 " " $1,536.00 " " $3,072.00 " " $2,150.40 " " $2,688.00 " " $2,457.60 " " $3,072.00 " " $2,995.20 " " $1,728.00 " " $1,574.40 " " $1,612.80 " " $1,536.00 " " $2,880.00 " " $2,496.00 "
73501 RADEX HIP UNILATERAL WITH PELVIS 1 VIEW $193.00 $173.70 $77.20 $154.40 $108.08 $135.10 $123.52 $154.40 $150.54 $86.85 $79.13 $81.06 $77.20 $144.75 $125.45
73502 RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS $221.00 $198.90 $88.40 $176.80 $123.76 $154.70 $141.44 $176.80 $172.38 $99.45 $90.61 $92.82 $88.40 $165.75 $143.65
73521 RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS $379.00 $341.10 $151.60 $303.20 $212.24 $265.30 $242.56 $303.20 $295.62 $170.55 $155.39 $159.18 $151.60 $284.25 $246.35
73552 RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS $252.00 $226.80 $100.80 $201.60 $141.12 $176.40 $161.28 $201.60 $196.56 $113.40 $103.32 $105.84 $100.80 $189.00 $163.80
73560 RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS $141.00 $126.90 $56.40 $112.80 $78.96 $98.70 $90.24 $112.80 $109.98 $63.45 $57.81 $59.22 $56.40 $105.75 $91.65
73562 RADIOLOGIC EXAMINATION KNEE 3 VIEWS $258.00 $232.20 $103.20 $206.40 $144.48 $180.60 $165.12 $206.40 $201.24 $116.10 $105.78 $108.36 $103.20 $193.50 $167.70
73564 RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS $203.00 $182.70 $81.20 $162.40 $113.68 $142.10 $129.92 $162.40 $158.34 $91.35 $83.23 $85.26 $81.20 $152.25 $131.95
73590 RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS $227.00 $204.30 $90.80 $181.60 $127.12 $158.90 $145.28 $181.60 $177.06 $102.15 $93.07 $95.34 $90.80 $170.25 $147.55
73600 RADIOLOGIC EXAMINATION ANKLE 2 VIEWS $133.00 $119.70 $53.20 $106.40 $74.48 $93.10 $85.12 $106.40 $103.74 $59.85 $54.53 $55.86 $53.20 $99.75 $86.45
73610 RADEX ANKLE COMPLETE MINIMUM 3 VIEWS $258.00 $232.20 $103.20 $206.40 $144.48 $180.60 $165.12 $206.40 $201.24 $116.10 $105.78 $108.36 $103.20 $193.50 $167.70
73620 RADIOLOGIC EXAMINATION FOOT 2 VIEWS $127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
73630 RADEX FOOT COMPLETE MINIMUM 3 VIEWS $235.00 $211.50 $94.00 $188.00 $131.60 $164.50 $150.40 $188.00 $183.30 $105.75 $96.35 $98.70 $94.00 $176.25 $152.75
73650 RADEX CALCANEUS MINIMUM 2 VIEWS $132.00 $118.80 $52.80 $105.60 $73.92 $92.40 $84.48 $105.60 $102.96 $59.40 $54.12 $55.44 $52.80 $99.00 $85.80
73660 RADEX TOE MINIMUM 2 VIEWS $193.00 $173.70 $77.20 $154.40 $108.08 $135.10 $123.52 $154.40 $150.54 $86.85 $79.13 $81.06 $77.20 $144.75 $125.45
73700 CT LOWER EXTREMITY W/O CONTRAST MATERIAL " $1,824.00 " " $1,641.60 " $729.60 " $1,459.20 " " $1,021.44 " " $1,276.80 " " $1,167.36 " " $1,459.20 " " $1,422.72 " $820.80 $747.84 $766.08 $729.60 " $1,368.00 " " $1,185.60 "
73701 CT LOWER EXTREMITY W/CONTRAST MATERIAL " $1,879.00 " " $1,691.10 " $751.60 " $1,503.20 " " $1,052.24 " " $1,315.30 " " $1,202.56 " " $1,503.20 " " $1,465.62 " $845.55 $770.39 $789.18 $751.60 " $1,409.25 " " $1,221.35 "
73718 MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL " $3,650.00 " " $3,285.00 " " $1,460.00 " " $2,920.00 " " $2,044.00 " " $2,555.00 " " $2,336.00 " " $2,920.00 " " $2,847.00 " " $1,642.50 " " $1,496.50 " " $1,533.00 " " $1,460.00 " " $2,737.50 " " $2,372.50 "
73721 MRI Lower Joint Extremity without Contrast " $2,651.00 " " $2,385.90 " " $1,060.40 " " $2,120.80 " " $1,484.56 " " $1,855.70 " " $1,696.64 " " $2,120.80 " " $2,067.78 " " $1,192.95 " " $1,086.91 " " $1,113.42 " " $1,060.40 " " $1,988.25 " " $1,723.15 "
73722 MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL " $3,879.00 " " $3,491.10 " " $1,551.60 " " $3,103.20 " " $2,172.24 " " $2,715.30 " " $2,482.56 " " $3,103.20 " " $3,025.62 " " $1,745.55 " " $1,590.39 " " $1,629.18 " " $1,551.60 " " $2,909.25 " " $2,521.35 "
74018 RADIOLOGIC EXAM ABDOMEN 1 VIEW $207.00 $186.30 $82.80 $165.60 $115.92 $144.90 $132.48 $165.60 $161.46 $93.15 $84.87 $86.94 $82.80 $155.25 $134.55
74019 RADIOLOGIC EXAM ABDOMEN 2 VIEWS $244.00 $219.60 $97.60 $195.20 $136.64 $170.80 $156.16 $195.20 $190.32 $109.80 $100.04 $102.48 $97.60 $183.00 $158.60
74174 CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG " $3,421.00 " " $3,078.90 " " $1,368.40 " " $2,736.80 " " $1,915.76 " " $2,394.70 " " $2,189.44 " " $2,736.80 " " $2,668.38 " " $1,539.45 " " $1,402.61 " " $1,436.82 " " $1,368.40 " " $2,565.75 " " $2,223.65 "
74176 CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL " $2,922.00 " " $2,629.80 " " $1,168.80 " " $2,337.60 " " $1,636.32 " " $2,045.40 " " $1,870.08 " " $2,337.60 " " $2,279.16 " " $1,314.90 " " $1,198.02 " " $1,227.24 " " $1,168.80 " " $2,191.50 " " $1,899.30 "
74177 CT ABDOMEN & PELVIS With CONTRAST MATERIAL " $3,526.00 " " $3,173.40 " " $1,410.40 " " $2,820.80 " " $1,974.56 " " $2,468.20 " " $2,256.64 " " $2,820.80 " " $2,750.28 " " $1,586.70 " " $1,445.66 " " $1,480.92 " " $1,410.40 " " $2,644.50 " " $2,291.90 "
74178 CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE " $4,069.00 " " $3,662.10 " " $1,627.60 " " $3,255.20 " " $2,278.64 " " $2,848.30 " " $2,604.16 " " $3,255.20 " " $3,173.82 " " $1,831.05 " " $1,668.29 " " $1,708.98 " " $1,627.60 " " $3,051.75 " " $2,644.85 "
74181 MRI ABDOMEN W/O CONTRAST MATERIAL " $3,363.00 " " $3,026.70 " " $1,345.20 " " $2,690.40 " " $1,883.28 " " $2,354.10 " " $2,152.32 " " $2,690.40 " " $2,623.14 " " $1,513.35 " " $1,378.83 " " $1,412.46 " " $1,345.20 " " $2,522.25 " " $2,185.95 "
74183 MRI ABDOMEN W/O & W/CONTRAST MATERIAL " $5,187.00 " " $4,668.30 " " $2,074.80 " " $4,149.60 " " $2,904.72 " " $3,630.90 " " $3,319.68 " " $4,149.60 " " $4,045.86 " " $2,334.15 " " $2,126.67 " " $2,178.54 " " $2,074.80 " " $3,890.25 " " $3,371.55 "
74220 RADEX ESOPHAGUS $562.00 $505.80 $224.80 $449.60 $314.72 $393.40 $359.68 $449.60 $438.36 $252.90 $230.42 $236.04 $224.80 $421.50 $365.30
74230 SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG $613.00 $551.70 $245.20 $490.40 $343.28 $429.10 $392.32 $490.40 $478.14 $275.85 $251.33 $257.46 $245.20 $459.75 $398.45
74420 X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL $450.00 $405.00 $180.00 $360.00 $252.00 $315.00 $288.00 $360.00 $351.00 $202.50 $184.50 $189.00 $180.00 $337.50 $292.50
75571 CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM $271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
75574 CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST " $3,408.00 " " $3,067.20 " " $1,363.20 " " $2,726.40 " " $1,908.48 " " $2,385.60 " " $2,181.12 " " $2,726.40 " " $2,658.24 " " $1,533.60 " " $1,397.28 " " $1,431.36 " " $1,363.20 " " $2,556.00 " " $2,215.20 "
75635 CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP " $3,686.00 " " $3,317.40 " " $1,474.40 " " $2,948.80 " " $2,064.16 " " $2,580.20 " " $2,359.04 " " $2,948.80 " " $2,875.08 " " $1,658.70 " " $1,511.26 " " $1,548.12 " " $1,474.40 " " $2,764.50 " " $2,395.90 "
76536 US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM $752.00 $676.80 $300.80 $601.60 $421.12 $526.40 $481.28 $601.60 $586.56 $338.40 $308.32 $315.84 $300.80 $564.00 $488.80
76604 US CHEST REAL TIME W/IMAGE DOCUMENTATION $226.00 $203.40 $90.40 $180.80 $126.56 $158.20 $144.64 $180.80 $176.28 $101.70 $92.66 $94.92 $90.40 $169.50 $146.90
76641 US BREAST UNI REAL TIME WITH IMAGE COMPLETE $473.00 $425.70 $189.20 $378.40 $264.88 $331.10 $302.72 $378.40 $368.94 $212.85 $193.93 $198.66 $189.20 $354.75 $307.45
76642 US BREAST UNI REAL TIME WITH IMAGE LIMITED $552.00 $496.80 $220.80 $441.60 $309.12 $386.40 $353.28 $441.60 $430.56 $248.40 $226.32 $231.84 $220.80 $414.00 $358.80
76700 US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION " $1,027.00 " $924.30 $410.80 $821.60 $575.12 $718.90 $657.28 $821.60 $801.06 $462.15 $421.07 $431.34 $410.80 $770.25 $667.55
76705 US ABDOMINAL REAL TIME W/IMAGE LIMITED $276.00 $248.40 $110.40 $220.80 $154.56 $193.20 $176.64 $220.80 $215.28 $124.20 $113.16 $115.92 $110.40 $207.00 $179.40
76706 US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA $492.00 $442.80 $196.80 $393.60 $275.52 $344.40 $314.88 $393.60 $383.76 $221.40 $201.72 $206.64 $196.80 $369.00 $319.80
76770 US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE " $1,016.00 " $914.40 $406.40 $812.80 $568.96 $711.20 $650.24 $812.80 $792.48 $457.20 $416.56 $426.72 $406.40 $762.00 $660.40
76775 US RETROPERITONEAL REAL TIME W/IMAGE LIMITED $764.00 $687.60 $305.60 $611.20 $427.84 $534.80 $488.96 $611.20 $595.92 $343.80 $313.24 $320.88 $305.60 $573.00 $496.60
76801 US EGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT $839.00 $755.10 $335.60 $671.20 $469.84 $587.30 $536.96 $671.20 $654.42 $377.55 $343.99 $352.38 $335.60 $629.25 $545.35
76802 US EG UTERUS 14 WK TRANSABDL EACH GESTATION $625.00 $562.50 $250.00 $500.00 $350.00 $437.50 $400.00 $500.00 $487.50 $281.25 $256.25 $262.50 $250.00 $468.75 $406.25
76805 OB Ultrasound equal or greater than 14 weeks $881.00 $792.90 $352.40 $704.80 $493.36 $616.70 $563.84 $704.80 $687.18 $396.45 $361.21 $370.02 $352.40 $660.75 $572.65
76815 US PREGNANT UTERUS LIMITED 1/> FETUSES $305.00 $274.50 $122.00 $244.00 $170.80 $213.50 $195.20 $244.00 $237.90 $137.25 $125.05 $128.10 $122.00 $228.75 $198.25
76816 US EG UTERUS REAL TIME F/U TRNSABDL PER FETUS $553.00 $497.70 $221.20 $442.40 $309.68 $387.10 $353.92 $442.40 $431.34 $248.85 $226.73 $232.26 $221.20 $414.75 $359.45
76817 US EG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG $826.00 $743.40 $330.40 $660.80 $462.56 $578.20 $528.64 $660.80 $644.28 $371.70 $338.66 $346.92 $330.40 $619.50 $536.90
76818 FETAL BIOPHYSICAL OFILE NON-STRESS TESTING $806.00 $725.40 $322.40 $644.80 $451.36 $564.20 $515.84 $644.80 $628.68 $362.70 $330.46 $338.52 $322.40 $604.50 $523.90
76819 FETAL BIOPHYSICAL OFILE W/O NON-STRESS TESTING $817.00 $735.30 $326.80 $653.60 $457.52 $571.90 $522.88 $653.60 $637.26 $367.65 $334.97 $343.14 $326.80 $612.75 $531.05
76830 Pelvic Ultrasound - Transvaginal $699.00 $629.10 $279.60 $559.20 $391.44 $489.30 $447.36 $559.20 $545.22 $314.55 $286.59 $293.58 $279.60 $524.25 $454.35
76856 US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE $983.00 $884.70 $393.20 $786.40 $550.48 $688.10 $629.12 $786.40 $766.74 $442.35 $403.03 $412.86 $393.20 $737.25 $638.95
76870 US SCROTUM & CONTENTS $889.00 $800.10 $355.60 $711.20 $497.84 $622.30 $568.96 $711.20 $693.42 $400.05 $364.49 $373.38 $355.60 $666.75 $577.85
76882 US LMTD JOINT/OTH NONVASC XTR STRUX R-T W/IMG $54.00 $48.60 $21.60 $43.20 $30.24 $37.80 $34.56 $43.20 $42.12 $24.30 $22.14 $22.68 $21.60 $40.50 $35.10
76937 US VASC ACCESS SITS VSL PATENCY NDL ENTRY $156.00 $140.40 $62.40 $124.80 $87.36 $109.20 $99.84 $124.80 $121.68 $70.20 $63.96 $65.52 $62.40 $117.00 $101.40
77065 MAMMOGRAPHY Uni-lateral Diagnostic $490.00 $441.00 $196.00 $392.00 $274.40 $343.00 $313.60 $392.00 $382.20 $220.50 $200.90 $205.80 $196.00 $367.50 $318.50
77066 MAMMOGRAPHY Bilateral Diagnostic $554.00 $498.60 $221.60 $443.20 $310.24 $387.80 $354.56 $443.20 $432.12 $249.30 $227.14 $232.68 $221.60 $415.50 $360.10
77067 SCREENING MAMMOGRAPHY $509.00 $458.10 $203.60 $407.20 $285.04 $356.30 $325.76 $407.20 $397.02 $229.05 $208.69 $213.78 $203.60 $381.75 $330.85
77080 DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL $387.00 $348.30 $154.80 $309.60 $216.72 $270.90 $247.68 $309.60 $301.86 $174.15 $158.67 $162.54 $154.80 $290.25 $251.55
78306 BONE &/JOINT IMAGING WHOLE BODY " $1,640.00 " " $1,476.00 " $656.00 " $1,312.00 " $918.40 " $1,148.00 " " $1,049.60 " " $1,312.00 " " $1,279.20 " $738.00 $672.40 $688.80 $656.00 " $1,230.00 " " $1,066.00 "
78452 MYOCARDIAL SPECT MULTIPLE STUDIES " $4,882.00 " " $4,393.80 " " $1,952.80 " " $3,905.60 " " $2,733.92 " " $3,417.40 " " $3,124.48 " " $3,905.60 " " $3,807.96 " " $2,196.90 " " $2,001.62 " " $2,050.44 " " $1,952.80 " " $3,661.50 " " $3,173.30 "
78815 PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH " $6,400.00 " " $5,760.00 " " $2,560.00 " " $5,120.00 " " $3,584.00 " " $4,480.00 " " $4,096.00 " " $5,120.00 " " $4,992.00 " " $2,880.00 " " $2,624.00 " " $2,688.00 " " $2,560.00 " " $4,800.00 " " $4,160.00 "
82040 Albumin $48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
84144 Progesterone $173.00 $155.70 $69.20 $138.40 $96.88 $121.10 $110.72 $138.40 $134.94 $77.85 $70.93 $72.66 $69.20 $129.75 $112.45
80048 BASIC METABOLIC PANEL $109.00 $98.10 $43.60 $87.20 $61.04 $76.30 $69.76 $87.20 $85.02 $49.05 $44.69 $45.78 $43.60 $81.75 $70.85
80053 COMEHENSIVE METABOLIC PANEL $113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
80061 LIPID PANEL $167.00 $150.30 $66.80 $133.60 $93.52 $116.90 $106.88 $133.60 $130.26 $75.15 $68.47 $70.14 $66.80 $125.25 $108.55
80069 RENAL FUNCTION PANEL $56.00 $50.40 $22.40 $44.80 $31.36 $39.20 $35.84 $44.80 $43.68 $25.20 $22.96 $23.52 $22.40 $42.00 $36.40
80076 HEPATIC FUNCTION PANEL $94.00 $84.60 $37.60 $75.20 $52.64 $65.80 $60.16 $75.20 $73.32 $42.30 $38.54 $39.48 $37.60 $70.50 $61.10
80162 Digoxin $141.00 $126.90 $56.40 $112.80 $78.96 $98.70 $90.24 $112.80 $109.98 $63.45 $57.81 $59.22 $56.40 $105.75 $91.65
81001 Urinalysis Complete $38.00 $34.20 $15.20 $30.40 $21.28 $26.60 $24.32 $30.40 $29.64 $17.10 $15.58 $15.96 $15.20 $28.50 $24.70
81003 Urinalysis Dipstick $10.00 $9.00 $4.00 $8.00 $5.60 $7.00 $6.40 $8.00 $7.80 $4.50 $4.10 $4.20 $4.00 $7.50 $6.50
81025 URINE PREGNANCY TEST $41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
82105 AFP-PRENATAL $169.00 $152.10 $67.60 $135.20 $94.64 $118.30 $108.16 $135.20 $131.82 $76.05 $69.29 $70.98 $67.60 $126.75 $109.85
82150 Amylase $56.00 $50.40 $22.40 $44.80 $31.36 $39.20 $35.84 $44.80 $43.68 $25.20 $22.96 $23.52 $22.40 $42.00 $36.40
82247 "BILIRUBIN, TOTAL" $55.00 $49.50 $22.00 $44.00 $30.80 $38.50 $35.20 $44.00 $42.90 $24.75 $22.55 $23.10 $22.00 $41.25 $35.75
82270 OCCULT BLOOD -3 DAY $34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
82306 Vitamin D 25 $220.00 $198.00 $88.00 $176.00 $123.20 $154.00 $140.80 $176.00 $171.60 $99.00 $90.20 $92.40 $88.00 $165.00 $143.00
82310 CALCIUM $55.00 $49.50 $22.00 $44.00 $30.80 $38.50 $35.20 $44.00 $42.90 $24.75 $22.55 $23.10 $22.00 $41.25 $35.75
82378 CEA $180.00 $162.00 $72.00 $144.00 $100.80 $126.00 $115.20 $144.00 $140.40 $81.00 $73.80 $75.60 $72.00 $135.00 $117.00
82435 CHLORIDE $48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
82465 CHOLESTEROL $42.00 $37.80 $16.80 $33.60 $23.52 $29.40 $26.88 $33.60 $32.76 $18.90 $17.22 $17.64 $16.80 $31.50 $27.30
82533 CORTISOL $288.00 $259.20 $115.20 $230.40 $161.28 $201.60 $184.32 $230.40 $224.64 $129.60 $118.08 $120.96 $115.20 $216.00 $187.20
82550 CK TOTAL $63.00 $56.70 $25.20 $50.40 $35.28 $44.10 $40.32 $50.40 $49.14 $28.35 $25.83 $26.46 $25.20 $47.25 $40.95
82565 CREATININE BLOOD $64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
82607 VITAMIN b-12 $177.00 $159.30 $70.80 $141.60 $99.12 $123.90 $113.28 $141.60 $138.06 $79.65 $72.57 $74.34 $70.80 $132.75 $115.05
82670 Estradiol $264.00 $237.60 $105.60 $211.20 $147.84 $184.80 $168.96 $211.20 $205.92 $118.80 $108.24 $110.88 $105.60 $198.00 $171.60
82746 FOLIC ACID $152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
82947 GLUCOSE QUANTITATIVE BLOOD $52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
83036 HEMOGLOBIN A1C $96.00 $86.40 $38.40 $76.80 $53.76 $67.20 $61.44 $76.80 $74.88 $43.20 $39.36 $40.32 $38.40 $72.00 $62.40
83655 Lead $103.00 $92.70 $41.20 $82.40 $57.68 $72.10 $65.92 $82.40 $80.34 $46.35 $42.23 $43.26 $41.20 $77.25 $66.95
83880 BRAIN NATRIURETIC PEPTIDE - BNP $217.00 $195.30 $86.80 $173.60 $121.52 $151.90 $138.88 $173.60 $169.26 $97.65 $88.97 $91.14 $86.80 $162.75 $141.05
84132 POTASSIUM Blood $59.00 $53.10 $23.60 $47.20 $33.04 $41.30 $37.76 $47.20 $46.02 $26.55 $24.19 $24.78 $23.60 $44.25 $38.35
84153 PSA PROSTATE SPECIFIC ANTIGEN TOTAL $169.00 $152.10 $67.60 $135.20 $94.64 $118.30 $108.16 $135.20 $131.82 $76.05 $69.29 $70.98 $67.60 $126.75 $109.85
84154 PSA PROSTATE SPECIFIC ANTIGEN FREE $149.00 $134.10 $59.60 $119.20 $83.44 $104.30 $95.36 $119.20 $116.22 $67.05 $61.09 $62.58 $59.60 $111.75 $96.85
84439 T-4 Thyroxine Free $106.00 $95.40 $42.40 $84.80 $59.36 $74.20 $67.84 $84.80 $82.68 $47.70 $43.46 $44.52 $42.40 $79.50 $68.90
84443 TSH ASSAY OF THYROID STIMULATING HORMONE $119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
84484 Troponin $164.00 $147.60 $65.60 $131.20 $91.84 $114.80 $104.96 $131.20 $127.92 $73.80 $67.24 $68.88 $65.60 $123.00 $106.60
84520 BUN $52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
85018 HEMOGLOBIN $32.00 $28.80 $12.80 $25.60 $17.92 $22.40 $20.48 $25.60 $24.96 $14.40 $13.12 $13.44 $12.80 $24.00 $20.80
85025 CBC Complete Blood Count $96.00 $86.40 $38.40 $76.80 $53.76 $67.20 $61.44 $76.80 $74.88 $43.20 $39.36 $40.32 $38.40 $72.00 $62.40
85027 BLOOD COUNT COMPLETE AUTOMATED $74.00 $66.60 $29.60 $59.20 $41.44 $51.80 $47.36 $59.20 $57.72 $33.30 $30.34 $31.08 $29.60 $55.50 $48.10
85610 PROTHROMBIN TIME $41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
85730 PTT THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD $60.00 $54.00 $24.00 $48.00 $33.60 $42.00 $38.40 $48.00 $46.80 $27.00 $24.60 $25.20 $24.00 $45.00 $39.00
86430 Rheumatoid Factor $57.00 $51.30 $22.80 $45.60 $31.92 $39.90 $36.48 $45.60 $44.46 $25.65 $23.37 $23.94 $22.80 $42.75 $37.05
86592 VDRL/RPR Syphilis $47.00 $42.30 $18.80 $37.60 $26.32 $32.90 $30.08 $37.60 $36.66 $21.15 $19.27 $19.74 $18.80 $35.25 $30.55
86677 H Pylori -Blood $160.00 $144.00 $64.00 $128.00 $89.60 $112.00 $102.40 $128.00 $124.80 $72.00 $65.60 $67.20 $64.00 $120.00 $104.00
86703 HIV $153.00 $137.70 $61.20 $122.40 $85.68 $107.10 $97.92 $122.40 $119.34 $68.85 $62.73 $64.26 $61.20 $114.75 $99.45
86704 Hepatitis B (hepatitis B surface antigen) $127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
86762 "Esophagitis, gastroent & misc digest disorders" $35.00 $31.50 $14.00 $28.00 $19.60 $24.50 $22.40 $28.00 $27.30 $15.75 $14.35 $14.70 $14.00 $26.25 $22.75
86803 Hepatitis C antibody $148.00 $133.20 $59.20 $118.40 $82.88 $103.60 $94.72 $118.40 $115.44 $66.60 $60.68 $62.16 $59.20 $111.00 $96.20
86850 Antibody Screen $94.00 $84.60 $37.60 $75.20 $52.64 $65.80 $60.16 $75.20 $73.32 $42.30 $38.54 $39.48 $37.60 $70.50 $61.10
86900 Vaginal delivery w O.R. proc except steril &/or D&C $41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
86901 C-Section without Sterilization with complications $72.00 $64.80 $28.80 $57.60 $40.32 $50.40 $46.08 $57.60 $56.16 $32.40 $29.52 $30.24 $28.80 $54.00 $46.80
87340 Hep b surface antigen $122.00 $109.80 $48.80 $97.60 $68.32 $85.40 $78.08 $97.60 $95.16 $54.90 $50.02 $51.24 $48.80 $91.50 $79.30
87426 COVID 19 ANTIGEN $60.00 $54.00 $24.00 $48.00 $33.60 $42.00 $38.40 $48.00 $46.80 $27.00 $24.60 $25.20 $24.00 $45.00 $39.00
87491 CHLAMYDIA PCR $181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
87591 GC PCR - Gonorrhea $181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
87804 INFLUENZA A&B $128.00 $115.20 $51.20 $102.40 $71.68 $89.60 $81.92 $102.40 $99.84 $57.60 $52.48 $53.76 $51.20 $96.00 $83.20
87880 Rapid Strep Test $64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
88305 Surgical Pathology Tissue LEVEL IV $757.00 $681.30 $302.80 $605.60 $423.92 $529.90 $484.48 $605.60 $590.46 $340.65 $310.37 $317.94 $302.80 $567.75 $492.05
91010 ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT " $2,143.00 " " $1,928.70 " $857.20 " $1,714.40 " " $1,200.08 " " $1,500.10 " " $1,371.52 " " $1,714.40 " " $1,671.54 " $964.35 $878.63 $900.06 $857.20 " $1,607.25 " " $1,392.95 "
92507 TX SPEECH LANG VOICE COMMJ &/AUDITORY OC IND $214.00 $192.60 $85.60 $171.20 $119.84 $149.80 $136.96 $171.20 $166.92 $96.30 $87.74 $89.88 $85.60 $160.50 $139.10
92523 EVAL SPEECH SOUND ODUCT LANGUAGE COMEHENSION $433.00 $389.70 $173.20 $346.40 $242.48 $303.10 $277.12 $346.40 $337.74 $194.85 $177.53 $181.86 $173.20 $324.75 $281.45
92526 TX SWALLOWING DYSFUNCTION&/ORAL FUNCJ FEEDING $267.00 $240.30 $106.80 $213.60 $149.52 $186.90 $170.88 $213.60 $208.26 $120.15 $109.47 $112.14 $106.80 $200.25 $173.55
92552 PURE TONE AUDIOMETRY AIR ONLY $129.00 $116.10 $51.60 $103.20 $72.24 $90.30 $82.56 $103.20 $100.62 $58.05 $52.89 $54.18 $51.60 $96.75 $83.85
92553 PURE TONE AUDIOMETRY AIR & BONE $125.00 $112.50 $50.00 $100.00 $70.00 $87.50 $80.00 $100.00 $97.50 $56.25 $51.25 $52.50 $50.00 $93.75 $81.25
92556 SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ $153.00 $137.70 $61.20 $122.40 $85.68 $107.10 $97.92 $122.40 $119.34 $68.85 $62.73 $64.26 $61.20 $114.75 $99.45
92557 COME AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ $168.00 $151.20 $67.20 $134.40 $94.08 $117.60 $107.52 $134.40 $131.04 $75.60 $68.88 $70.56 $67.20 $126.00 $109.20
92558 EVOKED OTOACOUSTIC EMISSIONS SCREEN AUTO ANALYS $127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
92567 TYMPANOMETRY $69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
92610 EVAL ORAL&PHARYNGEAL SWLNG FUNCJ $271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
92611 MOTION FLUOR EVAL SWLNG FUNCJ C/V REC $500.00 $450.00 $200.00 $400.00 $280.00 $350.00 $320.00 $400.00 $390.00 $225.00 $205.00 $210.00 $200.00 $375.00 $325.00
92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL " $1,303.00 " " $1,172.70 " $521.20 " $1,042.40 " $729.68 $912.10 $833.92 " $1,042.40 " " $1,016.34 " $586.35 $534.23 $547.26 $521.20 $977.25 $846.95
93005 EKG/ECG Electrocardiogram 12 lead trace only without read $146.00 $131.40 $58.40 $116.80 $81.76 $102.20 $93.44 $116.80 $113.88 $65.70 $59.86 $61.32 $58.40 $109.50 $94.90
93016 CV STRS TST XERS&/OR RX CONT ECG W/O I&R " $2,911.00 " " $2,619.90 " " $1,164.40 " " $2,328.80 " " $1,630.16 " " $2,037.70 " " $1,863.04 " " $2,328.80 " " $2,270.58 " " $1,309.95 " " $1,193.51 " " $1,222.62 " " $1,164.40 " " $2,183.25 " " $1,892.15 "
93224 XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I " $1,182.00 " " $1,063.80 " $472.80 $945.60 $661.92 $827.40 $756.48 $945.60 $921.96 $531.90 $484.62 $496.44 $472.80 $886.50 $768.30
93270 XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS $134.00 $120.60 $53.60 $107.20 $75.04 $93.80 $85.76 $107.20 $104.52 $60.30 $54.94 $56.28 $53.60 $100.50 $87.10
93306 ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D " $2,754.00 " " $2,478.60 " " $1,101.60 " " $2,203.20 " " $1,542.24 " " $1,927.80 " " $1,762.56 " " $2,203.20 " " $2,148.12 " " $1,239.30 " " $1,129.14 " " $1,156.68 " " $1,101.60 " " $2,065.50 " " $1,790.10 "
93308 limited or follow up 2D echocardiography including M-mode recording $427.00 $384.30 $170.80 $341.60 $239.12 $298.90 $273.28 $341.60 $333.06 $192.15 $175.07 $179.34 $170.80 $320.25 $277.55
93321 DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD $252.00 $226.80 $100.80 $201.60 $141.12 $176.40 $161.28 $201.60 $196.56 $113.40 $103.32 $105.84 $100.80 $189.00 $163.80
93325 DOP ECHOCARD COLOR FLOW VELOCITY MAPPING $330.00 $297.00 $132.00 $264.00 $184.80 $231.00 $211.20 $264.00 $257.40 $148.50 $135.30 $138.60 $132.00 $247.50 $214.50
93350 ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST $860.00 $774.00 $344.00 $688.00 $481.60 $602.00 $550.40 $688.00 $670.80 $387.00 $352.60 $361.20 $344.00 $645.00 $559.00
93788 AMBL BLD ESS W/TAPE/DISK 24/>HR ALYS W/RET $102.00 $91.80 $40.80 $81.60 $57.12 $71.40 $65.28 $81.60 $79.56 $45.90 $41.82 $42.84 $40.80 $76.50 $66.30
93798 OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING $271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
93880 DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY " $1,551.00 " " $1,395.90 " $620.40 " $1,240.80 " $868.56 " $1,085.70 " $992.64 " $1,240.80 " " $1,209.78 " $697.95 $635.91 $651.42 $620.40 " $1,163.25 " " $1,008.15 "
93922 NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL $692.00 $622.80 $276.80 $553.60 $387.52 $484.40 $442.88 $553.60 $539.76 $311.40 $283.72 $290.64 $276.80 $519.00 $449.80
93925 DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY $899.00 $809.10 $359.60 $719.20 $503.44 $629.30 $575.36 $719.20 $701.22 $404.55 $368.59 $377.58 $359.60 $674.25 $584.35
93970 DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY " $1,394.00 " " $1,254.60 " $557.60 " $1,115.20 " $780.64 $975.80 $892.16 " $1,115.20 " " $1,087.32 " $627.30 $571.54 $585.48 $557.60 " $1,045.50 " $906.10
93971 DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY $891.00 $801.90 $356.40 $712.80 $498.96 $623.70 $570.24 $712.80 $694.98 $400.95 $365.31 $374.22 $356.40 $668.25 $579.15
93975 DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/R ORGN COM " $1,014.00 " $912.60 $405.60 $811.20 $567.84 $709.80 $648.96 $811.20 $790.92 $456.30 $415.74 $425.88 $405.60 $760.50 $659.10
93978 DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/R ORGN LMT $535.00 $481.50 $214.00 $428.00 $299.60 $374.50 $342.40 $428.00 $417.30 $240.75 $219.35 $224.70 $214.00 $401.25 $347.75
94010 SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ $218.00 $196.20 $87.20 $174.40 $122.08 $152.60 $139.52 $174.40 $170.04 $98.10 $89.38 $91.56 $87.20 $163.50 $141.70
94060 BRNCDILAT RSPSE SPMTRY E&POST-BRNCDILAT ADMN $613.00 $551.70 $245.20 $490.40 $343.28 $429.10 $392.32 $490.40 $478.14 $275.85 $251.33 $257.46 $245.20 $459.75 $398.45
94640 INHALATION TREATMENT - Neb treatment $113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
94660 CPAP VENTILATION CPAP INITIATION&MGMT $168.00 $151.20 $67.20 $134.40 $94.08 $117.60 $107.52 $134.40 $131.04 $75.60 $68.88 $70.56 $67.20 $126.00 $109.20
94664 DEMO&/EVAL OF PT UTILIZ AERSL GEN/NEB/INHLR/IP $164.00 $147.60 $65.60 $131.20 $91.84 $114.80 $104.96 $131.20 $127.92 $73.80 $67.24 $68.88 $65.60 $123.00 $106.60
94726 PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST $346.00 $311.40 $138.40 $276.80 $193.76 $242.20 $221.44 $276.80 $269.88 $155.70 $141.86 $145.32 $138.40 $259.50 $224.90
94729 CO DIFFUSING CAPACITY $358.00 $322.20 $143.20 $286.40 $200.48 $250.60 $229.12 $286.40 $279.24 $161.10 $146.78 $150.36 $143.20 $268.50 $232.70
94760 NONINVASIVE EAR/PULSE OXIMETRY SINGLE DETER $30.00 $27.00 $12.00 $24.00 $16.80 $21.00 $19.20 $24.00 $23.40 $13.50 $12.30 $12.60 $12.00 $22.50 $19.50
94761 NONINVASIVE EAR/PULSE OXIMETRY MULTIPLE DETER $43.00 $38.70 $17.20 $34.40 $24.08 $30.10 $27.52 $34.40 $33.54 $19.35 $17.63 $18.06 $17.20 $32.25 $27.95
94762 NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR $299.00 $269.10 $119.60 $239.20 $167.44 $209.30 $191.36 $239.20 $233.22 $134.55 $122.59 $125.58 $119.60 $224.25 $194.35
95810 Sleep Study Polysomnography " $3,669.00 " " $3,302.10 " " $1,467.60 " " $2,935.20 " " $2,054.64 " " $2,568.30 " " $2,348.16 " " $2,935.20 " " $2,861.82 " " $1,651.05 " " $1,504.29 " " $1,540.98 " " $1,467.60 " " $2,751.75 " " $2,384.85 "
95811 POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND " $4,052.00 " " $3,646.80 " " $1,620.80 " " $3,241.60 " " $2,269.12 " " $2,836.40 " " $2,593.28 " " $3,241.60 " " $3,160.56 " " $1,823.40 " " $1,661.32 " " $1,701.84 " " $1,620.80 " " $3,039.00 " " $2,633.80 "
97016 APPL MODALITY 1/> AREAS VASOPNEUMATIC DEVICES $70.00 $63.00 $28.00 $56.00 $39.20 $49.00 $44.80 $56.00 $54.60 $31.50 $28.70 $29.40 $28.00 $52.50 $45.50
97022 APPLICATION MODALITY 1/> AREAS WHIRLPOOL $91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
97032 APPL MODALITY 1/> AREAS ELEC STIMJ EA 15 MIN $48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
97035 APPL MODALITY 1/> AREAS ULTRASOUND EA 15 MIN $40.00 $36.00 $16.00 $32.00 $22.40 $28.00 $25.60 $32.00 $31.20 $18.00 $16.40 $16.80 $16.00 $30.00 $26.00
97110 Physical Therapy Therapeutic Exercise per 15 Minutes $98.00 $88.20 $39.20 $78.40 $54.88 $68.60 $62.72 $78.40 $76.44 $44.10 $40.18 $41.16 $39.20 $73.50 $63.70
97112 THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA $112.00 $100.80 $44.80 $89.60 $62.72 $78.40 $71.68 $89.60 $87.36 $50.40 $45.92 $47.04 $44.80 $84.00 $72.80
97113 AQUATIC THERAPY 15MIN $130.00 $117.00 $52.00 $104.00 $72.80 $91.00 $83.20 $104.00 $101.40 $58.50 $53.30 $54.60 $52.00 $97.50 $84.50
97116 THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ W/STAIR $88.00 $79.20 $35.20 $70.40 $49.28 $61.60 $56.32 $70.40 $68.64 $39.60 $36.08 $36.96 $35.20 $66.00 $57.20
97129 THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES $75.00 $67.50 $30.00 $60.00 $42.00 $52.50 $48.00 $60.00 $58.50 $33.75 $30.75 $31.50 $30.00 $56.25 $48.75
97162 PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS $253.00 $227.70 $101.20 $202.40 $141.68 $177.10 $161.92 $202.40 $197.34 $113.85 $103.73 $106.26 $101.20 $189.75 $164.45
97163 PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS $253.00 $227.70 $101.20 $202.40 $141.68 $177.10 $161.92 $202.40 $197.34 $113.85 $103.73 $106.26 $101.20 $189.75 $164.45
97164 PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS $127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
97165 OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS $262.00 $235.80 $104.80 $209.60 $146.72 $183.40 $167.68 $209.60 $204.36 $117.90 $107.42 $110.04 $104.80 $196.50 $170.30
97166 OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS $269.00 $242.10 $107.60 $215.20 $150.64 $188.30 $172.16 $215.20 $209.82 $121.05 $110.29 $112.98 $107.60 $201.75 $174.85
97167 OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS $291.00 $261.90 $116.40 $232.80 $162.96 $203.70 $186.24 $232.80 $226.98 $130.95 $119.31 $122.22 $116.40 $218.25 $189.15
97530 Physical Therapy Therapeutic Activity per 15 min $103.00 $92.70 $41.20 $82.40 $57.68 $72.10 $65.92 $82.40 $80.34 $46.35 $42.23 $43.26 $41.20 $77.25 $66.95
97535 SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES $84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
97597 wound debridement $153.00 $137.70 $61.20 $122.40 $85.68 $107.10 $97.92 $122.40 $119.34 $68.85 $62.73 $64.26 $61.20 $114.75 $99.45
97602 Removal of devitalized tissue $143.00 $128.70 $57.20 $114.40 $80.08 $100.10 $91.52 $114.40 $111.54 $64.35 $58.63 $60.06 $57.20 $107.25 $92.95
97605 Negative pressure wound treatment $174.00 $156.60 $69.60 $139.20 $97.44 $121.80 $111.36 $139.20 $135.72 $78.30 $71.34 $73.08 $69.60 $130.50 $113.10
97607 Wound treatment $315.00 $283.50 $126.00 $252.00 $176.40 $220.50 $201.60 $252.00 $245.70 $141.75 $129.15 $132.30 $126.00 $236.25 $204.75
97750 Physical performace test $160.00 $144.00 $64.00 $128.00 $89.60 $112.00 $102.40 $128.00 $124.80 $72.00 $65.60 $67.20 $64.00 $120.00 $104.00
97802 "Medical nutrition therapy; initial assessment, individual, face-to-face with the patient, each 15 minutes" $83.00 $74.70 $33.20 $66.40 $46.48 $58.10 $53.12 $66.40 $64.74 $37.35 $34.03 $34.86 $33.20 $62.25 $53.95
115115 60 MINUTE MASSAGE RETAIL $103.00 $92.70 $41.20 $82.40 $57.68 $72.10 $65.92 $82.40 $80.34 $46.35 $42.23 $43.26 $41.20 $77.25 $66.95
115116 90 MINUTE MASSAGE RETAIL $82.00 $73.80 $32.80 $65.60 $45.92 $57.40 $52.48 $65.60 $63.96 $36.90 $33.62 $34.44 $32.80 $61.50 $53.30
115117 30 MINUTE MASSAGE RETAIL $52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
115118 ACUPUNCTURE INITIAL CONSULT RETAIL $88.00 $79.20 $35.20 $70.40 $49.28 $61.60 $56.32 $70.40 $68.64 $39.60 $36.08 $36.96 $35.20 $66.00 $57.20
115119 ACUPUNCTURE FOLLOW UP VISIT RETAIL $62.00 $55.80 $24.80 $49.60 $34.72 $43.40 $39.68 $49.60 $48.36 $27.90 $25.42 $26.04 $24.80 $46.50 $40.30
G0145 "Pap Smear Screening cytopathology, cervical or vaginal " $96.00 $86.40 $38.40 $76.80 $53.76 $67.20 $61.44 $76.80 $74.88 $43.20 $39.36 $40.32 $38.40 $72.00 $62.40
MS470 Knee replacement " $54,050.00 " " $48,645.00 " " $21,620.00 " " $43,240.00 " " $30,268.00 " " $37,835.00 " " $34,592.00 " " $43,240.00 " " $42,159.00 " " $24,322.50 " " $22,160.50 " " $22,701.00 " " $21,620.00 " " $40,537.50 " " $35,132.50 "
MS785 C-Section with Sterilization without complications " $32,578.65 " " $29,320.79 " " $13,031.46 " " $26,062.92 " " $18,244.04 " " $22,805.06 " " $20,850.34 " " $26,062.92 " " $25,411.35 " " $14,660.39 " " $13,357.25 " " $13,683.03 " " $13,031.46 " " $24,433.99 " " $21,176.12 "
MS788 Cesarean section " $27,474.10 " " $24,726.69 " " $10,989.64 " " $21,979.28 " " $15,385.50 " " $19,231.87 " " $17,583.42 " " $21,979.28 " " $21,429.80 " " $12,363.35 " " $11,264.38 " " $11,539.12 " " $10,989.64 " " $20,605.58 " " $17,858.17 "
MS795 Normal newborn " $4,105.00 " " $3,694.50 " " $1,642.00 " " $3,284.00 " " $2,298.80 " " $2,873.50 " " $2,627.20 " " $3,284.00 " " $3,201.90 " " $1,847.25 " " $1,683.05 " " $1,724.10 " " $1,642.00 " " $3,078.75 " " $2,668.25 "
MS798 Vaginal delivery w sterilization &/or D&C " $28,748.35 " " $25,873.52 " " $11,499.34 " " $22,998.68 " " $16,099.08 " " $20,123.85 " " $18,398.94 " " $22,998.68 " " $22,423.71 " " $12,936.76 " " $11,786.82 " " $12,074.31 " " $11,499.34 " " $21,561.26 " " $18,686.43 "
MS807 Vaginal delivery w/o sterilization/D&C " $14,314.65 " " $12,883.19 " " $5,725.86 " " $11,451.72 " " $8,016.20 " " $10,020.26 " " $9,161.38 " " $11,451.72 " " $11,165.43 " " $6,441.59 " " $5,869.01 " " $6,012.15 " " $5,725.86 " " $10,735.99 " " $9,304.52 "
U0003 COVID 19 HIGH THROUGHPUT $216.00 $194.40 $86.40 $172.80 $120.96 $151.20 $138.24 $172.80 $168.48 $97.20 $88.56 $90.72 $86.40 $162.00 $140.40
Fee Schedule Proc Code CPT_Code Procedure Name Base_Charge UNIT_Charge Cash Discounted Price Minimum Contracted Rate Maximum Contracted Rate Medicare Blue Cross HealthPartners Medica Preferred One Group Health Coop of Eau Claire United Healthcare PMAP Medicaid Blue Cross MA United Healthcare Cigna
WWH CRNA FEE SCHEDULE - 4201 00103 00103 PR ANESTHESIA EYELID RECONSTRUCTIVE PROCEDURE "1,405.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00120 00120 PR ANESTHESIA EXTERNAL MIDDLE & INNER EAR W/BX NOS "1,405.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00124 00124 PR ANES EXTERNAL MIDDLE & INNER EAR W/BX OTOSCOPY "1,405.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00126 00126 PR ANES XTRNL MID & INNER EAR W/BX TYMPANOTOMY "1,125.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00140 00140 PR ANESTHESIA EYE NOT OTHERWISE SPECIFIED "1,405.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00142 00142 PR ANESTHESIA EYE LENS SURGERY "1,125.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00160 00160 PR ANESTHESIA NOSE & ACCESSORY SINUSES NOS "1,405.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00164 00164 PR ANES NOSE & ACCESSORY SINUSES BIOPSY SOFT TISSUE "1,125.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00170 00170 PR ANESTHESIA INTRAORAL WITH BIOPSY NOS "1,405.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00300 00300 PR ANES INTEG MUSC & NRV HEAD NECK&POSTERIOR TRUNK "1,405.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00320 00320 PR ANES ESOPH THYRD LARYNX TRACH & LYMPH NECK 1YR "1,405.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00400 00400 PR ANES INTEG EXTREMITIES ANT TRUNK & PERINEUM NOS 844.00 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00404 00404 PR ANESTHESIA RADICAL/MODIFIED RADICAL BREAST "1,405.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00410 00410 PR ANES INTEG SYS ELEC CONVERSION ARRHYTHMIAS "1,125.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00472 00472 PR ANESTHESIA PARTIAL RIB RESECTION THORACOPLASTY "2,809.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00532 00532 PR ANESTHESIA ACCESS CENTRAL VENOUS CIRCULATION "1,125.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00630 00630 PR ANESTHESIA LUMBAR REGION NOS "2,248.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00731 00731 PR ANESTHESIA UPPER GI ENDOSCOPIC PX NOS "1,405.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00750 00750 PR ANESTHESIA HERNIA REPAIR UPPER ABDOMEN NOS "1,125.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00752 00752 PR ANES HRNA RPR UPR ABD LMBR&VENTRAL HERNIA&DEHISC "1,125.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00756 00756 PR ANES HRNA REPAIR UPR ABD TABDL RPR DIPHRG HRNA "1,967.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00790 00790 PR ANES INTRAPERITONEAL UPPER ABDOMEN W/LAPS NOS "1,967.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00800 00800 PR ANESTHESIA LOWER ANTERIOR ABDOMINAL WALL NOS "1,967.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00811 00811 PR ANESTHESIA LOWER INTST ENDOSCOPIC PX NOS "1,125.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00812 00812 PR ANESTHESIA LOWER INTST ENDOSCOPIC PX SCR COLSC 844.00 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00813 00813 PR ANESTHESIA COMBINED UPPER&LOWER GI ENDOSCOPIC PX "1,405.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00820 00820 PR ANESTHESIA LOWER POSTERIOR ABDOMINAL WALL "1,405.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00830 00830 PR ANESTHESIA HERNIA REPAIR LOWER ABDOMEN NOS "1,125.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00832 00832 PR ANES LWR ABD VENTRAL & INCISIONAL HERNIA REPAIR "1,686.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00840 00840 PR ANESTHESIA INTRAPERITONEAL LOWER ABD W/LAPS NOS "1,686.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00851 00851 PR ANES IPER LWR ABD W/LAPS TUBAL LIGATION/TRANSECT "1,686.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00860 00860 PR ANES EXTRAPERITONEAL LWR ABD W/URINARY TRACT NOS "1,686.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00872 00872 PR ANES LITHOTRP XTRCORP SHOCK WAVE W/WATER BATH "1,967.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00873 00873 PR ANES LITHOTRP XTRCORP SHOCK WAVE W/O WATER BATH "1,405.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00902 00902 PR ANESTHESIA ANORECTAL PROCEDURE "1,405.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00910 00910 PR ANES TRANSURETHRAL W/URETHROCYSTOSCOPY NOS 844.00 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00912 00912 PR ANES TRANSURETHRAL RESECTION OF BLADDER TUMOR "1,405.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00914 00914 PR ANESTHESIA TRANSURETHRAL RESECTION OF PROSTATE "1,405.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00918 00918 PR ANES TRURL FRAGMNTJ MANJ&/RMVL URETERAL CALCULUS "1,405.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00920 00920 PR ANESTHESIA MALE GENITALIA INCL OPEN URETHRAL PX 844.00 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00940 00940 PR ANESTHESIA VAGINAL PROCEDURE W/BIOPSY NOS 844.00 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00944 00944 PR ANESTHESIA VAGINAL HYSTERECTOMY INCL BIOPSY "1,686.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 00952 00952 PR ANES HYSTEROSCOPY&/HYSTEROSALPINGOGRAPHY W/BX "1,125.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 01210 01210 PR ANESTHESIA OPEN HIP JOINT PROCEDURE NOS "1,686.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 01260 01260 PR ANES VEINS OF UPPER LEG INCLUDING EXPLORATION "1,686.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 01320 01320 PR ANES NERVE MUSC TENDON FASCIA&BURSA KNEE&/POPLT "1,125.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 01382 01382 PR ANESTH DIAGNOSTIC ARTHROSCOPIC PROC KNEE JOINT 844.00 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 01400 01400 PR ANES OPEN/SURG ARTHROSCOPIC PROC KNEE JOINT NOS "1,125.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 01402 01402 PR ANESTH OPEN/SURG ARTHRS TOTAL KNEE ARTHROPLASTY "1,967.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 01470 01470 PR ANES NRV/MUS/TND/FASC LOWER LEG/ANKLE/FOOT NOS 844.00 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 01472 01472 PR ANES RPR RUPTURED ACHILLES TENDON W/WO GRAFT "1,405.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 01480 01480 PR ANES OPEN PROC BONES LOWER LEG/ANKLE/FOOT NOS 844.00 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 01482 01482 PR ANES RADICAL RESECJ INCL BELOW KNEE AMPUTATION "1,967.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 01620 01620 PR ANES CLOSED HUMRL H/N STRNCLAV JOINT& SHO JOINT "1,125.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 01630 01630 PR ANES ARTHRS HUMERAL H/N STRNCLAV & SHOULDER NOS "1,405.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 01710 01710 PR ANES NRV MUSC TDN FSCA&BRS UPR ARM/ELBOW NOS "1,125.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 01740 01740 PR ANES OPEN/SURG ARTHROSCOPIC ELBOW PROC NOS "1,125.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 01810 01810 PR ANES NERVE MUSCLE TDN FASCIA&BURSA FOREARM WRIST 844.00 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 01820 01820 PR ANES RADIUS ULNA WRIST/HAND BONES CLOSED PX 844.00 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 01830 01830 PR ANES ARTHRS/ENDSCPY DSTL RADIUS ULNA/WRIST/HAND 844.00 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 01922 01922 PR ANES NON-INVASIVE IMAGING/RADIATION THERAPY "1,967.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 01961 01961 PR ANESTHESIA CESAREAN DELIVERY ONLY "1,967.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 01965 01965 PR ANESTHESIA INCOMPLETE/MISSED ABORTION "1,125.00" 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 01967 01967 PR NEURAXIAL LABOR ANALG/ANES PLND VAGINAL DELIVERY 983.00 $884.70 $393.20 $786.40 $550.48 $688.10 $629.12 $786.40 $766.74 $442.35 $403.03 $412.86 $393.20 $737.25 $638.95
WWH CRNA FEE SCHEDULE - 4201 01968 01968 PR ANES CESARN DLVR FLWG NEURAXIAL LABOR ANALG/ANES 844.00 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH CRNA FEE SCHEDULE - 4201 01996 01996 PR DAILY HOSP MGMT EDRL/SARACH CONT DRUG ADMN 434.00 $390.60 $173.60 $347.20 $243.04 $303.80 $277.76 $347.20 $338.52 $195.30 $177.94 $182.28 $173.60 $325.50 $282.10
WWH CRNA FEE SCHEDULE - 4201 110178 110178 HCHG DESFLURANE PER 15 MIN 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH CRNA FEE SCHEDULE - 4201 110181 110181 HCHG ISOFLURANE PER 15 MIN 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH CRNA FEE SCHEDULE - 4201 110182 110182 HCHG SEVOFLURANE PER 15 MIN 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH CRNA FEE SCHEDULE - 4201 112562 76937 HCHG ANESTH US GUIDED VASCULAR ACCESS 156.00 $140.40 $62.40 $124.80 $87.36 $109.20 $99.84 $124.80 $121.68 $70.20 $63.96 $65.52 $62.40 $117.00 $101.40
WWH CRNA FEE SCHEDULE - 4201 115451 76942 HCHG ANES US GUIDE 518.00 $466.20 $207.20 $414.40 $290.08 $362.60 $331.52 $414.40 $404.04 $233.10 $212.38 $217.56 $207.20 $388.50 $336.70
WWH CRNA FEE SCHEDULE - 4201 31500 31500 PR INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE 651.00 $585.90 $260.40 $520.80 $364.56 $455.70 $416.64 $520.80 $507.78 $292.95 $266.91 $273.42 $260.40 $488.25 $423.15
WWH CRNA FEE SCHEDULE - 4201 36000 36000 PR INTRODUCTION NEEDLE/INTRACATHETER VEIN 185.00 $166.50 $74.00 $148.00 $103.60 $129.50 $118.40 $148.00 $144.30 $83.25 $75.85 $77.70 $74.00 $138.75 $120.25
WWH CRNA FEE SCHEDULE - 4201 36400 36400 PR VNPNXR <3 YEARS PHY/QHP SKILL FEMRAL/JUGLAR VEIN 75.00 $67.50 $30.00 $60.00 $42.00 $52.50 $48.00 $60.00 $58.50 $33.75 $30.75 $31.50 $30.00 $56.25 $48.75
WWH CRNA FEE SCHEDULE - 4201 36410 36410 PR VNPNXR 3 YEARS/> PHYS/QHP SKILL 83.00 $74.70 $33.20 $66.40 $46.48 $58.10 $53.12 $66.40 $64.74 $37.35 $34.03 $34.86 $33.20 $62.25 $53.95
WWH CRNA FEE SCHEDULE - 4201 36556 36556 PR INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/> 950.00 $855.00 $380.00 $760.00 $532.00 $665.00 $608.00 $760.00 $741.00 $427.50 $389.50 $399.00 $380.00 $712.50 $617.50
WWH CRNA FEE SCHEDULE - 4201 36569 36569 PR INSERTION PICC W/O IMG GDN 5 YR/> 950.00 $855.00 $380.00 $760.00 $532.00 $665.00 $608.00 $760.00 $741.00 $427.50 $389.50 $399.00 $380.00 $712.50 $617.50
WWH CRNA FEE SCHEDULE - 4201 62270 62270 PR SPINAL PUNCTURE LUMBAR DIAGNOSTIC 484.00 $435.60 $193.60 $387.20 $271.04 $338.80 $309.76 $387.20 $377.52 $217.80 $198.44 $203.28 $193.60 $363.00 $314.60
WWH CRNA FEE SCHEDULE - 4201 62273 62273 PR INJECTION EPIDURAL BLOOD/CLOT PATCH "1,139.00" " $1,025.10 " $455.60 $911.20 $637.84 $797.30 $728.96 $911.20 $888.42 $512.55 $466.99 $478.38 $455.60 $854.25 $740.35
WWH CRNA FEE SCHEDULE - 4201 62322 62322 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN "1,194.00" " $1,074.60 " $477.60 $955.20 $668.64 $835.80 $764.16 $955.20 $931.32 $537.30 $489.54 $501.48 $477.60 $895.50 $776.10
WWH CRNA FEE SCHEDULE - 4201 62326 62326 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN "1,031.00" $927.90 $412.40 $824.80 $577.36 $721.70 $659.84 $824.80 $804.18 $463.95 $422.71 $433.02 $412.40 $773.25 $670.15
WWH CRNA FEE SCHEDULE - 4201 64415 64415 PR INJECTION AA&/STRD BRACHIAL PLEXUS W/IMG GDN "1,091.00" $981.90 $436.40 $872.80 $610.96 $763.70 $698.24 $872.80 $850.98 $490.95 $447.31 $458.22 $436.40 $818.25 $709.15
WWH CRNA FEE SCHEDULE - 4201 64417 64417 PR INJECTION AA&/STRD AXILLARY NERVE W/IMG GDN 651.00 $585.90 $260.40 $520.80 $364.56 $455.70 $416.64 $520.80 $507.78 $292.95 $266.91 $273.42 $260.40 $488.25 $423.15
WWH CRNA FEE SCHEDULE - 4201 64420 64420 PR INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE 787.00 $708.30 $314.80 $629.60 $440.72 $550.90 $503.68 $629.60 $613.86 $354.15 $322.67 $330.54 $314.80 $590.25 $511.55
WWH CRNA FEE SCHEDULE - 4201 64425 64425 PR INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS 746.00 $671.40 $298.40 $596.80 $417.76 $522.20 $477.44 $596.80 $581.88 $335.70 $305.86 $313.32 $298.40 $559.50 $484.90
WWH CRNA FEE SCHEDULE - 4201 64445 64445 PR INJECTION AA&/STRD SCIATIC NERVE W/IMG GDN "1,082.00" $973.80 $432.80 $865.60 $605.92 $757.40 $692.48 $865.60 $843.96 $486.90 $443.62 $454.44 $432.80 $811.50 $703.30
WWH CRNA FEE SCHEDULE - 4201 64447 64447 PR INJECTION AA&/STRD FEMORAL NERVE W/IMG GDN "1,082.00" $973.80 $432.80 $865.60 $605.92 $757.40 $692.48 $865.60 $843.96 $486.90 $443.62 $454.44 $432.80 $811.50 $703.30
WWH CRNA FEE SCHEDULE - 4201 64450 64450 PR INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH 353.00 $317.70 $141.20 $282.40 $197.68 $247.10 $225.92 $282.40 $275.34 $158.85 $144.73 $148.26 $141.20 $264.75 $229.45
WWH CRNA FEE SCHEDULE - 4201 64461 64461 PR PVB THORACIC SINGLE INJECTION SITE W/IMG GID 600.00 $540.00 $240.00 $480.00 $336.00 $420.00 $384.00 $480.00 $468.00 $270.00 $246.00 $252.00 $240.00 $450.00 $390.00
WWH CRNA FEE SCHEDULE - 4201 64486 64486 PR TAP BLOCK UNILATERAL BY INJECTION(S) "1,355.00" " $1,219.50 " $542.00 " $1,084.00 " $758.80 $948.50 $867.20 " $1,084.00 " " $1,056.90 " $609.75 $555.55 $569.10 $542.00 " $1,016.25 " $880.75
WWH CRNA FEE SCHEDULE - 4201 64488 64488 PR TAP BLOCK BILATERAL BY INJECTION(S) "1,793.00" " $1,613.70 " $717.20 " $1,434.40 " " $1,004.08 " " $1,255.10 " " $1,147.52 " " $1,434.40 " " $1,398.54 " $806.85 $735.13 $753.06 $717.20 " $1,344.75 " " $1,165.45 "
WWH CRNA FEE SCHEDULE - 4201 64999.24 64999 PR ERECTOR SPINAE NERVE BLOCK AFFILIATE ONLY 613.00 $551.70 $245.20 $490.40 $343.28 $429.10 $392.32 $490.40 $478.14 $275.85 $251.33 $257.46 $245.20 $459.75 $398.45
WWH CRNA FEE SCHEDULE - 4201 64999.26 64999 PR FASCIA ILIACA BLOCK AFFILIATE ONLY 613.00 $551.70 $245.20 $490.40 $343.28 $429.10 $392.32 $490.40 $478.14 $275.85 $251.33 $257.46 $245.20 $459.75 $398.45
WWH CRNA FEE SCHEDULE - 4201 76937 76937 PR US VASC ACCESS SITS VSL PATENCY NDL ENTRY 156.00 $140.40 $62.40 $124.80 $87.36 $109.20 $99.84 $124.80 $121.68 $70.20 $63.96 $65.52 $62.40 $117.00 $101.40
WWH CRNA FEE SCHEDULE - 4201 76942.22 76942 PR ULTRASOUND GUIDED NEEDLE PLCMT 518.00 $466.20 $207.20 $414.40 $290.08 $362.60 $331.52 $414.40 $404.04 $233.10 $212.38 $217.56 $207.20 $388.50 $336.70
WWH CRNA FEE SCHEDULE - 4201 99100 99100 PR ANESTHESIA EXTREME AGE PATIENT UNDER 1 YR/< 174.00 $156.60 $69.60 $139.20 $97.44 $121.80 $111.36 $139.20 $135.72 $78.30 $71.34 $73.08 $69.60 $130.50 $113.10
WWH CRNA FEE SCHEDULE - 4201 99140 99140 PR ANES COMPLICJ EMERGENCY CONDITIONS SPECIFY 317.00 $285.30 $126.80 $253.60 $177.52 $221.90 $202.88 $253.60 $247.26 $142.65 $129.97 $133.14 $126.80 $237.75 $206.05
WWH CRNA FEE SCHEDULE - 4201 99465 99465 PR DELIVERY/BIRTHING ROOM RESUSCITATION 700.00 $630.00 $280.00 $560.00 $392.00 $490.00 $448.00 $560.00 $546.00 $315.00 $287.00 $294.00 $280.00 $525.00 $455.00
WWH CRNA FEE SCHEDULE - 4201 999998 99998 PR ANES CRNA UNITS WWH ONLY PASS THRU 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH ED PROFEE SCHEDULE - 4203 10021 10021 PR FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION 558.00 $502.20 $223.20 $446.40 $312.48 $390.60 $357.12 $446.40 $435.24 $251.10 $228.78 $234.36 $223.20 $418.50 $362.70
WWH ED PROFEE SCHEDULE - 4203 10060 10060 PR INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE 452.00 $406.80 $180.80 $361.60 $253.12 $316.40 $289.28 $361.60 $352.56 $203.40 $185.32 $189.84 $180.80 $339.00 $293.80
WWH ED PROFEE SCHEDULE - 4203 10061 10061 PR INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE 824.00 $741.60 $329.60 $659.20 $461.44 $576.80 $527.36 $659.20 $642.72 $370.80 $337.84 $346.08 $329.60 $618.00 $535.60
WWH ED PROFEE SCHEDULE - 4203 10080 10080 PR INCISION & DRAINAGE PILONIDAL CYST SIMPLE 754.00 $678.60 $301.60 $603.20 $422.24 $527.80 $482.56 $603.20 $588.12 $339.30 $309.14 $316.68 $301.60 $565.50 $490.10
WWH ED PROFEE SCHEDULE - 4203 10120 10120 PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE 486.00 $437.40 $194.40 $388.80 $272.16 $340.20 $311.04 $388.80 $379.08 $218.70 $199.26 $204.12 $194.40 $364.50 $315.90
WWH ED PROFEE SCHEDULE - 4203 10140 10140 PR I&D HEMATOMA SEROMA/FLUID COLLECTION 646.00 $581.40 $258.40 $516.80 $361.76 $452.20 $413.44 $516.80 $503.88 $290.70 $264.86 $271.32 $258.40 $484.50 $419.90
WWH ED PROFEE SCHEDULE - 4203 10160 10160 PR PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST 470.00 $423.00 $188.00 $376.00 $263.20 $329.00 $300.80 $376.00 $366.60 $211.50 $192.70 $197.40 $188.00 $352.50 $305.50
WWH ED PROFEE SCHEDULE - 4203 11010 11010 PR DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS "2,250.00" " $2,025.00 " $900.00 " $1,800.00 " " $1,260.00 " " $1,575.00 " " $1,440.00 " " $1,800.00 " " $1,755.00 " " $1,012.50 " $922.50 $945.00 $900.00 " $1,687.50 " " $1,462.50 "
WWH ED PROFEE SCHEDULE - 4203 11042 11042 PR DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< 379.00 $341.10 $151.60 $303.20 $212.24 $265.30 $242.56 $303.20 $295.62 $170.55 $155.39 $159.18 $151.60 $284.25 $246.35
WWH ED PROFEE SCHEDULE - 4203 11044 11044 PR DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/< "1,809.00" " $1,628.10 " $723.60 " $1,447.20 " " $1,013.04 " " $1,266.30 " " $1,157.76 " " $1,447.20 " " $1,411.02 " $814.05 $741.69 $759.78 $723.60 " $1,356.75 " " $1,175.85 "
WWH ED PROFEE SCHEDULE - 4203 11200 11200 PR REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15 396.00 $356.40 $158.40 $316.80 $221.76 $277.20 $253.44 $316.80 $308.88 $178.20 $162.36 $166.32 $158.40 $297.00 $257.40
WWH ED PROFEE SCHEDULE - 4203 11401 11401 PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM 675.00 $607.50 $270.00 $540.00 $378.00 $472.50 $432.00 $540.00 $526.50 $303.75 $276.75 $283.50 $270.00 $506.25 $438.75
WWH ED PROFEE SCHEDULE - 4203 11404 11404 PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM 899.00 $809.10 $359.60 $719.20 $503.44 $629.30 $575.36 $719.20 $701.22 $404.55 $368.59 $377.58 $359.60 $674.25 $584.35
WWH ED PROFEE SCHEDULE - 4203 11420 11420 PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/< 557.00 $501.30 $222.80 $445.60 $311.92 $389.90 $356.48 $445.60 $434.46 $250.65 $228.37 $233.94 $222.80 $417.75 $362.05
WWH ED PROFEE SCHEDULE - 4203 11730 11730 PR AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 420.00 $378.00 $168.00 $336.00 $235.20 $294.00 $268.80 $336.00 $327.60 $189.00 $172.20 $176.40 $168.00 $315.00 $273.00
WWH ED PROFEE SCHEDULE - 4203 11740 11740 PR EVACUATION SUBUNGUAL HEMATOMA 194.00 $174.60 $77.60 $155.20 $108.64 $135.80 $124.16 $155.20 $151.32 $87.30 $79.54 $81.48 $77.60 $145.50 $126.10
WWH ED PROFEE SCHEDULE - 4203 11750 11750 PR EXCISION NAIL MATRIX PERMANENT REMOVAL 616.00 $554.40 $246.40 $492.80 $344.96 $431.20 $394.24 $492.80 $480.48 $277.20 $252.56 $258.72 $246.40 $462.00 $400.40
WWH ED PROFEE SCHEDULE - 4203 11760 11760 PR REPAIR NAIL BED 636.00 $572.40 $254.40 $508.80 $356.16 $445.20 $407.04 $508.80 $496.08 $286.20 $260.76 $267.12 $254.40 $477.00 $413.40
WWH ED PROFEE SCHEDULE - 4203 12001 12001 PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< 521.00 $468.90 $208.40 $416.80 $291.76 $364.70 $333.44 $416.80 $406.38 $234.45 $213.61 $218.82 $208.40 $390.75 $338.65
WWH ED PROFEE SCHEDULE - 4203 12002 12002 PR SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM 615.00 $553.50 $246.00 $492.00 $344.40 $430.50 $393.60 $492.00 $479.70 $276.75 $252.15 $258.30 $246.00 $461.25 $399.75
WWH ED PROFEE SCHEDULE - 4203 12004 12004 PR SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM 761.00 $684.90 $304.40 $608.80 $426.16 $532.70 $487.04 $608.80 $593.58 $342.45 $312.01 $319.62 $304.40 $570.75 $494.65
WWH ED PROFEE SCHEDULE - 4203 12005 12005 PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM "1,080.00" $972.00 $432.00 $864.00 $604.80 $756.00 $691.20 $864.00 $842.40 $486.00 $442.80 $453.60 $432.00 $810.00 $702.00
WWH ED PROFEE SCHEDULE - 4203 12006 12006 PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM "1,343.00" " $1,208.70 " $537.20 " $1,074.40 " $752.08 $940.10 $859.52 " $1,074.40 " " $1,047.54 " $604.35 $550.63 $564.06 $537.20 " $1,007.25 " $872.95
WWH ED PROFEE SCHEDULE - 4203 12007 12007 PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM "1,527.00" " $1,374.30 " $610.80 " $1,221.60 " $855.12 " $1,068.90 " $977.28 " $1,221.60 " " $1,191.06 " $687.15 $626.07 $641.34 $610.80 " $1,145.25 " $992.55
WWH ED PROFEE SCHEDULE - 4203 12011 12011 PR REPAIR SUPERF WOUND FACE EARS EYELIDS NOSE LIPS <= 2.5 CM 615.00 $553.50 $246.00 $492.00 $344.40 $430.50 $393.60 $492.00 $479.70 $276.75 $252.15 $258.30 $246.00 $461.25 $399.75
WWH ED PROFEE SCHEDULE - 4203 12013 12013 PR REPAIR SUPERF WOUND FACE EARS EYELIDS NOSE LIPS 2.6-5 CM 709.00 $638.10 $283.60 $567.20 $397.04 $496.30 $453.76 $567.20 $553.02 $319.05 $290.69 $297.78 $283.60 $531.75 $460.85
WWH ED PROFEE SCHEDULE - 4203 12014 12014 PR REPAIR SUPERF WOUND FACE EARS EYELIDS NOSE LIPS 5.1-7.5 CM 988.00 $889.20 $395.20 $790.40 $553.28 $691.60 $632.32 $790.40 $770.64 $444.60 $405.08 $414.96 $395.20 $741.00 $642.20
WWH ED PROFEE SCHEDULE - 4203 12015 12015 PR REPAIR SUPERF WOUND FACE EARS EYELIDS NOSE LIPS 7.6-12.5 CM "1,105.00" $994.50 $442.00 $884.00 $618.80 $773.50 $707.20 $884.00 $861.90 $497.25 $453.05 $464.10 $442.00 $828.75 $718.25
WWH ED PROFEE SCHEDULE - 4203 12020 12020 PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE "1,046.00" $941.40 $418.40 $836.80 $585.76 $732.20 $669.44 $836.80 $815.88 $470.70 $428.86 $439.32 $418.40 $784.50 $679.90
WWH ED PROFEE SCHEDULE - 4203 12031 12031 PR REPAIR INTERMED WOUND SCALP TRUNK EXTREM < OR = 2.5CM 906.00 $815.40 $362.40 $724.80 $507.36 $634.20 $579.84 $724.80 $706.68 $407.70 $371.46 $380.52 $362.40 $679.50 $588.90
WWH ED PROFEE SCHEDULE - 4203 12032 12032 PR REPAIR INTERMED WOUND SCALP TRUNK EXTREM 2.6-7.5 CM "1,341.00" " $1,206.90 " $536.40 " $1,072.80 " $750.96 $938.70 $858.24 " $1,072.80 " " $1,045.98 " $603.45 $549.81 $563.22 $536.40 " $1,005.75 " $871.65
WWH ED PROFEE SCHEDULE - 4203 12034 12034 PR REPAIR INTERMED WOUND SCALP TRUNK EXTREM 7.6-12.5 CM "1,276.00" " $1,148.40 " $510.40 " $1,020.80 " $714.56 $893.20 $816.64 " $1,020.80 " $995.28 $574.20 $523.16 $535.92 $510.40 $957.00 $829.40
WWH ED PROFEE SCHEDULE - 4203 12035 12035 PR REPAIR INTERMED WOUND SCALP TRUNK EXTREM 12.6-20 CM "1,702.00" " $1,531.80 " $680.80 " $1,361.60 " $953.12 " $1,191.40 " " $1,089.28 " " $1,361.60 " " $1,327.56 " $765.90 $697.82 $714.84 $680.80 " $1,276.50 " " $1,106.30 "
WWH ED PROFEE SCHEDULE - 4203 12037 12037 PR REPAIR INTERMED WOUND SCALP TRUNK EXTREM OVER 30 CM "2,159.00" " $1,943.10 " $863.60 " $1,727.20 " " $1,209.04 " " $1,511.30 " " $1,381.76 " " $1,727.20 " " $1,684.02 " $971.55 $885.19 $906.78 $863.60 " $1,619.25 " " $1,403.35 "
WWH ED PROFEE SCHEDULE - 4203 12041 12041 PR REPAIR INTERMED WOUND NECK HANDS FEET EXT GEN < OR = 2.5 CM 930.00 $837.00 $372.00 $744.00 $520.80 $651.00 $595.20 $744.00 $725.40 $418.50 $381.30 $390.60 $372.00 $697.50 $604.50
WWH ED PROFEE SCHEDULE - 4203 12042 12042 PR REPAIR INTERMED WOUND NECK HANDS FEET EXT GEN 2.6-7.5 CM "1,170.00" " $1,053.00 " $468.00 $936.00 $655.20 $819.00 $748.80 $936.00 $912.60 $526.50 $479.70 $491.40 $468.00 $877.50 $760.50
WWH ED PROFEE SCHEDULE - 4203 12044 12044 PR REPAIR INTERMED WOUND NECK HANDS FEET EXT GEN 7.6-12.5 CM "1,485.00" " $1,336.50 " $594.00 " $1,188.00 " $831.60 " $1,039.50 " $950.40 " $1,188.00 " " $1,158.30 " $668.25 $608.85 $623.70 $594.00 " $1,113.75 " $965.25
WWH ED PROFEE SCHEDULE - 4203 12045 12045 PR REPAIR INTERMED WOUND NECK HANDS FEET EXT GEN 12.6-20 CM "1,124.00" " $1,011.60 " $449.60 $899.20 $629.44 $786.80 $719.36 $899.20 $876.72 $505.80 $460.84 $472.08 $449.60 $843.00 $730.60
WWH ED PROFEE SCHEDULE - 4203 12051 12051 PR REPAIR INTERMED WOUND FACE EARS EYELIDS NOSE LIPS <= 2.5 CM 796.00 $716.40 $318.40 $636.80 $445.76 $557.20 $509.44 $636.80 $620.88 $358.20 $326.36 $334.32 $318.40 $597.00 $517.40
WWH ED PROFEE SCHEDULE - 4203 12052 12052 PR REPAIR INTERMED WOUND FACE EARS EYELIDS NOSE LIPS 2.5-5.0 CM "1,053.00" $947.70 $421.20 $842.40 $589.68 $737.10 $673.92 $842.40 $821.34 $473.85 $431.73 $442.26 $421.20 $789.75 $684.45
WWH ED PROFEE SCHEDULE - 4203 12053 12053 PR REPAIR INTERMED WOUND FACE EARS EYELIDS NOSE LIPS 5.1-7.5 CM "1,544.00" " $1,389.60 " $617.60 " $1,235.20 " $864.64 " $1,080.80 " $988.16 " $1,235.20 " " $1,204.32 " $694.80 $633.04 $648.48 $617.60 " $1,158.00 " " $1,003.60 "
WWH ED PROFEE SCHEDULE - 4203 12054 12054 PR REPAIR INTERMED WOUND FACE EARS EYELIDS NOSE LIPS 7.6-12.5 CM "1,755.00" " $1,579.50 " $702.00 " $1,404.00 " $982.80 " $1,228.50 " " $1,123.20 " " $1,404.00 " " $1,368.90 " $789.75 $719.55 $737.10 $702.00 " $1,316.25 " " $1,140.75 "
WWH ED PROFEE SCHEDULE - 4203 13121 13121 PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM "1,729.00" " $1,556.10 " $691.60 " $1,383.20 " $968.24 " $1,210.30 " " $1,106.56 " " $1,383.20 " " $1,348.62 " $778.05 $708.89 $726.18 $691.60 " $1,296.75 " " $1,123.85 "
WWH ED PROFEE SCHEDULE - 4203 13122 13122 PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/< 591.00 $531.90 $236.40 $472.80 $330.96 $413.70 $378.24 $472.80 $460.98 $265.95 $242.31 $248.22 $236.40 $443.25 $384.15
WWH ED PROFEE SCHEDULE - 4203 13131 13131 PR REPAIR COMPLEX WOUND HEAD FACE NECK HANDS FEET 1.1-2.5 CM "1,194.00" " $1,074.60 " $477.60 $955.20 $668.64 $835.80 $764.16 $955.20 $931.32 $537.30 $489.54 $501.48 $477.60 $895.50 $776.10
WWH ED PROFEE SCHEDULE - 4203 13132 13132 PR REPAIR COMPLEX WOUND HEAD FACE NECK HANDS FEET 2.6-7.5 CM "2,758.00" " $2,482.20 " " $1,103.20 " " $2,206.40 " " $1,544.48 " " $1,930.60 " " $1,765.12 " " $2,206.40 " " $2,151.24 " " $1,241.10 " " $1,130.78 " " $1,158.36 " " $1,103.20 " " $2,068.50 " " $1,792.70 "
WWH ED PROFEE SCHEDULE - 4203 16000 16000 PR INITIAL TX 1ST DEGREE BURN LOCAL TX 297.00 $267.30 $118.80 $237.60 $166.32 $207.90 $190.08 $237.60 $231.66 $133.65 $121.77 $124.74 $118.80 $222.75 $193.05
WWH ED PROFEE SCHEDULE - 4203 16020 16020 PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL 323.00 $290.70 $129.20 $258.40 $180.88 $226.10 $206.72 $258.40 $251.94 $145.35 $132.43 $135.66 $129.20 $242.25 $209.95
WWH ED PROFEE SCHEDULE - 4203 16025 16025 PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM 425.00 $382.50 $170.00 $340.00 $238.00 $297.50 $272.00 $340.00 $331.50 $191.25 $174.25 $178.50 $170.00 $318.75 $276.25
WWH ED PROFEE SCHEDULE - 4203 16030 16030 PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE 840.00 $756.00 $336.00 $672.00 $470.40 $588.00 $537.60 $672.00 $655.20 $378.00 $344.40 $352.80 $336.00 $630.00 $546.00
WWH ED PROFEE SCHEDULE - 4203 17250 17250 PR CHEMICAL CAUTERIZATION OF GRANULATION TISSUE 261.00 $234.90 $104.40 $208.80 $146.16 $182.70 $167.04 $208.80 $203.58 $117.45 $107.01 $109.62 $104.40 $195.75 $169.65
WWH ED PROFEE SCHEDULE - 4203 20103 20103 PR EXPLORATION PENETRATING WOUND SPX EXTREMITY "2,749.00" " $2,474.10 " " $1,099.60 " " $2,199.20 " " $1,539.44 " " $1,924.30 " " $1,759.36 " " $2,199.20 " " $2,144.22 " " $1,237.05 " " $1,127.09 " " $1,154.58 " " $1,099.60 " " $2,061.75 " " $1,786.85 "
WWH ED PROFEE SCHEDULE - 4203 20550 20550 PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS 282.00 $253.80 $112.80 $225.60 $157.92 $197.40 $180.48 $225.60 $219.96 $126.90 $115.62 $118.44 $112.80 $211.50 $183.30
WWH ED PROFEE SCHEDULE - 4203 20551 20551 PR INJECTION SINGLE TENDON ORIGIN/INSERTION 226.00 $203.40 $90.40 $180.80 $126.56 $158.20 $144.64 $180.80 $176.28 $101.70 $92.66 $94.92 $90.40 $169.50 $146.90
WWH ED PROFEE SCHEDULE - 4203 20552 20552 PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES 317.00 $285.30 $126.80 $253.60 $177.52 $221.90 $202.88 $253.60 $247.26 $142.65 $129.97 $133.14 $126.80 $237.75 $206.05
WWH ED PROFEE SCHEDULE - 4203 20553 20553 PR INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES 290.00 $261.00 $116.00 $232.00 $162.40 $203.00 $185.60 $232.00 $226.20 $130.50 $118.90 $121.80 $116.00 $217.50 $188.50
WWH ED PROFEE SCHEDULE - 4203 20605 20605 PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US 291.00 $261.90 $116.40 $232.80 $162.96 $203.70 $186.24 $232.80 $226.98 $130.95 $119.31 $122.22 $116.40 $218.25 $189.15
WWH ED PROFEE SCHEDULE - 4203 20610 20610 PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US 361.00 $324.90 $144.40 $288.80 $202.16 $252.70 $231.04 $288.80 $281.58 $162.45 $148.01 $151.62 $144.40 $270.75 $234.65
WWH ED PROFEE SCHEDULE - 4203 20950 20950 PR MNTR INTERSTITIAL FLUID PRESSURE CMPRT SYNDROME "1,001.00" $900.90 $400.40 $800.80 $560.56 $700.70 $640.64 $800.80 $780.78 $450.45 $410.41 $420.42 $400.40 $750.75 $650.65
WWH ED PROFEE SCHEDULE - 4203 21337 21337 PR CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION "1,426.00" " $1,283.40 " $570.40 " $1,140.80 " $798.56 $998.20 $912.64 " $1,140.80 " " $1,112.28 " $641.70 $584.66 $598.92 $570.40 " $1,069.50 " $926.90
WWH ED PROFEE SCHEDULE - 4203 21480 21480 PR CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ 426.00 $383.40 $170.40 $340.80 $238.56 $298.20 $272.64 $340.80 $332.28 $191.70 $174.66 $178.92 $170.40 $319.50 $276.90
WWH ED PROFEE SCHEDULE - 4203 23545 23545 PR CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION "1,610.00" " $1,449.00 " $644.00 " $1,288.00 " $901.60 " $1,127.00 " " $1,030.40 " " $1,288.00 " " $1,255.80 " $724.50 $660.10 $676.20 $644.00 " $1,207.50 " " $1,046.50 "
WWH ED PROFEE SCHEDULE - 4203 23605 23605 PR CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ "2,265.00" " $2,038.50 " $906.00 " $1,812.00 " " $1,268.40 " " $1,585.50 " " $1,449.60 " " $1,812.00 " " $1,766.70 " " $1,019.25 " $928.65 $951.30 $906.00 " $1,698.75 " " $1,472.25 "
WWH ED PROFEE SCHEDULE - 4203 23650 23650 PR CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES "1,276.00" " $1,148.40 " $510.40 " $1,020.80 " $714.56 $893.20 $816.64 " $1,020.80 " $995.28 $574.20 $523.16 $535.92 $510.40 $957.00 $829.40
WWH ED PROFEE SCHEDULE - 4203 23655 23655 PR CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES "1,692.00" " $1,522.80 " $676.80 " $1,353.60 " $947.52 " $1,184.40 " " $1,082.88 " " $1,353.60 " " $1,319.76 " $761.40 $693.72 $710.64 $676.80 " $1,269.00 " " $1,099.80 "
WWH ED PROFEE SCHEDULE - 4203 23665 23665 PR CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ "1,713.00" " $1,541.70 " $685.20 " $1,370.40 " $959.28 " $1,199.10 " " $1,096.32 " " $1,370.40 " " $1,336.14 " $770.85 $702.33 $719.46 $685.20 " $1,284.75 " " $1,113.45 "
WWH ED PROFEE SCHEDULE - 4203 23931 23931 PR INCISION&DRAINAGE UPPER ARM/ELBOW BURSA "1,228.00" " $1,105.20 " $491.20 $982.40 $687.68 $859.60 $785.92 $982.40 $957.84 $552.60 $503.48 $515.76 $491.20 $921.00 $798.20
WWH ED PROFEE SCHEDULE - 4203 24200 24200 PR RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS 826.00 $743.40 $330.40 $660.80 $462.56 $578.20 $528.64 $660.80 $644.28 $371.70 $338.66 $346.92 $330.40 $619.50 $536.90
WWH ED PROFEE SCHEDULE - 4203 24600 24600 PR TREATMENT CLOSED ELBOW DISLOCATION W/O ANES "1,693.00" " $1,523.70 " $677.20 " $1,354.40 " $948.08 " $1,185.10 " " $1,083.52 " " $1,354.40 " " $1,320.54 " $761.85 $694.13 $711.06 $677.20 " $1,269.75 " " $1,100.45 "
WWH ED PROFEE SCHEDULE - 4203 24605 24605 PR TREATMENT CLOSED ELBOW DISLOCATION REQ ANES "1,982.00" " $1,783.80 " $792.80 " $1,585.60 " " $1,109.92 " " $1,387.40 " " $1,268.48 " " $1,585.60 " " $1,545.96 " $891.90 $812.62 $832.44 $792.80 " $1,486.50 " " $1,288.30 "
WWH ED PROFEE SCHEDULE - 4203 24640 24640 PR CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ 517.00 $465.30 $206.80 $413.60 $289.52 $361.90 $330.88 $413.60 $403.26 $232.65 $211.97 $217.14 $206.80 $387.75 $336.05
WWH ED PROFEE SCHEDULE - 4203 24655 24655 PR CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION "1,865.00" " $1,678.50 " $746.00 " $1,492.00 " " $1,044.40 " " $1,305.50 " " $1,193.60 " " $1,492.00 " " $1,454.70 " $839.25 $764.65 $783.30 $746.00 " $1,398.75 " " $1,212.25 "
WWH ED PROFEE SCHEDULE - 4203 25535 25535 PR CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION "2,088.00" " $1,879.20 " $835.20 " $1,670.40 " " $1,169.28 " " $1,461.60 " " $1,336.32 " " $1,670.40 " " $1,628.64 " $939.60 $856.08 $876.96 $835.20 " $1,566.00 " " $1,357.20 "
WWH ED PROFEE SCHEDULE - 4203 25565 25565 PR CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ "1,822.00" " $1,639.80 " $728.80 " $1,457.60 " " $1,020.32 " " $1,275.40 " " $1,166.08 " " $1,457.60 " " $1,421.16 " $819.90 $747.02 $765.24 $728.80 " $1,366.50 " " $1,184.30 "
WWH ED PROFEE SCHEDULE - 4203 25605 25605 PR CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF "2,975.00" " $2,677.50 " " $1,190.00 " " $2,380.00 " " $1,666.00 " " $2,082.50 " " $1,904.00 " " $2,380.00 " " $2,320.50 " " $1,338.75 " " $1,219.75 " " $1,249.50 " " $1,190.00 " " $2,231.25 " " $1,933.75 "
WWH ED PROFEE SCHEDULE - 4203 25622 25622 PR CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ "1,076.00" $968.40 $430.40 $860.80 $602.56 $753.20 $688.64 $860.80 $839.28 $484.20 $441.16 $451.92 $430.40 $807.00 $699.40
WWH ED PROFEE SCHEDULE - 4203 25690 25690 PR CLOSED TX LUNATE DISLOCATION W/MANIPULATION "2,358.00" " $2,122.20 " $943.20 " $1,886.40 " " $1,320.48 " " $1,650.60 " " $1,509.12 " " $1,886.40 " " $1,839.24 " " $1,061.10 " $966.78 $990.36 $943.20 " $1,768.50 " " $1,532.70 "
WWH ED PROFEE SCHEDULE - 4203 26010 26010 PR DRAINAGE FINGER ABSCESS SIMPLE "1,106.00" $995.40 $442.40 $884.80 $619.36 $774.20 $707.84 $884.80 $862.68 $497.70 $453.46 $464.52 $442.40 $829.50 $718.90
WWH ED PROFEE SCHEDULE - 4203 26011 26011 PR DRAINAGE FINGER ABSCESS COMPLICATED "1,418.00" " $1,276.20 " $567.20 " $1,134.40 " $794.08 $992.60 $907.52 " $1,134.40 " " $1,106.04 " $638.10 $581.38 $595.56 $567.20 " $1,063.50 " $921.70
WWH ED PROFEE SCHEDULE - 4203 26410 26410 PR REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH "2,349.00" " $2,114.10 " $939.60 " $1,879.20 " " $1,315.44 " " $1,644.30 " " $1,503.36 " " $1,879.20 " " $1,832.22 " " $1,057.05 " $963.09 $986.58 $939.60 " $1,761.75 " " $1,526.85 "
WWH ED PROFEE SCHEDULE - 4203 26418 26418 PR REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH "2,936.00" " $2,642.40 " " $1,174.40 " " $2,348.80 " " $1,644.16 " " $2,055.20 " " $1,879.04 " " $2,348.80 " " $2,290.08 " " $1,321.20 " " $1,203.76 " " $1,233.12 " " $1,174.40 " " $2,202.00 " " $1,908.40 "
WWH ED PROFEE SCHEDULE - 4203 26433 26433 PR REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRF "2,355.00" " $2,119.50 " $942.00 " $1,884.00 " " $1,318.80 " " $1,648.50 " " $1,507.20 " " $1,884.00 " " $1,836.90 " " $1,059.75 " $965.55 $989.10 $942.00 " $1,766.25 " " $1,530.75 "
WWH ED PROFEE SCHEDULE - 4203 26605 26605 PR CLTX METACARPAL FX W/MANIPULATION EACH BONE "1,492.00" " $1,342.80 " $596.80 " $1,193.60 " $835.52 " $1,044.40 " $954.88 " $1,193.60 " " $1,163.76 " $671.40 $611.72 $626.64 $596.80 " $1,119.00 " $969.80
WWH ED PROFEE SCHEDULE - 4203 26641 26641 PR CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ "1,653.00" " $1,487.70 " $661.20 " $1,322.40 " $925.68 " $1,157.10 " " $1,057.92 " " $1,322.40 " " $1,289.34 " $743.85 $677.73 $694.26 $661.20 " $1,239.75 " " $1,074.45 "
WWH ED PROFEE SCHEDULE - 4203 26670 26670 PR CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES "1,207.00" " $1,086.30 " $482.80 $965.60 $675.92 $844.90 $772.48 $965.60 $941.46 $543.15 $494.87 $506.94 $482.80 $905.25 $784.55
WWH ED PROFEE SCHEDULE - 4203 26700 26700 PR CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES "1,415.00" " $1,273.50 " $566.00 " $1,132.00 " $792.40 $990.50 $905.60 " $1,132.00 " " $1,103.70 " $636.75 $580.15 $594.30 $566.00 " $1,061.25 " $919.75
WWH ED PROFEE SCHEDULE - 4203 26725 26725 PR CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA "1,592.00" " $1,432.80 " $636.80 " $1,273.60 " $891.52 " $1,114.40 " " $1,018.88 " " $1,273.60 " " $1,241.76 " $716.40 $652.72 $668.64 $636.80 " $1,194.00 " " $1,034.80 "
WWH ED PROFEE SCHEDULE - 4203 26742 26742 PR CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ "1,765.00" " $1,588.50 " $706.00 " $1,412.00 " $988.40 " $1,235.50 " " $1,129.60 " " $1,412.00 " " $1,376.70 " $794.25 $723.65 $741.30 $706.00 " $1,323.75 " " $1,147.25 "
WWH ED PROFEE SCHEDULE - 4203 26755 26755 PR CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA "1,408.00" " $1,267.20 " $563.20 " $1,126.40 " $788.48 $985.60 $901.12 " $1,126.40 " " $1,098.24 " $633.60 $577.28 $591.36 $563.20 " $1,056.00 " $915.20
WWH ED PROFEE SCHEDULE - 4203 26770 26770 PR CLTX IPHAL JT DISLC W/MANJ W/O ANES "1,192.00" " $1,072.80 " $476.80 $953.60 $667.52 $834.40 $762.88 $953.60 $929.76 $536.40 $488.72 $500.64 $476.80 $894.00 $774.80
WWH ED PROFEE SCHEDULE - 4203 26775 26775 PR CLTX IPHAL JT DISLC W/MANJ REQ ANES "1,783.00" " $1,604.70 " $713.20 " $1,426.40 " $998.48 " $1,248.10 " " $1,141.12 " " $1,426.40 " " $1,390.74 " $802.35 $731.03 $748.86 $713.20 " $1,337.25 " " $1,158.95 "
WWH ED PROFEE SCHEDULE - 4203 26951 26951 PR AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR "2,672.00" " $2,404.80 " " $1,068.80 " " $2,137.60 " " $1,496.32 " " $1,870.40 " " $1,710.08 " " $2,137.60 " " $2,084.16 " " $1,202.40 " " $1,095.52 " " $1,122.24 " " $1,068.80 " " $2,004.00 " " $1,736.80 "
WWH ED PROFEE SCHEDULE - 4203 27250 27250 PR CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA "1,364.00" " $1,227.60 " $545.60 " $1,091.20 " $763.84 $954.80 $872.96 " $1,091.20 " " $1,063.92 " $613.80 $559.24 $572.88 $545.60 " $1,023.00 " $886.60
WWH ED PROFEE SCHEDULE - 4203 27265 27265 PR CLTX POST HIP ARTHRP DISLC W/O ANES "1,966.00" " $1,769.40 " $786.40 " $1,572.80 " " $1,100.96 " " $1,376.20 " " $1,258.24 " " $1,572.80 " " $1,533.48 " $884.70 $806.06 $825.72 $786.40 " $1,474.50 " " $1,277.90 "
WWH ED PROFEE SCHEDULE - 4203 27266 27266 PR CLTX POST HIP ARTHRP DISLC REQ ANES "2,815.00" " $2,533.50 " " $1,126.00 " " $2,252.00 " " $1,576.40 " " $1,970.50 " " $1,801.60 " " $2,252.00 " " $2,195.70 " " $1,266.75 " " $1,154.15 " " $1,182.30 " " $1,126.00 " " $2,111.25 " " $1,829.75 "
WWH ED PROFEE SCHEDULE - 4203 27301 27301 PR I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION "2,323.00" " $2,090.70 " $929.20 " $1,858.40 " " $1,300.88 " " $1,626.10 " " $1,486.72 " " $1,858.40 " " $1,811.94 " " $1,045.35 " $952.43 $975.66 $929.20 " $1,742.25 " " $1,509.95 "
WWH ED PROFEE SCHEDULE - 4203 27502 27502 PR CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ "3,513.00" " $3,161.70 " " $1,405.20 " " $2,810.40 " " $1,967.28 " " $2,459.10 " " $2,248.32 " " $2,810.40 " " $2,740.14 " " $1,580.85 " " $1,440.33 " " $1,475.46 " " $1,405.20 " " $2,634.75 " " $2,283.45 "
WWH ED PROFEE SCHEDULE - 4203 27560 27560 PR CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA "1,678.00" " $1,510.20 " $671.20 " $1,342.40 " $939.68 " $1,174.60 " " $1,073.92 " " $1,342.40 " " $1,308.84 " $755.10 $687.98 $704.76 $671.20 " $1,258.50 " " $1,090.70 "
WWH ED PROFEE SCHEDULE - 4203 27752 27752 PR CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ "2,069.00" " $1,862.10 " $827.60 " $1,655.20 " " $1,158.64 " " $1,448.30 " " $1,324.16 " " $1,655.20 " " $1,613.82 " $931.05 $848.29 $868.98 $827.60 " $1,551.75 " " $1,344.85 "
WWH ED PROFEE SCHEDULE - 4203 27762 27762 PR CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ "1,921.00" " $1,728.90 " $768.40 " $1,536.80 " " $1,075.76 " " $1,344.70 " " $1,229.44 " " $1,536.80 " " $1,498.38 " $864.45 $787.61 $806.82 $768.40 " $1,440.75 " " $1,248.65 "
WWH ED PROFEE SCHEDULE - 4203 27788 27788 PR CLTX DSTL FIBULAR FX LAT MALLS W/MANJ "1,566.00" " $1,409.40 " $626.40 " $1,252.80 " $876.96 " $1,096.20 " " $1,002.24 " " $1,252.80 " " $1,221.48 " $704.70 $642.06 $657.72 $626.40 " $1,174.50 " " $1,017.90 "
WWH ED PROFEE SCHEDULE - 4203 27810 27810 PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ "2,219.00" " $1,997.10 " $887.60 " $1,775.20 " " $1,242.64 " " $1,553.30 " " $1,420.16 " " $1,775.20 " " $1,730.82 " $998.55 $909.79 $931.98 $887.60 " $1,664.25 " " $1,442.35 "
WWH ED PROFEE SCHEDULE - 4203 27818 27818 PR CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION "2,297.00" " $2,067.30 " $918.80 " $1,837.60 " " $1,286.32 " " $1,607.90 " " $1,470.08 " " $1,837.60 " " $1,791.66 " " $1,033.65 " $941.77 $964.74 $918.80 " $1,722.75 " " $1,493.05 "
WWH ED PROFEE SCHEDULE - 4203 27825 27825 PR CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ "2,356.00" " $2,120.40 " $942.40 " $1,884.80 " " $1,319.36 " " $1,649.20 " " $1,507.84 " " $1,884.80 " " $1,837.68 " " $1,060.20 " $965.96 $989.52 $942.40 " $1,767.00 " " $1,531.40 "
WWH ED PROFEE SCHEDULE - 4203 28190 28190 PR REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS 838.00 $754.20 $335.20 $670.40 $469.28 $586.60 $536.32 $670.40 $653.64 $377.10 $343.58 $351.96 $335.20 $628.50 $544.70
WWH ED PROFEE SCHEDULE - 4203 28405 28405 PR CLOSED TX CALCANEAL FRACTURE W/MANIPULATION "1,496.00" " $1,346.40 " $598.40 " $1,196.80 " $837.76 " $1,047.20 " $957.44 " $1,196.80 " " $1,166.88 " $673.20 $613.36 $628.32 $598.40 " $1,122.00 " $972.40
WWH ED PROFEE SCHEDULE - 4203 28435 28435 PR CLOSED TX TALUS FRACTURE W/MANIPULATION "1,520.00" " $1,368.00 " $608.00 " $1,216.00 " $851.20 " $1,064.00 " $972.80 " $1,216.00 " " $1,185.60 " $684.00 $623.20 $638.40 $608.00 " $1,140.00 " $988.00
WWH ED PROFEE SCHEDULE - 4203 28475 28475 PR CLTX METAR FX W/MANJ "1,096.00" $986.40 $438.40 $876.80 $613.76 $767.20 $701.44 $876.80 $854.88 $493.20 $449.36 $460.32 $438.40 $822.00 $712.40
WWH ED PROFEE SCHEDULE - 4203 28490 28490 PR CLTX FX GRT TOE PHLX/PHLG W/O MANJ 587.00 $528.30 $234.80 $469.60 $328.72 $410.90 $375.68 $469.60 $457.86 $264.15 $240.67 $246.54 $234.80 $440.25 $381.55
WWH ED PROFEE SCHEDULE - 4203 28495 28495 PR CLTX FX GRT TOE PHLX/PHLG W/MANJ 752.00 $676.80 $300.80 $601.60 $421.12 $526.40 $481.28 $601.60 $586.56 $338.40 $308.32 $315.84 $300.80 $564.00 $488.80
WWH ED PROFEE SCHEDULE - 4203 28515 28515 PR CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ 596.00 $536.40 $238.40 $476.80 $333.76 $417.20 $381.44 $476.80 $464.88 $268.20 $244.36 $250.32 $238.40 $447.00 $387.40
WWH ED PROFEE SCHEDULE - 4203 28570 28570 PR CLOSED TX TALOTARSAL JOINT DISLC W/O ANES 570.00 $513.00 $228.00 $456.00 $319.20 $399.00 $364.80 $456.00 $444.60 $256.50 $233.70 $239.40 $228.00 $427.50 $370.50
WWH ED PROFEE SCHEDULE - 4203 28630 28630 PR CLTX METATARSOPHLNGL JT DISLC W/O ANES 715.00 $643.50 $286.00 $572.00 $400.40 $500.50 $457.60 $572.00 $557.70 $321.75 $293.15 $300.30 $286.00 $536.25 $464.75
WWH ED PROFEE SCHEDULE - 4203 29065 29065 PR APPLICATION CAST SHOULDER HAND LONG ARM 462.00 $415.80 $184.80 $369.60 $258.72 $323.40 $295.68 $369.60 $360.36 $207.90 $189.42 $194.04 $184.80 $346.50 $300.30
WWH ED PROFEE SCHEDULE - 4203 29075 29075 PR APPLICATION CAST ELBOW FINGER SHORT ARM 521.00 $468.90 $208.40 $416.80 $291.76 $364.70 $333.44 $416.80 $406.38 $234.45 $213.61 $218.82 $208.40 $390.75 $338.65
WWH ED PROFEE SCHEDULE - 4203 29085 29085 PR APPLICATION CAST HAND & LOWER FOREARM GAUNTLET 439.00 $395.10 $175.60 $351.20 $245.84 $307.30 $280.96 $351.20 $342.42 $197.55 $179.99 $184.38 $175.60 $329.25 $285.35
WWH ED PROFEE SCHEDULE - 4203 29086 29086 PR APPLICATION CAST FINGER 340.00 $306.00 $136.00 $272.00 $190.40 $238.00 $217.60 $272.00 $265.20 $153.00 $139.40 $142.80 $136.00 $255.00 $221.00
WWH ED PROFEE SCHEDULE - 4203 29105 29105 PR APPLICATION LONG ARM SPLINT SHOULDER HAND 329.00 $296.10 $131.60 $263.20 $184.24 $230.30 $210.56 $263.20 $256.62 $148.05 $134.89 $138.18 $131.60 $246.75 $213.85
WWH ED PROFEE SCHEDULE - 4203 29125 29125 PR APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC 296.00 $266.40 $118.40 $236.80 $165.76 $207.20 $189.44 $236.80 $230.88 $133.20 $121.36 $124.32 $118.40 $222.00 $192.40
WWH ED PROFEE SCHEDULE - 4203 29126 29126 PR APPLICATION SHORT ARM SPLINT DYNAMIC 322.00 $289.80 $128.80 $257.60 $180.32 $225.40 $206.08 $257.60 $251.16 $144.90 $132.02 $135.24 $128.80 $241.50 $209.30
WWH ED PROFEE SCHEDULE - 4203 29130 29130 PR APPLICATION FINGER SPLINT STATIC 182.00 $163.80 $72.80 $145.60 $101.92 $127.40 $116.48 $145.60 $141.96 $81.90 $74.62 $76.44 $72.80 $136.50 $118.30
WWH ED PROFEE SCHEDULE - 4203 29131 29131 PR APPLICATION FINGER SPLINT DYNAMIC 230.00 $207.00 $92.00 $184.00 $128.80 $161.00 $147.20 $184.00 $179.40 $103.50 $94.30 $96.60 $92.00 $172.50 $149.50
WWH ED PROFEE SCHEDULE - 4203 29200 29200 PR STRAPPING THORAX 54.00 $48.60 $21.60 $43.20 $30.24 $37.80 $34.56 $43.20 $42.12 $24.30 $22.14 $22.68 $21.60 $40.50 $35.10
WWH ED PROFEE SCHEDULE - 4203 29240 29240 PR STRAPPING SHOULDER 115.00 $103.50 $46.00 $92.00 $64.40 $80.50 $73.60 $92.00 $89.70 $51.75 $47.15 $48.30 $46.00 $86.25 $74.75
WWH ED PROFEE SCHEDULE - 4203 29260 29260 PR STRAPPING ELBOW/WRIST 125.00 $112.50 $50.00 $100.00 $70.00 $87.50 $80.00 $100.00 $97.50 $56.25 $51.25 $52.50 $50.00 $93.75 $81.25
WWH ED PROFEE SCHEDULE - 4203 29280 29280 PR STRAPPING HAND/FINGER 229.00 $206.10 $91.60 $183.20 $128.24 $160.30 $146.56 $183.20 $178.62 $103.05 $93.89 $96.18 $91.60 $171.75 $148.85
WWH ED PROFEE SCHEDULE - 4203 29345 29345 PR APPLICATION LONG LEG CAST THIGH-TOE 638.00 $574.20 $255.20 $510.40 $357.28 $446.60 $408.32 $510.40 $497.64 $287.10 $261.58 $267.96 $255.20 $478.50 $414.70
WWH ED PROFEE SCHEDULE - 4203 29405 29405 PR APPLICATION SHORT LEG CAST BELOW KNEE-TOE 387.00 $348.30 $154.80 $309.60 $216.72 $270.90 $247.68 $309.60 $301.86 $174.15 $158.67 $162.54 $154.80 $290.25 $251.55
WWH ED PROFEE SCHEDULE - 4203 29425 29425 PR APPLICATION SHORT LEG CAST WALKING/AMBULATORY 455.00 $409.50 $182.00 $364.00 $254.80 $318.50 $291.20 $364.00 $354.90 $204.75 $186.55 $191.10 $182.00 $341.25 $295.75
WWH ED PROFEE SCHEDULE - 4203 29505 29505 PR APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES 369.00 $332.10 $147.60 $295.20 $206.64 $258.30 $236.16 $295.20 $287.82 $166.05 $151.29 $154.98 $147.60 $276.75 $239.85
WWH ED PROFEE SCHEDULE - 4203 29515 29515 PR APPLICATION SHORT LEG SPLINT CALF FOOT 272.00 $244.80 $108.80 $217.60 $152.32 $190.40 $174.08 $217.60 $212.16 $122.40 $111.52 $114.24 $108.80 $204.00 $176.80
WWH ED PROFEE SCHEDULE - 4203 29530 29530 PR STRAPPING KNEE 136.00 $122.40 $54.40 $108.80 $76.16 $95.20 $87.04 $108.80 $106.08 $61.20 $55.76 $57.12 $54.40 $102.00 $88.40
WWH ED PROFEE SCHEDULE - 4203 29540 29540 PR STRAPPING ANKLE &/FOOT 106.00 $95.40 $42.40 $84.80 $59.36 $74.20 $67.84 $84.80 $82.68 $47.70 $43.46 $44.52 $42.40 $79.50 $68.90
WWH ED PROFEE SCHEDULE - 4203 29550 29550 PR STRAPPING TOES 103.00 $92.70 $41.20 $82.40 $57.68 $72.10 $65.92 $82.40 $80.34 $46.35 $42.23 $43.26 $41.20 $77.25 $66.95
WWH ED PROFEE SCHEDULE - 4203 29580 29580 PR STRAPPING UNNA BOOT 255.00 $229.50 $102.00 $204.00 $142.80 $178.50 $163.20 $204.00 $198.90 $114.75 $104.55 $107.10 $102.00 $191.25 $165.75
WWH ED PROFEE SCHEDULE - 4203 30300 30300 PR REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE 822.00 $739.80 $328.80 $657.60 $460.32 $575.40 $526.08 $657.60 $641.16 $369.90 $337.02 $345.24 $328.80 $616.50 $534.30
WWH ED PROFEE SCHEDULE - 4203 30901 30901 PR CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE 475.00 $427.50 $190.00 $380.00 $266.00 $332.50 $304.00 $380.00 $370.50 $213.75 $194.75 $199.50 $190.00 $356.25 $308.75
WWH ED PROFEE SCHEDULE - 4203 30905 30905 PR CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST "1,106.00" $995.40 $442.40 $884.80 $619.36 $774.20 $707.84 $884.80 $862.68 $497.70 $453.46 $464.52 $442.40 $829.50 $718.90
WWH ED PROFEE SCHEDULE - 4203 30906 30906 PR CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ "1,227.00" " $1,104.30 " $490.80 $981.60 $687.12 $858.90 $785.28 $981.60 $957.06 $552.15 $503.07 $515.34 $490.80 $920.25 $797.55
WWH ED PROFEE SCHEDULE - 4203 31500 31500 PR INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE 639.00 $575.10 $255.60 $511.20 $357.84 $447.30 $408.96 $511.20 $498.42 $287.55 $261.99 $268.38 $255.60 $479.25 $415.35
WWH ED PROFEE SCHEDULE - 4203 31505 31505 PR LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX 397.00 $357.30 $158.80 $317.60 $222.32 $277.90 $254.08 $317.60 $309.66 $178.65 $162.77 $166.74 $158.80 $297.75 $258.05
WWH ED PROFEE SCHEDULE - 4203 31525 31525 PR LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN "1,209.00" " $1,088.10 " $483.60 $967.20 $677.04 $846.30 $773.76 $967.20 $943.02 $544.05 $495.69 $507.78 $483.60 $906.75 $785.85
WWH ED PROFEE SCHEDULE - 4203 32551 32551 PR TUBE THORACOSTOMY INCLUDES WATER SEAL 955.00 $859.50 $382.00 $764.00 $534.80 $668.50 $611.20 $764.00 $744.90 $429.75 $391.55 $401.10 $382.00 $716.25 $620.75
WWH ED PROFEE SCHEDULE - 4203 32554 32554 PR THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING 610.00 $549.00 $244.00 $488.00 $341.60 $427.00 $390.40 $488.00 $475.80 $274.50 $250.10 $256.20 $244.00 $457.50 $396.50
WWH ED PROFEE SCHEDULE - 4203 32555 32555 PR THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING "1,075.00" $967.50 $430.00 $860.00 $602.00 $752.50 $688.00 $860.00 $838.50 $483.75 $440.75 $451.50 $430.00 $806.25 $698.75
WWH ED PROFEE SCHEDULE - 4203 35207 35207 PR REPAIR BLOOD VESSEL DIRECT HAND FINGER "4,183.00" " $3,764.70 " " $1,673.20 " " $3,346.40 " " $2,342.48 " " $2,928.10 " " $2,677.12 " " $3,346.40 " " $3,262.74 " " $1,882.35 " " $1,715.03 " " $1,756.86 " " $1,673.20 " " $3,137.25 " " $2,718.95 "
WWH ED PROFEE SCHEDULE - 4203 35226 35226 PR RPR BLOOD VESSEL DIRECT LOWER EXTREMITY "5,107.00" " $4,596.30 " " $2,042.80 " " $4,085.60 " " $2,859.92 " " $3,574.90 " " $3,268.48 " " $4,085.60 " " $3,983.46 " " $2,298.15 " " $2,093.87 " " $2,144.94 " " $2,042.80 " " $3,830.25 " " $3,319.55 "
WWH ED PROFEE SCHEDULE - 4203 36000 36000 PR INTRODUCTION NEEDLE/INTRACATHETER VEIN 182.00 $163.80 $72.80 $145.60 $101.92 $127.40 $116.48 $145.60 $141.96 $81.90 $74.62 $76.44 $72.80 $136.50 $118.30
WWH ED PROFEE SCHEDULE - 4203 36430 36430 PR TRANSFUSION BLOOD/BLOOD COMPONENTS 318.00 $286.20 $127.20 $254.40 $178.08 $222.60 $203.52 $254.40 $248.04 $143.10 $130.38 $133.56 $127.20 $238.50 $206.70
WWH ED PROFEE SCHEDULE - 4203 36556 36556 PR INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/> 930.00 $837.00 $372.00 $744.00 $520.80 $651.00 $595.20 $744.00 $725.40 $418.50 $381.30 $390.60 $372.00 $697.50 $604.50
WWH ED PROFEE SCHEDULE - 4203 36569 36569 PR INSERTION PICC W/O IMG GDN 5 YR/> 930.00 $837.00 $372.00 $744.00 $520.80 $651.00 $595.20 $744.00 $725.40 $418.50 $381.30 $390.60 $372.00 $697.50 $604.50
WWH ED PROFEE SCHEDULE - 4203 36600 36600 PR ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH ED PROFEE SCHEDULE - 4203 36680 36680 PR PLACEMENT NEEDLE INTRAOSSEOUS INFUSION 393.00 $353.70 $157.20 $314.40 $220.08 $275.10 $251.52 $314.40 $306.54 $176.85 $161.13 $165.06 $157.20 $294.75 $255.45
WWH ED PROFEE SCHEDULE - 4203 40650 40650 PR RPR LIP FULL THICKNESS VERMILION ONLY "1,660.00" " $1,494.00 " $664.00 " $1,328.00 " $929.60 " $1,162.00 " " $1,062.40 " " $1,328.00 " " $1,294.80 " $747.00 $680.60 $697.20 $664.00 " $1,245.00 " " $1,079.00 "
WWH ED PROFEE SCHEDULE - 4203 41250 41250 PR RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG "1,121.00" " $1,008.90 " $448.40 $896.80 $627.76 $784.70 $717.44 $896.80 $874.38 $504.45 $459.61 $470.82 $448.40 $840.75 $728.65
WWH ED PROFEE SCHEDULE - 4203 41599 41599 PR UNLISTED PROCEDURE TONGUE FLOOR MOUTH 791.00 $711.90 $316.40 $632.80 $442.96 $553.70 $506.24 $632.80 $616.98 $355.95 $324.31 $332.22 $316.40 $593.25 $514.15
WWH ED PROFEE SCHEDULE - 4203 41800 41800 PR DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS 594.00 $534.60 $237.60 $475.20 $332.64 $415.80 $380.16 $475.20 $463.32 $267.30 $243.54 $249.48 $237.60 $445.50 $386.10
WWH ED PROFEE SCHEDULE - 4203 42000 42000 PR DRAINAGE ABSCESS PALATE UVULA 684.00 $615.60 $273.60 $547.20 $383.04 $478.80 $437.76 $547.20 $533.52 $307.80 $280.44 $287.28 $273.60 $513.00 $444.60
WWH ED PROFEE SCHEDULE - 4203 42700 42700 PR I&D ABSCESS PERITONSILLAR 619.00 $557.10 $247.60 $495.20 $346.64 $433.30 $396.16 $495.20 $482.82 $278.55 $253.79 $259.98 $247.60 $464.25 $402.35
WWH ED PROFEE SCHEDULE - 4203 42999.2 42999 PR PUNCTURE ASPIRATION ABSCESS PERITONSILLAR 405.00 $364.50 $162.00 $324.00 $226.80 $283.50 $259.20 $324.00 $315.90 $182.25 $166.05 $170.10 $162.00 $303.75 $263.25
WWH ED PROFEE SCHEDULE - 4203 43761 43761 PR REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO 626.00 $563.40 $250.40 $500.80 $350.56 $438.20 $400.64 $500.80 $488.28 $281.70 $256.66 $262.92 $250.40 $469.50 $406.90
WWH ED PROFEE SCHEDULE - 4203 43762 43762 PR PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC 809.00 $728.10 $323.60 $647.20 $453.04 $566.30 $517.76 $647.20 $631.02 $364.05 $331.69 $339.78 $323.60 $606.75 $525.85
WWH ED PROFEE SCHEDULE - 4203 44141 44141 PR COLECTOMY PRTL W/SKIN LEVEL CECOST/COLOSTOMY "7,127.00" " $6,414.30 " " $2,850.80 " " $5,701.60 " " $3,991.12 " " $4,988.90 " " $4,561.28 " " $5,701.60 " " $5,559.06 " " $3,207.15 " " $2,922.07 " " $2,993.34 " " $2,850.80 " " $5,345.25 " " $4,632.55 "
WWH ED PROFEE SCHEDULE - 4203 45005 45005 PR I&D SUBMUCOSAL ABSCESS RECTUM "1,183.00" " $1,064.70 " $473.20 $946.40 $662.48 $828.10 $757.12 $946.40 $922.74 $532.35 $485.03 $496.86 $473.20 $887.25 $768.95
WWH ED PROFEE SCHEDULE - 4203 45999.4 45999 PR RECTAL FOREIGN BODY REMOVAL AFFILIATE ONLY "1,011.00" $909.90 $404.40 $808.80 $566.16 $707.70 $647.04 $808.80 $788.58 $454.95 $414.51 $424.62 $404.40 $758.25 $657.15
WWH ED PROFEE SCHEDULE - 4203 46050 46050 PR I&D PERIANAL ABSCESS SUPERFICIAL 686.00 $617.40 $274.40 $548.80 $384.16 $480.20 $439.04 $548.80 $535.08 $308.70 $281.26 $288.12 $274.40 $514.50 $445.90
WWH ED PROFEE SCHEDULE - 4203 46083 46083 PR INCISION THROMBOSED HEMORRHOID EXTERNAL 777.00 $699.30 $310.80 $621.60 $435.12 $543.90 $497.28 $621.60 $606.06 $349.65 $318.57 $326.34 $310.80 $582.75 $505.05
WWH ED PROFEE SCHEDULE - 4203 46600 46600 PR ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD 380.00 $342.00 $152.00 $304.00 $212.80 $266.00 $243.20 $304.00 $296.40 $171.00 $155.80 $159.60 $152.00 $285.00 $247.00
WWH ED PROFEE SCHEDULE - 4203 49082 49082 PR ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE 510.00 $459.00 $204.00 $408.00 $285.60 $357.00 $326.40 $408.00 $397.80 $229.50 $209.10 $214.20 $204.00 $382.50 $331.50
WWH ED PROFEE SCHEDULE - 4203 49083 49083 PR ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE 959.00 $863.10 $383.60 $767.20 $537.04 $671.30 $613.76 $767.20 $748.02 $431.55 $393.19 $402.78 $383.60 $719.25 $623.35
WWH ED PROFEE SCHEDULE - 4203 51700 51700 PR BLDR IRRIGATION SMPL LAVAGE &/INSTLJ 469.00 $422.10 $187.60 $375.20 $262.64 $328.30 $300.16 $375.20 $365.82 $211.05 $192.29 $196.98 $187.60 $351.75 $304.85
WWH ED PROFEE SCHEDULE - 4203 51701 51701 PR INSJ NON-NDWELLG BLADDER CATHETER 304.00 $273.60 $121.60 $243.20 $170.24 $212.80 $194.56 $243.20 $237.12 $136.80 $124.64 $127.68 $121.60 $228.00 $197.60
WWH ED PROFEE SCHEDULE - 4203 51702 51702 PR INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE 364.00 $327.60 $145.60 $291.20 $203.84 $254.80 $232.96 $291.20 $283.92 $163.80 $149.24 $152.88 $145.60 $273.00 $236.60
WWH ED PROFEE SCHEDULE - 4203 51703 51703 PR INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED 454.00 $408.60 $181.60 $363.20 $254.24 $317.80 $290.56 $363.20 $354.12 $204.30 $186.14 $190.68 $181.60 $340.50 $295.10
WWH ED PROFEE SCHEDULE - 4203 51705 51705 PR CHANGE CYSTOSTOMY TUBE SIMPLE 491.00 $441.90 $196.40 $392.80 $274.96 $343.70 $314.24 $392.80 $382.98 $220.95 $201.31 $206.22 $196.40 $368.25 $319.15
WWH ED PROFEE SCHEDULE - 4203 52224 52224 PR CYSTO W/REMOVAL OF LESIONS SMALL "3,617.00" " $3,255.30 " " $1,446.80 " " $2,893.60 " " $2,025.52 " " $2,531.90 " " $2,314.88 " " $2,893.60 " " $2,821.26 " " $1,627.65 " " $1,482.97 " " $1,519.14 " " $1,446.80 " " $2,712.75 " " $2,351.05 "
WWH ED PROFEE SCHEDULE - 4203 54220 54220 PR IRRIGATION CORPORA CAVERNOSA PRIAPISM 814.00 $732.60 $325.60 $651.20 $455.84 $569.80 $520.96 $651.20 $634.92 $366.30 $333.74 $341.88 $325.60 $610.50 $529.10
WWH ED PROFEE SCHEDULE - 4203 55100 55100 PR DRAINAGE SCROTAL WALL ABSCESS 856.00 $770.40 $342.40 $684.80 $479.36 $599.20 $547.84 $684.80 $667.68 $385.20 $350.96 $359.52 $342.40 $642.00 $556.40
WWH ED PROFEE SCHEDULE - 4203 56405 56405 PR I&D VULVA/PERINEAL ABSCESS 560.00 $504.00 $224.00 $448.00 $313.60 $392.00 $358.40 $448.00 $436.80 $252.00 $229.60 $235.20 $224.00 $420.00 $364.00
WWH ED PROFEE SCHEDULE - 4203 56420 56420 PR I&D OF BARTHOLINS GLAND ABSCESS 481.00 $432.90 $192.40 $384.80 $269.36 $336.70 $307.84 $384.80 $375.18 $216.45 $197.21 $202.02 $192.40 $360.75 $312.65
WWH ED PROFEE SCHEDULE - 4203 57180 57180 PR INTRO ANY HEMOSTATIC AGENT/PACK VAG HEMRRG SPX 438.00 $394.20 $175.20 $350.40 $245.28 $306.60 $280.32 $350.40 $341.64 $197.10 $179.58 $183.96 $175.20 $328.50 $284.70
WWH ED PROFEE SCHEDULE - 4203 58301 58301 PR REMOVAL INTRAUTERINE DEVICE IUD 366.00 $329.40 $146.40 $292.80 $204.96 $256.20 $234.24 $292.80 $285.48 $164.70 $150.06 $153.72 $146.40 $274.50 $237.90
WWH ED PROFEE SCHEDULE - 4203 59300 59300 PR EPISIOTOMY/VAG RPR OTH/THN ATTENDING 757.00 $681.30 $302.80 $605.60 $423.92 $529.90 $484.48 $605.60 $590.46 $340.65 $310.37 $317.94 $302.80 $567.75 $492.05
WWH ED PROFEE SCHEDULE - 4203 59414 59414 PR DELIVERY PLACENTA SEPARATE PROCEDURE 577.00 $519.30 $230.80 $461.60 $323.12 $403.90 $369.28 $461.60 $450.06 $259.65 $236.57 $242.34 $230.80 $432.75 $375.05
WWH ED PROFEE SCHEDULE - 4203 62270 62270 PR SPINAL PUNCTURE LUMBAR DIAGNOSTIC 474.00 $426.60 $189.60 $379.20 $265.44 $331.80 $303.36 $379.20 $369.72 $213.30 $194.34 $199.08 $189.60 $355.50 $308.10
WWH ED PROFEE SCHEDULE - 4203 64400 64400 PR NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH 479.00 $431.10 $191.60 $383.20 $268.24 $335.30 $306.56 $383.20 $373.62 $215.55 $196.39 $201.18 $191.60 $359.25 $311.35
WWH ED PROFEE SCHEDULE - 4203 64405 64405 PR INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV 519.00 $467.10 $207.60 $415.20 $290.64 $363.30 $332.16 $415.20 $404.82 $233.55 $212.79 $217.98 $207.60 $389.25 $337.35
WWH ED PROFEE SCHEDULE - 4203 64415 64415 PR INJECTION AA&/STRD BRACHIAL PLEXUS W/IMG GDN "1,069.00" $962.10 $427.60 $855.20 $598.64 $748.30 $684.16 $855.20 $833.82 $481.05 $438.29 $448.98 $427.60 $801.75 $694.85
WWH ED PROFEE SCHEDULE - 4203 64421 64421 PR MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES "1,032.00" $928.80 $412.80 $825.60 $577.92 $722.40 $660.48 $825.60 $804.96 $464.40 $423.12 $433.44 $412.80 $774.00 $670.80
WWH ED PROFEE SCHEDULE - 4203 64447 64447 PR INJECTION AA&/STRD FEMORAL NERVE W/IMG GDN "1,060.00" $954.00 $424.00 $848.00 $593.60 $742.00 $678.40 $848.00 $826.80 $477.00 $434.60 $445.20 $424.00 $795.00 $689.00
WWH ED PROFEE SCHEDULE - 4203 64450 64450 PR INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH 346.00 $311.40 $138.40 $276.80 $193.76 $242.20 $221.44 $276.80 $269.88 $155.70 $141.86 $145.32 $138.40 $259.50 $224.90
WWH ED PROFEE SCHEDULE - 4203 64505 64505 PR INJECTION ANES AGENT SPHENOPALATINE GANGLION 451.00 $405.90 $180.40 $360.80 $252.56 $315.70 $288.64 $360.80 $351.78 $202.95 $184.91 $189.42 $180.40 $338.25 $293.15
WWH ED PROFEE SCHEDULE - 4203 65205 65205 PR REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL 235.00 $211.50 $94.00 $188.00 $131.60 $164.50 $150.40 $188.00 $183.30 $105.75 $96.35 $98.70 $94.00 $176.25 $152.75
WWH ED PROFEE SCHEDULE - 4203 65210 65210 PR RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR 310.00 $279.00 $124.00 $248.00 $173.60 $217.00 $198.40 $248.00 $241.80 $139.50 $127.10 $130.20 $124.00 $232.50 $201.50
WWH ED PROFEE SCHEDULE - 4203 65220 65220 PR RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP 302.00 $271.80 $120.80 $241.60 $169.12 $211.40 $193.28 $241.60 $235.56 $135.90 $123.82 $126.84 $120.80 $226.50 $196.30
WWH ED PROFEE SCHEDULE - 4203 65222 65222 PR RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP 250.00 $225.00 $100.00 $200.00 $140.00 $175.00 $160.00 $200.00 $195.00 $112.50 $102.50 $105.00 $100.00 $187.50 $162.50
WWH ED PROFEE SCHEDULE - 4203 67700 67700 PR BLEPHAROTOMY DRAINAGE ABSCESS EYELID "1,104.00" $993.60 $441.60 $883.20 $618.24 $772.80 $706.56 $883.20 $861.12 $496.80 $452.64 $463.68 $441.60 $828.00 $717.60
WWH ED PROFEE SCHEDULE - 4203 67938 67938 PR REMOVAL EMBEDDED FOREIGN BODY EYELID 882.00 $793.80 $352.80 $705.60 $493.92 $617.40 $564.48 $705.60 $687.96 $396.90 $361.62 $370.44 $352.80 $661.50 $573.30
WWH ED PROFEE SCHEDULE - 4203 69000 69000 PR DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE 782.00 $703.80 $312.80 $625.60 $437.92 $547.40 $500.48 $625.60 $609.96 $351.90 $320.62 $328.44 $312.80 $586.50 $508.30
WWH ED PROFEE SCHEDULE - 4203 69200 69200 PR RMVL FB XTRNL AUDITORY CANAL W/O ANES 504.00 $453.60 $201.60 $403.20 $282.24 $352.80 $322.56 $403.20 $393.12 $226.80 $206.64 $211.68 $201.60 $378.00 $327.60
WWH ED PROFEE SCHEDULE - 4203 69205 69205 PR RMVL FB XTRNL AUDITORY CANAL ANES 470.00 $423.00 $188.00 $376.00 $263.20 $329.00 $300.80 $376.00 $366.60 $211.50 $192.70 $197.40 $188.00 $352.50 $305.50
WWH ED PROFEE SCHEDULE - 4203 69210 69210 PR REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT 199.00 $179.10 $79.60 $159.20 $111.44 $139.30 $127.36 $159.20 $155.22 $89.55 $81.59 $83.58 $79.60 $149.25 $129.35
WWH ED PROFEE SCHEDULE - 4203 76604 76604 PR US CHEST REAL TIME W/IMAGE DOCUMENTATION 226.00 $203.40 $90.40 $180.80 $126.56 $158.20 $144.64 $180.80 $176.28 $101.70 $92.66 $94.92 $90.40 $169.50 $146.90
WWH ED PROFEE SCHEDULE - 4203 76604.22 76604 PR US CHEST 226.00 $203.40 $90.40 $180.80 $126.56 $158.20 $144.64 $180.80 $176.28 $101.70 $92.66 $94.92 $90.40 $169.50 $146.90
WWH ED PROFEE SCHEDULE - 4203 76705.22 76705 PR US ABDOMEN LIMITED 276.00 $248.40 $110.40 $220.80 $154.56 $193.20 $176.64 $220.80 $215.28 $124.20 $113.16 $115.92 $110.40 $207.00 $179.40
WWH ED PROFEE SCHEDULE - 4203 76815.22 76815 PR OB LIMITED 1 OR MORE FETUSES 305.00 $274.50 $122.00 $244.00 $170.80 $213.50 $195.20 $244.00 $237.90 $137.25 $125.05 $128.10 $122.00 $228.75 $198.25
WWH ED PROFEE SCHEDULE - 4203 76882.22 76882 PR US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG READ ONLY 54.00 $48.60 $21.60 $43.20 $30.24 $37.80 $34.56 $43.20 $42.12 $24.30 $22.14 $22.68 $21.60 $40.50 $35.10
WWH ED PROFEE SCHEDULE - 4203 76937 76937 PR US VASC ACCESS SITS VSL PATENCY NDL ENTRY 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH ED PROFEE SCHEDULE - 4203 92950 92950 PR CARDIOPULMONARY RESUSCITATION "1,266.00" " $1,139.40 " $506.40 " $1,012.80 " $708.96 $886.20 $810.24 " $1,012.80 " $987.48 $569.70 $519.06 $531.72 $506.40 $949.50 $822.90
WWH ED PROFEE SCHEDULE - 4203 92960 92960 PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL "1,303.00" " $1,172.70 " $521.20 " $1,042.40 " $729.68 $912.10 $833.92 " $1,042.40 " " $1,016.34 " $586.35 $534.23 $547.26 $521.20 $977.25 $846.95
WWH ED PROFEE SCHEDULE - 4203 93308 93308 PR ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD 427.00 $384.30 $170.80 $341.60 $239.12 $298.90 $273.28 $341.60 $333.06 $192.15 $175.07 $179.34 $170.80 $320.25 $277.55
WWH ED PROFEE SCHEDULE - 4203 94640 94640 PR PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH ED PROFEE SCHEDULE - 4203 97597 97597 PR DEBRIDEMENT OPEN WOUND 20 SQ CM/< 153.00 $137.70 $61.20 $122.40 $85.68 $107.10 $97.92 $122.40 $119.34 $68.85 $62.73 $64.26 $61.20 $114.75 $99.45
WWH ED PROFEE SCHEDULE - 4203 99151 99151 PR MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS 204.00 $183.60 $81.60 $163.20 $114.24 $142.80 $130.56 $163.20 $159.12 $91.80 $83.64 $85.68 $81.60 $153.00 $132.60
WWH ED PROFEE SCHEDULE - 4203 99152 99152 PR MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS 148.00 $133.20 $59.20 $118.40 $82.88 $103.60 $94.72 $118.40 $115.44 $66.60 $60.68 $62.16 $59.20 $111.00 $96.20
WWH ED PROFEE SCHEDULE - 4203 99153 99153 PR MOD SED SAME PHYS/QHP EACH ADDL 15 MINS 46.00 $41.40 $18.40 $36.80 $25.76 $32.20 $29.44 $36.80 $35.88 $20.70 $18.86 $19.32 $18.40 $34.50 $29.90
WWH ED PROFEE SCHEDULE - 4203 99281 99281 PR EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH ED PROFEE SCHEDULE - 4203 99282 99282 PR EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM 218.00 $196.20 $87.20 $174.40 $122.08 $152.60 $139.52 $174.40 $170.04 $98.10 $89.38 $91.56 $87.20 $163.50 $141.70
WWH ED PROFEE SCHEDULE - 4203 99283 99283 PR EMERGENCY DEPARTMENT VISIT LOW MDM 335.00 $301.50 $134.00 $268.00 $187.60 $234.50 $214.40 $268.00 $261.30 $150.75 $137.35 $140.70 $134.00 $251.25 $217.75
WWH ED PROFEE SCHEDULE - 4203 99284 99284 PR EMERGENCY DEPARTMENT VISIT MODERATE MDM 614.00 $552.60 $245.60 $491.20 $343.84 $429.80 $392.96 $491.20 $478.92 $276.30 $251.74 $257.88 $245.60 $460.50 $399.10
WWH ED PROFEE SCHEDULE - 4203 99285 99285 PR EMERGENCY DEPARTMENT VISIT HIGH MDM 908.00 $817.20 $363.20 $726.40 $508.48 $635.60 $581.12 $726.40 $708.24 $408.60 $372.28 $381.36 $363.20 $681.00 $590.20
WWH ED PROFEE SCHEDULE - 4203 99291 99291 PR CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN "1,107.00" $996.30 $442.80 $885.60 $619.92 $774.90 $708.48 $885.60 $863.46 $498.15 $453.87 $464.94 $442.80 $830.25 $719.55
WWH ED PROFEE SCHEDULE - 4203 99292 99292 PR CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN 599.00 $539.10 $239.60 $479.20 $335.44 $419.30 $383.36 $479.20 $467.22 $269.55 $245.59 $251.58 $239.60 $449.25 $389.35
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 0124A 0124A (IA) PR IMM ADMN SARSCOV2 30MCG/0.3 ML BIVALENT BST (PFIZER) 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 100006 100006 HCHG LEAVE OF ABSENCE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 100007 G0378 HCHG OBSERVATION 59.00 $53.10 $23.60 $47.20 $33.04 $41.30 $37.76 $47.20 $46.02 $26.55 $24.19 $24.78 $23.60 $44.25 $38.35
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 100009 100009 HCHG NURSERY NO CHARGE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 100014 100014 HCHG CUSTODIAL CARE I 205.00 $184.50 $82.00 $164.00 $114.80 $143.50 $131.20 $164.00 $159.90 $92.25 $84.05 $86.10 $82.00 $153.75 $133.25
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 100022 100022 HCHG SWING BED 796.00 $716.40 $318.40 $636.80 $445.76 $557.20 $509.44 $636.80 $620.88 $358.20 $326.36 $334.32 $318.40 $597.00 $517.40
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 100024 100024 HCHG MED/SURG/OB ROOM "1,591.00" " $1,431.90 " $636.40 " $1,272.80 " $890.96 " $1,113.70 " " $1,018.24 " " $1,272.80 " " $1,240.98 " $715.95 $652.31 $668.22 $636.40 " $1,193.25 " " $1,034.15 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 100026 HCHG INFANT CARE LEVEL 1 "1,167.00" " $1,050.30 " $466.80 $933.60 $653.52 $816.90 $746.88 $933.60 $910.26 $525.15 $478.47 $490.14 $466.80 $875.25 $758.55
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 100037 100037 HCHG TELEMETRY ANC LEV 3 973.00 $875.70 $389.20 $778.40 $544.88 $681.10 $622.72 $778.40 $758.94 $437.85 $398.93 $408.66 $389.20 $729.75 $632.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 100052 100052 HCHG RESPITE ROOM AFFILIATE ONLY 375.00 $337.50 $150.00 $300.00 $210.00 $262.50 $240.00 $300.00 $292.50 $168.75 $153.75 $157.50 $150.00 $281.25 $243.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 100053 100053 HCHG MED/SURG/OB ROOM W TELE AFFILIATE ONLY "2,652.00" " $2,386.80 " " $1,060.80 " " $2,121.60 " " $1,485.12 " " $1,856.40 " " $1,697.28 " " $2,121.60 " " $2,068.56 " " $1,193.40 " " $1,087.32 " " $1,113.84 " " $1,060.80 " " $1,989.00 " " $1,723.80 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 100054 G0378 HCHG OBSERVATION W TELEMETRY WWH ONLY 95.00 $85.50 $38.00 $76.00 $53.20 $66.50 $60.80 $76.00 $74.10 $42.75 $38.95 $39.90 $38.00 $71.25 $61.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110014 36592 HCHG BLOOD DRAW THROUGH CENTRAL OR PERIPHERAL VAD 174.00 $156.60 $69.60 $139.20 $97.44 $121.80 $111.36 $139.20 $135.72 $78.30 $71.34 $73.08 $69.60 $130.50 $113.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110015 36591 HCHG BLOOD DRAW THROUGH COMPLETELY IMPLANTED VAD 158.00 $142.20 $63.20 $126.40 $88.48 $110.60 $101.12 $126.40 $123.24 $71.10 $64.78 $66.36 $63.20 $118.50 $102.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110023 36415 HCHG ROUTINE VENIPUNCTURE 26.00 $23.40 $10.40 $20.80 $14.56 $18.20 $16.64 $20.80 $20.28 $11.70 $10.66 $10.92 $10.40 $19.50 $16.90
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110187 94642 HCHG RC AEROSOL INHALATION OF PENTAMIDINE 122.00 $109.80 $48.80 $97.60 $68.32 $85.40 $78.08 $97.60 $95.16 $54.90 $50.02 $51.24 $48.80 $91.50 $79.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110188 94640 HCHG RC AIRWAY INHALATION TX 169.00 $152.10 $67.60 $135.20 $94.64 $118.30 $108.16 $135.20 $131.82 $76.05 $69.29 $70.98 $67.60 $126.75 $109.85
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110193 94640 HCHG RC AIRWAY INHALATION TX IPPB 164.00 $147.60 $65.60 $131.20 $91.84 $114.80 $104.96 $131.20 $127.92 $73.80 $67.24 $68.88 $65.60 $123.00 $106.60
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110195 94640 HCHG RC AIRWAY INHALATION TX MDI/DPI 169.00 $152.10 $67.60 $135.20 $94.64 $118.30 $108.16 $135.20 $131.82 $76.05 $69.29 $70.98 $67.60 $126.75 $109.85
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110203 94667 HCHG RC MANIPULATION CHEST WALL INITIAL BASIC 117.00 $105.30 $46.80 $93.60 $65.52 $81.90 $74.88 $93.60 $91.26 $52.65 $47.97 $49.14 $46.80 $87.75 $76.05
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110205 94668 HCHG RC MANIPULATION CHEST WALL SUBSEQ BASIC 144.00 $129.60 $57.60 $115.20 $80.64 $100.80 $92.16 $115.20 $112.32 $64.80 $59.04 $60.48 $57.60 $108.00 $93.60
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110207 94664 HCHG RC NEBULIZER/INHALER INSTRUCTION 164.00 $147.60 $65.60 $131.20 $91.84 $114.80 $104.96 $131.20 $127.92 $73.80 $67.24 $68.88 $65.60 $123.00 $106.60
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110208 94660 HCHG RC CPAP/BI-LEVEL TREATMENT 168.00 $151.20 $67.20 $134.40 $94.08 $117.60 $107.52 $134.40 $131.04 $75.60 $68.88 $70.56 $67.20 $126.00 $109.20
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110210 G0238 HCHG THER PROC IMPROVE RESP FUNC 15MIN 1:1 99.00 $89.10 $39.60 $79.20 $55.44 $69.30 $63.36 $79.20 $77.22 $44.55 $40.59 $41.58 $39.60 $74.25 $64.35
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110211 G0239 "HCHG THER PROC IMPRV RESP FUNC/INCR ENDUR,GROUP" 129.00 $116.10 $51.60 $103.20 $72.24 $90.30 $82.56 $103.20 $100.62 $58.05 $52.89 $54.18 $51.60 $96.75 $83.85
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110212 G0237 HCHG THER PROC INCR RESP STRNGTH/ENDUR 15MIN 1:1 92.00 $82.80 $36.80 $73.60 $51.52 $64.40 $58.88 $73.60 $71.76 $41.40 $37.72 $38.64 $36.80 $69.00 $59.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110221 G0283 HCHG PT E-STIM UNATTENDED OTHER THAN WOUND 55.00 $49.50 $22.00 $44.00 $30.80 $38.50 $35.20 $44.00 $42.90 $24.75 $22.55 $23.10 $22.00 $41.25 $35.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110231 97113 HCHG PT AQUATIC THERAPY 15MIN 130.00 $117.00 $52.00 $104.00 $72.80 $91.00 $83.20 $104.00 $101.40 $58.50 $53.30 $54.60 $52.00 $97.50 $84.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110237 97034 HCHG PT CONTRAST BATH 15MIN 60.00 $54.00 $24.00 $48.00 $33.60 $42.00 $38.40 $48.00 $46.80 $27.00 $24.60 $25.20 $24.00 $45.00 $39.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110239 97032 HCHG PT E-STIM-ATTENDED 15MIN 48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110242 97750 HCHG PT FUNCTIONAL CAPACITY EVAL 15MIN 160.00 $144.00 $64.00 $128.00 $89.60 $112.00 $102.40 $128.00 $124.80 $72.00 $65.60 $67.20 $64.00 $120.00 $104.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110243 97116 HCHG PT GAIT TRAINING 15MIN 88.00 $79.20 $35.20 $70.40 $49.28 $61.60 $56.32 $70.40 $68.64 $39.60 $36.08 $36.96 $35.20 $66.00 $57.20
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110244 97150 HCHG PT GROUP THERAPY 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110246 97033 HCHG PT IONTOPHORESIS 15MIN 118.00 $106.20 $47.20 $94.40 $66.08 $82.60 $75.52 $94.40 $92.04 $53.10 $48.38 $49.56 $47.20 $88.50 $76.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110247 97140 HCHG PT MANUAL THERAPY 15MIN 103.00 $92.70 $41.20 $82.40 $57.68 $72.10 $65.92 $82.40 $80.34 $46.35 $42.23 $43.26 $41.20 $77.25 $66.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110248 97124 HCHG PT MASSAGE 15 MIN 33.00 $29.70 $13.20 $26.40 $18.48 $23.10 $21.12 $26.40 $25.74 $14.85 $13.53 $13.86 $13.20 $24.75 $21.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110249 97012 HCHG PT MECHANICAL TRACTION 55.00 $49.50 $22.00 $44.00 $30.80 $38.50 $35.20 $44.00 $42.90 $24.75 $22.55 $23.10 $22.00 $41.25 $35.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110250 97112 HCHG PT NEUROMUSCULAR RE-ED 15MIN 112.00 $100.80 $44.80 $89.60 $62.72 $78.40 $71.68 $89.60 $87.36 $50.40 $45.92 $47.04 $44.80 $84.00 $72.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110251 97602 HCHG PT NONSELECTIVE DEBRIDEMENT/SLOUGH WOUNDS 143.00 $128.70 $57.20 $114.40 $80.08 $100.10 $91.52 $114.40 $111.54 $64.35 $58.63 $60.06 $57.20 $107.25 $92.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110253 97018 HCHG PT PARAFFIN BATH 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110255 97750 HCHG PT PHYSICAL PERF TEST/MEASUREMENT 15MIN 160.00 $144.00 $64.00 $128.00 $89.60 $112.00 $102.40 $128.00 $124.80 $72.00 $65.60 $67.20 $64.00 $120.00 $104.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110259 97164 HCHG PT RE-EVALUATION 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110261 97535 HCHG PT SELFCARE/HOME MNGMNT 15MIN 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110271 97530 HCHG PT THERAPEUTIC ACTIVITY 15MIN 103.00 $92.70 $41.20 $82.40 $57.68 $72.10 $65.92 $82.40 $80.34 $46.35 $42.23 $43.26 $41.20 $77.25 $66.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110272 97110 HCHG PT THERAPEUTIC EXERCISE 15MIN 98.00 $88.20 $39.20 $78.40 $54.88 $68.60 $62.72 $78.40 $76.44 $44.10 $40.18 $41.16 $39.20 $73.50 $63.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110273 97035 HCHG PT ULTRASOUND 15MIN 40.00 $36.00 $16.00 $32.00 $22.40 $28.00 $25.60 $32.00 $31.20 $18.00 $16.40 $16.80 $16.00 $30.00 $26.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110274 97016 HCHG PT VASOPNEUMATIC DEVICE 70.00 $63.00 $28.00 $56.00 $39.20 $49.00 $44.80 $56.00 $54.60 $31.50 $28.70 $29.40 $28.00 $52.50 $45.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110276 97022 HCHG PT WHIRLPOOL 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110278 97546 HCHG PT WORK CONDITIONING EA ADDL HR 190.00 $171.00 $76.00 $152.00 $106.40 $133.00 $121.60 $152.00 $148.20 $85.50 $77.90 $79.80 $76.00 $142.50 $123.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110279 97545 HCHG PT WORK CONDITIONING INITIAL 2HRS 298.00 $268.20 $119.20 $238.40 $166.88 $208.60 $190.72 $238.40 $232.44 $134.10 $122.18 $125.16 $119.20 $223.50 $193.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110281 97545 HCHG PT WORK HARDENING INITIAL 2HRS 298.00 $268.20 $119.20 $238.40 $166.88 $208.60 $190.72 $238.40 $232.44 $134.10 $122.18 $125.16 $119.20 $223.50 $193.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110284 G0283 HCHG OT E-STIM UNATTENDED OTHER THAN WOUND 47.00 $42.30 $18.80 $37.60 $26.32 $32.90 $30.08 $37.60 $36.66 $21.15 $19.27 $19.74 $18.80 $35.25 $30.55
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110291 29125 HCHG OT APPLICATION SHORTARM SPLINT STATIC 269.00 $242.10 $107.60 $215.20 $150.64 $188.30 $172.16 $215.20 $209.82 $121.05 $110.29 $112.98 $107.60 $201.75 $174.85
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110296 97537 HCHG OT COMM/WORK REINTEGRATION 15MIN 54.00 $48.60 $21.60 $43.20 $30.24 $37.80 $34.56 $43.20 $42.12 $24.30 $22.14 $22.68 $21.60 $40.50 $35.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110297 97034 HCHG OT CONTRAST BATH 15MIN 60.00 $54.00 $24.00 $48.00 $33.60 $42.00 $38.40 $48.00 $46.80 $27.00 $24.60 $25.20 $24.00 $45.00 $39.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110299 97032 HCHG OT E-STIM ATTENDED 15MIN 48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110301 97022 HCHG OT FLUIDOTHERAPY 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110305 97033 HCHG OT IONTOPHORESIS 15MIN 100.00 $90.00 $40.00 $80.00 $56.00 $70.00 $64.00 $80.00 $78.00 $45.00 $41.00 $42.00 $40.00 $75.00 $65.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110306 97140 HCHG OT MANUAL THERAPY 15MIN 95.00 $85.50 $38.00 $76.00 $53.20 $66.50 $60.80 $76.00 $74.10 $42.75 $38.95 $39.90 $38.00 $71.25 $61.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110307 97124 HCHG OT MASSAGE 15MIN 33.00 $29.70 $13.20 $26.40 $18.48 $23.10 $21.12 $26.40 $25.74 $14.85 $13.53 $13.86 $13.20 $24.75 $21.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110308 97112 HCHG OT NEUROMUSCULAR RE-ED 15MIN 106.00 $95.40 $42.40 $84.80 $59.36 $74.20 $67.84 $84.80 $82.68 $47.70 $43.46 $44.52 $42.40 $79.50 $68.90
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110311 97018 HCHG OT PARAFFIN BATH 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110313 97750 HCHG OT PHYSICAL PERF TEST/MEASUREMENT 15MIN 160.00 $144.00 $64.00 $128.00 $89.60 $112.00 $102.40 $128.00 $124.80 $72.00 $65.60 $67.20 $64.00 $120.00 $104.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110317 97168 HCHG OT RE-EVALUATION 142.00 $127.80 $56.80 $113.60 $79.52 $99.40 $90.88 $113.60 $110.76 $63.90 $58.22 $59.64 $56.80 $106.50 $92.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110319 97535 HCHG OT SELFCARE/HOME MNGMNT 15MIN 103.00 $92.70 $41.20 $82.40 $57.68 $72.10 $65.92 $82.40 $80.34 $46.35 $42.23 $43.26 $41.20 $77.25 $66.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110330 97530 HCHG OT THERAPEUTIC ACTIVITY 15MIN 71.00 $63.90 $28.40 $56.80 $39.76 $49.70 $45.44 $56.80 $55.38 $31.95 $29.11 $29.82 $28.40 $53.25 $46.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110331 97110 HCHG OT THERAPEUTIC EXERCISE 15MIN 102.00 $91.80 $40.80 $81.60 $57.12 $71.40 $65.28 $81.60 $79.56 $45.90 $41.82 $42.84 $40.80 $76.50 $66.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110332 97035 HCHG OT ULTRASOUND 15MIN 40.00 $36.00 $16.00 $32.00 $22.40 $28.00 $25.60 $32.00 $31.20 $18.00 $16.40 $16.80 $16.00 $30.00 $26.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110333 97542 HCHG OT WHEELCHAIR MGT/PROPUL 15MIN 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110334 97022 HCHG OT WHIRLPOOL 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110335 97546 HCHG OT WORK CONDITIONING EA ADDL HR 190.00 $171.00 $76.00 $152.00 $106.40 $133.00 $121.60 $152.00 $148.20 $85.50 $77.90 $79.80 $76.00 $142.50 $123.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110336 97545 HCHG OT WORK CONDITIONING INITIAL 2HRS 298.00 $268.20 $119.20 $238.40 $166.88 $208.60 $190.72 $238.40 $232.44 $134.10 $122.18 $125.16 $119.20 $223.50 $193.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110338 97545 HCHG OT WORK HARDENING INITIAL 2HRS 298.00 $268.20 $119.20 $238.40 $166.88 $208.60 $190.72 $238.40 $232.44 $134.10 $122.18 $125.16 $119.20 $223.50 $193.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110341 92610 HCHG SLP EVAL ORAL/PHAR SWALLOWING 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110343 92507 HCHG SLP INDIV TX COMMUNICATION 214.00 $192.60 $85.60 $171.20 $119.84 $149.80 $136.96 $171.20 $166.92 $96.30 $87.74 $89.88 $85.60 $160.50 $139.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110344 96105 HCHG SLP ASSESSMENT OF APHASIA W REPORT PER HR 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110350 92607 HCHG SLP EVAL FOR SPCH GEN COMM DEV 1ST HR 238.00 $214.20 $95.20 $190.40 $133.28 $166.60 $152.32 $190.40 $185.64 $107.10 $97.58 $99.96 $95.20 $178.50 $154.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110351 92608 HCHG SLP EVAL FOR SPCH GEN COMM DEV ADDL 30 MIN 151.00 $135.90 $60.40 $120.80 $84.56 $105.70 $96.64 $120.80 $117.78 $67.95 $61.91 $63.42 $60.40 $113.25 $98.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110352 92611 HCHG SLP EVAL VIDEO SWALLOW 500.00 $450.00 $200.00 $400.00 $280.00 $350.00 $320.00 $400.00 $390.00 $225.00 $205.00 $210.00 $200.00 $375.00 $325.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110360 92609 HCHG SLP TX FOR SPCH GEN DEVICE 126.00 $113.40 $50.40 $100.80 $70.56 $88.20 $80.64 $100.80 $98.28 $56.70 $51.66 $52.92 $50.40 $94.50 $81.90
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110361 92526 HCHG SLP TX SWALLOW DYS/ORAL FUNC FEEDING 267.00 $240.30 $106.80 $213.60 $149.52 $186.90 $170.88 $213.60 $208.26 $120.15 $109.47 $112.14 $106.80 $200.25 $173.55
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110362 99291 HCHG ED CRITICAL CARE LEVEL VI "2,164.00" " $1,947.60 " $865.60 " $1,731.20 " " $1,211.84 " " $1,514.80 " " $1,384.96 " " $1,731.20 " " $1,687.92 " $973.80 $887.24 $908.88 $865.60 " $1,623.00 " " $1,406.60 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110363 99292 HCHG ED CRITICAL CARE LEVEL VI EA ADDL 30 MIN 611.00 $549.90 $244.40 $488.80 $342.16 $427.70 $391.04 $488.80 $476.58 $274.95 $250.51 $256.62 $244.40 $458.25 $397.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110367 92950 HCHG ED CODE BLUE RESUSCITATION 844.00 $759.60 $337.60 $675.20 $472.64 $590.80 $540.16 $675.20 $658.32 $379.80 $346.04 $354.48 $337.60 $633.00 $548.60
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110372 51702 HCHG ED INSERT INDWELL BLADD CATH SIMPLE 296.00 $266.40 $118.40 $236.80 $165.76 $207.20 $189.44 $236.80 $230.88 $133.20 $121.36 $124.32 $118.40 $222.00 $192.40
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110373 51701 HCHG ED INSERTION NON-INDWELL/STRGT BLADDER CATH 241.00 $216.90 $96.40 $192.80 $134.96 $168.70 $154.24 $192.80 $187.98 $108.45 $98.81 $101.22 $96.40 $180.75 $156.65
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110374 99281 ED LVL 1 HCHG 211.00 $189.90 $84.40 $168.80 $118.16 $147.70 $135.04 $168.80 $164.58 $94.95 $86.51 $88.62 $84.40 $158.25 $137.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110375 99282 ED LVL 2 HCHG 298.00 $268.20 $119.20 $238.40 $166.88 $208.60 $190.72 $238.40 $232.44 $134.10 $122.18 $125.16 $119.20 $223.50 $193.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110376 99283 ED LVL 3 HCHG 671.00 $603.90 $268.40 $536.80 $375.76 $469.70 $429.44 $536.80 $523.38 $301.95 $275.11 $281.82 $268.40 $503.25 $436.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110377 99284 ED LVL 4 HCHG 974.00 $876.60 $389.60 $779.20 $545.44 $681.80 $623.36 $779.20 $759.72 $438.30 $399.34 $409.08 $389.60 $730.50 $633.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110378 99285 ED LVL 5 HCHG "1,488.00" " $1,339.20 " $595.20 " $1,190.40 " $833.28 " $1,041.60 " $952.32 " $1,190.40 " " $1,160.64 " $669.60 $610.08 $624.96 $595.20 " $1,116.00 " $967.20
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110379 110379 HCHG ED EMERGENT PROCEDURE INTERMEDIATE 266.00 $239.40 $106.40 $212.80 $148.96 $186.20 $170.24 $212.80 $207.48 $119.70 $109.06 $111.72 $106.40 $199.50 $172.90
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110380 110380 HCHG ED EMERGENT PROCEDURE MAJOR 423.00 $380.70 $169.20 $338.40 $236.88 $296.10 $270.72 $338.40 $329.94 $190.35 $173.43 $177.66 $169.20 $317.25 $274.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110381 110381 HCHG ED EMERGENT PROCEDURE MINOR 136.00 $122.40 $54.40 $108.80 $76.16 $95.20 $87.04 $108.80 $106.08 $61.20 $55.76 $57.12 $54.40 $102.00 $88.40
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110398 94060 HCHG BRONCHOSPASM EVAL-BEDSIDE 613.00 $551.70 $245.20 $490.40 $343.28 $429.10 $392.32 $490.40 $478.14 $275.85 $251.33 $257.46 $245.20 $459.75 $398.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110400 94729 HCHG PFT C0 MEMBRANE DIFFUSE CAPACITY 358.00 $322.20 $143.20 $286.40 $200.48 $250.60 $229.12 $286.40 $279.24 $161.10 $146.78 $150.36 $143.20 $268.50 $232.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110418 94762 HCHG RC PULSE OXIMETRY OVERNIGHT 299.00 $269.10 $119.60 $239.20 $167.44 $209.30 $191.36 $239.20 $233.22 $134.55 $122.59 $125.58 $119.60 $224.25 $194.35
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110419 94761 HCHG PULSE OXIMETRY MULTIPLE DETERMINATIONS 43.00 $38.70 $17.20 $34.40 $24.08 $30.10 $27.52 $34.40 $33.54 $19.35 $17.63 $18.06 $17.20 $32.25 $27.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110420 94760 HCHG RC PULSE OXIMETRY SINGLE DETERMINATION 30.00 $27.00 $12.00 $24.00 $16.80 $21.00 $19.20 $24.00 $23.40 $13.50 $12.30 $12.60 $12.00 $22.50 $19.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110423 94010 HCHG SPIROMETRY BEDSIDE 218.00 $196.20 $87.20 $174.40 $122.08 $152.60 $139.52 $174.40 $170.04 $98.10 $89.38 $91.56 $87.20 $163.50 $141.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110429 92568 HCHG AUDIOLOGY ACOUSTIC REFLEX TEST 68.00 $61.20 $27.20 $54.40 $38.08 $47.60 $43.52 $54.40 $53.04 $30.60 $27.88 $28.56 $27.20 $51.00 $44.20
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110430 92557 HCHG AUDIOLOGY COMPREHENSIVE THRESHOLD EVAL 168.00 $151.20 $67.20 $134.40 $94.08 $117.60 $107.52 $134.40 $131.04 $75.60 $68.88 $70.56 $67.20 $126.00 $109.20
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110432 92552 HCHG AUDIOLOGY PURE TONE AIR 129.00 $116.10 $51.60 $103.20 $72.24 $90.30 $82.56 $103.20 $100.62 $58.05 $52.89 $54.18 $51.60 $96.75 $83.85
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110433 92553 HCHG AUDIOLOGY PURE TONE AIR & BONE 125.00 $112.50 $50.00 $100.00 $70.00 $87.50 $80.00 $100.00 $97.50 $56.25 $51.25 $52.50 $50.00 $93.75 $81.25
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110434 92555 HCHG AUDIOLOGY SRT 81.00 $72.90 $32.40 $64.80 $45.36 $56.70 $51.84 $64.80 $63.18 $36.45 $33.21 $34.02 $32.40 $60.75 $52.65
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110435 92556 HCHG AUDIOLOGY SRT & SPEECH RECOGNITION ABILITY 153.00 $137.70 $61.20 $122.40 $85.68 $107.10 $97.92 $122.40 $119.34 $68.85 $62.73 $64.26 $61.20 $114.75 $99.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110436 92565 HCHG AUDIOLOGY STENGER TEST PURE TONE 57.00 $51.30 $22.80 $45.60 $31.92 $39.90 $36.48 $45.60 $44.46 $25.65 $23.37 $23.94 $22.80 $42.75 $37.05
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110438 92567 HCHG AUDIOLOGY TYMPANOMETRY 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110440 92588 HCHG DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS COMP/DX EVAL 170.00 $153.00 $68.00 $136.00 $95.20 $119.00 $108.80 $136.00 $132.60 $76.50 $69.70 $71.40 $68.00 $127.50 $110.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110441 92587 HCHG DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LTD 206.00 $185.40 $82.40 $164.80 $115.36 $144.20 $131.84 $164.80 $160.68 $92.70 $84.46 $86.52 $82.40 $154.50 $133.90
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110448 92593 "HCHG HEARING AID CHECK, BINAURAL" 81.00 $72.90 $32.40 $64.80 $45.36 $56.70 $51.84 $64.80 $63.18 $36.45 $33.21 $34.02 $32.40 $60.75 $52.65
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110449 92592 "HCHG HEARING AID CHECK, MONAURAL" 50.00 $45.00 $20.00 $40.00 $28.00 $35.00 $32.00 $40.00 $39.00 $22.50 $20.50 $21.00 $20.00 $37.50 $32.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110468 92960 "HCHG CARDIOVERSION ELECTIVE, EXTERNAL" "1,464.00" " $1,317.60 " $585.60 " $1,171.20 " $819.84 " $1,024.80 " $936.96 " $1,171.20 " " $1,141.92 " $658.80 $600.24 $614.88 $585.60 " $1,098.00 " $951.60
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110473 92950 HCHG CODE BLUE RESUSCITATION 844.00 $759.60 $337.60 $675.20 $472.64 $590.80 $540.16 $675.20 $658.32 $379.80 $346.04 $354.48 $337.60 $633.00 $548.60
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110479 93321 HCHG RAD DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD 252.00 $226.80 $100.80 $201.60 $141.12 $176.40 $161.28 $201.60 $196.56 $113.40 $103.32 $105.84 $100.80 $189.00 $163.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110481 93308 HCHG ECHO 2D F-U OR LTD STUDY W BUBBLE "1,094.00" $984.60 $437.60 $875.20 $612.64 $765.80 $700.16 $875.20 $853.32 $492.30 $448.54 $459.48 $437.60 $820.50 $711.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110561 92977 HCHG THROMBOLYSIS CORONARY IV INFUSION 713.00 $641.70 $285.20 $570.40 $399.28 $499.10 $456.32 $570.40 $556.14 $320.85 $292.33 $299.46 $285.20 $534.75 $463.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110643 51700 "HCHG AMBULATORY/BLADDER IRRIGATION, SIMPLE" 559.00 $503.10 $223.60 $447.20 $313.04 $391.30 $357.76 $447.20 $436.02 $251.55 $229.19 $234.78 $223.60 $419.25 $363.35
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110677 99214 HCHG EST PT FAC VISIT LEVEL IV 282.00 $253.80 $112.80 $225.60 $157.92 $197.40 $180.48 $225.60 $219.96 $126.90 $115.62 $118.44 $112.80 $211.50 $183.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110679 99211 HCHG EST PT FAC VISIT LEVEL I 216.00 $194.40 $86.40 $172.80 $120.96 $151.20 $138.24 $172.80 $168.48 $97.20 $88.56 $90.72 $86.40 $162.00 $140.40
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110680 99212 HCHG EST PT FAC VISIT LEVEL II 119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110681 99213 HCHG EST PT FAC VISIT LEVEL III 190.00 $171.00 $76.00 $152.00 $106.40 $133.00 $121.60 $152.00 $148.20 $85.50 $77.90 $79.80 $76.00 $142.50 $123.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110736 RECOV HCHG PHASE I/PACU LEVEL I 185.00 $166.50 $74.00 $148.00 $103.60 $129.50 $118.40 $148.00 $144.30 $83.25 $75.85 $77.70 $74.00 $138.75 $120.25
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110737 RECOV HCHG PHASE I/PACU LEVEL II 352.00 $316.80 $140.80 $281.60 $197.12 $246.40 $225.28 $281.60 $274.56 $158.40 $144.32 $147.84 $140.80 $264.00 $228.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110738 RECOV HCHG PHASE I/PACU LEVEL III 496.00 $446.40 $198.40 $396.80 $277.76 $347.20 $317.44 $396.80 $386.88 $223.20 $203.36 $208.32 $198.40 $372.00 $322.40
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110739 RECOV HCHG PHASE I/PACU LEVEL IV 981.00 $882.90 $392.40 $784.80 $549.36 $686.70 $627.84 $784.80 $765.18 $441.45 $402.21 $412.02 $392.40 $735.75 $637.65
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110748 110748 HCHG BIRTHING VAGINAL UNCOMPLICATED "1,953.00" " $1,757.70 " $781.20 " $1,562.40 " " $1,093.68 " " $1,367.10 " " $1,249.92 " " $1,562.40 " " $1,523.34 " $878.85 $800.73 $820.26 $781.20 " $1,464.75 " " $1,269.45 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110749 110749 HCHG BIRTHING VAGINAL COMPLICATED "2,278.00" " $2,050.20 " $911.20 " $1,822.40 " " $1,275.68 " " $1,594.60 " " $1,457.92 " " $1,822.40 " " $1,776.84 " " $1,025.10 " $933.98 $956.76 $911.20 " $1,708.50 " " $1,480.70 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110753 110753 HCHG LABOR CARE LEVEL A HOURLY 174.00 $156.60 $69.60 $139.20 $97.44 $121.80 $111.36 $139.20 $135.72 $78.30 $71.34 $73.08 $69.60 $130.50 $113.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110754 110754 HCHG LABOR CARE LEVEL B HOURLY 211.00 $189.90 $84.40 $168.80 $118.16 $147.70 $135.04 $168.80 $164.58 $94.95 $86.51 $88.62 $84.40 $158.25 $137.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110755 110755 HCHG LABOR CARE LEVEL C HOURLY 248.00 $223.20 $99.20 $198.40 $138.88 $173.60 $158.72 $198.40 $193.44 $111.60 $101.68 $104.16 $99.20 $186.00 $161.20
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110756 110756 HCHG LABOR CARE LEVEL D HOURLY 299.00 $269.10 $119.60 $239.20 $167.44 $209.30 $191.36 $239.20 $233.22 $134.55 $122.59 $125.58 $119.60 $224.25 $194.35
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110758 54150 HCHG CIRCUMCISION W REGIONAL BLOCK 797.00 $717.30 $318.80 $637.60 $446.32 $557.90 $510.08 $637.60 $621.66 $358.65 $326.77 $334.74 $318.80 $597.75 $518.05
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110760 93005 HCHG EKG 12LEAD TRACING ONLY WO REPORT/INTERP 146.00 $131.40 $58.40 $116.80 $81.76 $102.20 $93.44 $116.80 $113.88 $65.70 $59.86 $61.32 $58.40 $109.50 $94.90
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110763 93041 "HCHG RHYTHM ECG,1 TO 3 LEADS TRACING ONLY" 22.00 $19.80 $8.80 $17.60 $12.32 $15.40 $14.08 $17.60 $17.16 $9.90 $9.02 $9.24 $8.80 $16.50 $14.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110768 93225 HCHG EXTNL ECG CONTINUOUS RHYTHM HOOK UP AND REC UP TO 48 HR 240.00 $216.00 $96.00 $192.00 $134.40 $168.00 $153.60 $192.00 $187.20 $108.00 $98.40 $100.80 $96.00 $180.00 $156.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110769 93226 HCHG EXTNL ECG CONTIN MONIT SCAN AND ANALY UP TO 48 HR 387.00 $348.30 $154.80 $309.60 $216.72 $270.90 $247.68 $309.60 $301.86 $174.15 $158.67 $162.54 $154.80 $290.25 $251.55
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110771 93270 HCHG PT ACTIVATED EVENT RECORDING ONLY 134.00 $120.60 $53.60 $107.20 $75.04 $93.80 $85.76 $107.20 $104.52 $60.30 $54.94 $56.28 $53.60 $100.50 $87.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110772 110772 HCHG OUTPATIENT TELEMETRY 36.00 $32.40 $14.40 $28.80 $20.16 $25.20 $23.04 $28.80 $28.08 $16.20 $14.76 $15.12 $14.40 $27.00 $23.40
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110816 59000 HCHG AMNIOCENTESIS DIAGNOSTIC "1,016.00" $914.40 $406.40 $812.80 $568.96 $711.20 $650.24 $812.80 $792.48 $457.20 $416.56 $426.72 $406.40 $762.00 $660.40
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110820 59412 "HCHG ANTEPARTUM MANIPULATION,EXTERNAL CEPHALIC" "1,275.00" " $1,147.50 " $510.00 " $1,020.00 " $714.00 $892.50 $816.00 " $1,020.00 " $994.50 $573.75 $522.75 $535.50 $510.00 $956.25 $828.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110822 29445 HCHG APPLICATION OF RIGID TOTAL CONTACT COST 584.00 $525.60 $233.60 $467.20 $327.04 $408.80 $373.76 $467.20 $455.52 $262.80 $239.44 $245.28 $233.60 $438.00 $379.60
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110827 36600 HCHG ARTERIAL PUNCTURE 201.00 $180.90 $80.40 $160.80 $112.56 $140.70 $128.64 $160.80 $156.78 $90.45 $82.41 $84.42 $80.40 $150.75 $130.65
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110843 51720 HCHG BLADDER INSTILLATION ANTI-CA AGENT 667.00 $600.30 $266.80 $533.60 $373.52 $466.90 $426.88 $533.60 $520.26 $300.15 $273.47 $280.14 $266.80 $500.25 $433.55
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110893 11042 HCHG DEBRIDE SQ TISSUE FIRST 20 SQ CM 379.00 $341.10 $151.60 $303.20 $212.24 $265.30 $242.56 $303.20 $295.62 $170.55 $155.39 $159.18 $151.60 $284.25 $246.35
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110896 11043 HCHG DEBRIDE TO MUSC/FASCIA FIRST 20 SQ CM 761.00 $684.90 $304.40 $608.80 $426.16 $532.70 $487.04 $608.80 $593.58 $342.45 $312.01 $319.62 $304.40 $570.75 $494.65
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110897 11720 HCHG DEBRIDEMENT OF NAILS ONE TO FIVE 129.00 $116.10 $51.60 $103.20 $72.24 $90.30 $82.56 $103.20 $100.62 $58.05 $52.89 $54.18 $51.60 $96.75 $83.85
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110898 11721 HCHG DEBRIDEMENT OF NAILS SIX OR MORE 163.00 $146.70 $65.20 $130.40 $91.28 $114.10 $104.32 $130.40 $127.14 $73.35 $66.83 $68.46 $65.20 $122.25 $105.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110900 36593 HCHG DECLOT IVAD OR CATH W THROMBOLYTIC 247.00 $222.30 $98.80 $197.60 $138.32 $172.90 $158.08 $197.60 $192.66 $111.15 $101.27 $103.74 $98.80 $185.25 $160.55
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110948 59899 "HCHG UNLISTED PROC, MATERNITY CARE & DELIVERY" "2,023.00" " $1,820.70 " $809.20 " $1,618.40 " " $1,132.88 " " $1,416.10 " " $1,294.72 " " $1,618.40 " " $1,577.94 " $910.35 $829.43 $849.66 $809.20 " $1,517.25 " " $1,314.95 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 110958 10060 HCHG I&D ABSCESS/CARB/CYST SINGLE SIMPLE 379.00 $341.10 $151.60 $303.20 $212.24 $265.30 $242.56 $303.20 $295.62 $170.55 $155.39 $159.18 $151.60 $284.25 $246.35
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111041 51702 HCHG INSERT INDWELL BLADD CATH SIMPLE TX 296.00 $266.40 $118.40 $236.80 $165.76 $207.20 $189.44 $236.80 $230.88 $133.20 $121.36 $124.32 $118.40 $222.00 $192.40
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111047 36568 HCHG INSERT PICC WO SUBQ PORT/PUMP WO GUIDANCE <5 YRS "1,526.00" " $1,373.40 " $610.40 " $1,220.80 " $854.56 " $1,068.20 " $976.64 " $1,220.80 " " $1,190.28 " $686.70 $625.66 $640.92 $610.40 " $1,144.50 " $991.90
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111048 36569 HCHG INSERT PICC WO SUBQ PORT/PUMP WO GUIDANCE =>5 YRS 731.00 $657.90 $292.40 $584.80 $409.36 $511.70 $467.84 $584.80 $570.18 $328.95 $299.71 $307.02 $292.40 $548.25 $475.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111052 51701 HCHG INSERTION NON-INDWELL/STRGT BLADDER CATH-TX 241.00 $216.90 $96.40 $192.80 $134.96 $168.70 $154.24 $192.80 $187.98 $108.45 $98.81 $101.22 $96.40 $180.75 $156.65
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111054 59200 HCHG INSERTION OF CERVICAL DILATOR 569.00 $512.10 $227.60 $455.20 $318.64 $398.30 $364.16 $455.20 $443.82 $256.05 $233.29 $238.98 $227.60 $426.75 $369.85
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111070 31720 HCHG NASOTRACHEAL SUCTIONING 251.00 $225.90 $100.40 $200.80 $140.56 $175.70 $160.64 $200.80 $195.78 $112.95 $102.91 $105.42 $100.40 $188.25 $163.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111072 99214 HCHG E/M EST PT LEVEL IV 311.00 $279.90 $124.40 $248.80 $174.16 $217.70 $199.04 $248.80 $242.58 $139.95 $127.51 $130.62 $124.40 $233.25 $202.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111073 99215 HCHG E/M EST PT LEVEL V 403.00 $362.70 $161.20 $322.40 $225.68 $282.10 $257.92 $322.40 $314.34 $181.35 $165.23 $169.26 $161.20 $302.25 $261.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111074 99211 HCHG E/M EST PT LEVEL I 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111075 99212 HCHG E/M EST PT LEVEL II 163.00 $146.70 $65.20 $130.40 $91.28 $114.10 $104.32 $130.40 $127.14 $73.35 $66.83 $68.46 $65.20 $122.25 $105.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111076 99213 HCHG E/M EST PT LEVEL III 208.00 $187.20 $83.20 $166.40 $116.48 $145.60 $133.12 $166.40 $162.24 $93.60 $85.28 $87.36 $83.20 $156.00 $135.20
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111082 11055 HCHG PARING OR CUTTING CORN/CALLUS 164.00 $147.60 $65.60 $131.20 $91.84 $114.80 $104.96 $131.20 $127.92 $73.80 $67.24 $68.88 $65.60 $123.00 $106.60
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111083 11057 HCHG PARING/CURET >4 LESIONS 142.00 $127.80 $56.80 $113.60 $79.52 $99.40 $90.88 $113.60 $110.76 $63.90 $58.22 $59.64 $56.80 $106.50 $92.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111084 11056 HCHG PARING/CURET 2-4 LESIONS 196.00 $176.40 $78.40 $156.80 $109.76 $137.20 $125.44 $156.80 $152.88 $88.20 $80.36 $82.32 $78.40 $147.00 $127.40
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111135 29580 HCHG STRAPPING UNNA BOOT UNILATERAL 171.00 $153.90 $68.40 $136.80 $95.76 $119.70 $109.44 $136.80 $133.38 $76.95 $70.11 $71.82 $68.40 $128.25 $111.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111147 11719 HCHG TRIMMING NONDYSTROPHIC NAILS 76.00 $68.40 $30.40 $60.80 $42.56 $53.20 $48.64 $60.80 $59.28 $34.20 $31.16 $31.92 $30.40 $57.00 $49.40
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111170 G0008 HCHG ADMIN OF SEASONAL INFLUENZA VACCINE 11.00 $9.90 $4.40 $8.80 $6.16 $7.70 $7.04 $8.80 $8.58 $4.95 $4.51 $4.62 $4.40 $8.25 $7.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111171 G0009 HCHG ADMIN OF PNEUMOCOCCAL VACCINE 39.00 $35.10 $15.60 $31.20 $21.84 $27.30 $24.96 $31.20 $30.42 $17.55 $15.99 $16.38 $15.60 $29.25 $25.35
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111172 90471 HCHG IMMUN ADMIN IM/SQ ONE VACCINE (SGL/COMBO) 40.00 $36.00 $16.00 $32.00 $22.40 $28.00 $25.60 $32.00 $31.20 $18.00 $16.40 $16.80 $16.00 $30.00 $26.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111173 90472 HCHG IMMUN ADMIN IM/SQ EA ADDL (SGL/COMBO) 29.00 $26.10 $11.60 $23.20 $16.24 $20.30 $18.56 $23.20 $22.62 $13.05 $11.89 $12.18 $11.60 $21.75 $18.85
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111213 93788 HCHG CONTIN AMB BP MONITORING >24 HOURS SCAN ANALYSIS 102.00 $91.80 $40.80 $81.60 $57.12 $71.40 $65.28 $81.60 $79.56 $45.90 $41.82 $42.84 $40.80 $76.50 $66.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111216 95250 HCHG CONT GLUC MON HKUP & RECORD > 72 HRS 446.00 $401.40 $178.40 $356.80 $249.76 $312.20 $285.44 $356.80 $347.88 $200.70 $182.86 $187.32 $178.40 $334.50 $289.90
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111225 59025 HCHG FETAL NON-STRESS TEST 298.00 $268.20 $119.20 $238.40 $166.88 $208.60 $190.72 $238.40 $232.44 $134.10 $122.18 $125.16 $119.20 $223.50 $193.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111229 95810 HCHG POLYSOMNOGRAPHY => 6YRS =>4 PARAMETERS "3,669.00" " $3,302.10 " " $1,467.60 " " $2,935.20 " " $2,054.64 " " $2,568.30 " " $2,348.16 " " $2,935.20 " " $2,861.82 " " $1,651.05 " " $1,504.29 " " $1,540.98 " " $1,467.60 " " $2,751.75 " " $2,384.85 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111230 95811 HCHG POLYSOMNOGRAPHY => 6YRS =>4 PARAMETERS W CPAP OR BILEVEL "4,052.00" " $3,646.80 " " $1,620.80 " " $3,241.60 " " $2,269.12 " " $2,836.40 " " $2,593.28 " " $3,241.60 " " $3,160.56 " " $1,823.40 " " $1,661.32 " " $1,701.84 " " $1,620.80 " " $3,039.00 " " $2,633.80 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111263 99195 HCHG PHLEBOTOMY THERAPEUTIC 413.00 $371.70 $165.20 $330.40 $231.28 $289.10 $264.32 $330.40 $322.14 $185.85 $169.33 $173.46 $165.20 $309.75 $268.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111271 G0109 HCHG DSMT OUTPT GROUP PER 30 MIN 55.00 $49.50 $22.00 $44.00 $30.80 $38.50 $35.20 $44.00 $42.90 $24.75 $22.55 $23.10 $22.00 $41.25 $35.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111272 G0108 HCHG DSMT OUTPT INDIV PER 30 MIN 102.00 $91.80 $40.80 $81.60 $57.12 $71.40 $65.28 $81.60 $79.56 $45.90 $41.82 $42.84 $40.80 $76.50 $66.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111278 97804 HCHG MNT GROUP EA 30 MIN 29.00 $26.10 $11.60 $23.20 $16.24 $20.30 $18.56 $23.20 $22.62 $13.05 $11.89 $12.18 $11.60 $21.75 $18.85
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111279 97802 HCHG MNT INDIV INITIAL EA 15MIN 83.00 $74.70 $33.20 $66.40 $46.48 $58.10 $53.12 $66.40 $64.74 $37.35 $34.03 $34.86 $33.20 $62.25 $53.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111280 97803 HCHG MNT INDIV SUBSEQ EA 15 MIN 67.00 $60.30 $26.80 $53.60 $37.52 $46.90 $42.88 $53.60 $52.26 $30.15 $27.47 $28.14 $26.80 $50.25 $43.55
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111289 93797 HCHG O/P CARDIAC REHAB EVAL WITHOUT CONT MONITOR 144.00 $129.60 $57.60 $115.20 $80.64 $100.80 $92.16 $115.20 $112.32 $64.80 $59.04 $60.48 $57.60 $108.00 $93.60
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111290 93798 HCHG O/P CARDIAC REHAB EVAL W/CONT MONT 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111291 93798 HCHG O/P CARDIAC REHAB W/CONT MONITOR 298.00 $268.20 $119.20 $238.40 $166.88 $208.60 $190.72 $238.40 $232.44 $134.10 $122.18 $125.16 $119.20 $223.50 $193.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111292 93797 HCHG O/P CARDIAC REHAB WITHOUT CONT MONITOR 144.00 $129.60 $57.60 $115.20 $80.64 $100.80 $92.16 $115.20 $112.32 $64.80 $59.04 $60.48 $57.60 $108.00 $93.60
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111359 91010 HCHG ESOPHAGEAL MOTILITY STUDY "2,143.00" " $1,928.70 " $857.20 " $1,714.40 " " $1,200.08 " " $1,500.10 " " $1,371.52 " " $1,714.40 " " $1,671.54 " $964.35 $878.63 $900.06 $857.20 " $1,607.25 " " $1,392.95 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111478 94660 HCHG RC CPAP/BI-LEVEL CONTINUOUS 541.00 $486.90 $216.40 $432.80 $302.96 $378.70 $346.24 $432.80 $421.98 $243.45 $221.81 $227.22 $216.40 $405.75 $351.65
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111485 76815 HCHG US OB LIMITED 1 OR MORE FETUSES 620.00 $558.00 $248.00 $496.00 $347.20 $434.00 $396.80 $496.00 $483.60 $279.00 $254.20 $260.40 $248.00 $465.00 $403.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111486 36591 HCHG ED BLOOD DRAW THROUGH COMPLETELY IMPLANTED VAD 158.00 $142.20 $63.20 $126.40 $88.48 $110.60 $101.12 $126.40 $123.24 $71.10 $64.78 $66.36 $63.20 $118.50 $102.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111491 97597 HCHG PT SELECTIVE DEBRIDE 20 SQ CM OR LESS 246.00 $221.40 $98.40 $196.80 $137.76 $172.20 $157.44 $196.80 $191.88 $110.70 $100.86 $103.32 $98.40 $184.50 $159.90
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111495 97597 HCHG SELECTIVE DEBRIDE 20 SQ CM OR LESS 314.00 $282.60 $125.60 $251.20 $175.84 $219.80 $200.96 $251.20 $244.92 $141.30 $128.74 $131.88 $125.60 $235.50 $204.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111496 97598 HCHG PT SELECTV DEBRIDE EA ADDL 20 SQ CM OR PART THEREOF 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111500 97598 HCHG SELECTV DEBRIDE EA ADDL 20 SQ CM OR PART THEREOF 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111501 97605 HCHG PT VAC/NPWT <= 50 SQ CM W DME 174.00 $156.60 $69.60 $139.20 $97.44 $121.80 $111.36 $139.20 $135.72 $78.30 $71.34 $73.08 $69.60 $130.50 $113.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111504 97606 HCHG PT VAC/NPWT > 50 SQ CM W DME 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111514 92625 HCHG TINNITUS ASSESSMENT 132.00 $118.80 $52.80 $105.60 $73.92 $92.40 $84.48 $105.60 $102.96 $59.40 $54.12 $55.44 $52.80 $99.00 $85.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111598 97010 HCHG PT HOT PACK COLD PACK 22.00 $19.80 $8.80 $17.60 $12.32 $15.40 $14.08 $17.60 $17.16 $9.90 $9.02 $9.24 $8.80 $16.50 $14.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111599 97010 HCHG OT HOT PACK COLD PACK 22.00 $19.80 $8.80 $17.60 $12.32 $15.40 $14.08 $17.60 $17.16 $9.90 $9.02 $9.24 $8.80 $16.50 $14.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111766 97760 HCHG PT ORTHOTIC FIT/TRAIN UPR/LWR EXT TRUNK INITIAL ENC 15 MIN 134.00 $120.60 $53.60 $107.20 $75.04 $93.80 $85.76 $107.20 $104.52 $60.30 $54.94 $56.28 $53.60 $100.50 $87.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111767 97760 HCHG OT ORTHOTIC FIT/TRAIN UPR/LWR EXT TRUNK INITIAL ENC 15 MIN 134.00 $120.60 $53.60 $107.20 $75.04 $93.80 $85.76 $107.20 $104.52 $60.30 $54.94 $56.28 $53.60 $100.50 $87.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111768 96401 HCHG CHEMO ADMIN SQ/IM NON-HORMONAL ANTI NEOPL 226.00 $203.40 $90.40 $180.80 $126.56 $158.20 $144.64 $180.80 $176.28 $101.70 $92.66 $94.92 $90.40 $169.50 $146.90
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111769 96402 HCHG CHEMO ADMIN SQ/IM HORMON ANTI NEOPL 180.00 $162.00 $72.00 $144.00 $100.80 $126.00 $115.20 $144.00 $140.40 $81.00 $73.80 $75.60 $72.00 $135.00 $117.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111770 96523 HCHG IRRIG DRUG DELIVERY DEVICE 153.00 $137.70 $61.20 $122.40 $85.68 $107.10 $97.92 $122.40 $119.34 $68.85 $62.73 $64.26 $61.20 $114.75 $99.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111783 96372 HCHG INJECTION SQ/IM 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111784 96372 HCHG ED INJECTION SQ/IM 107.00 $96.30 $42.80 $85.60 $59.92 $74.90 $68.48 $85.60 $83.46 $48.15 $43.87 $44.94 $42.80 $80.25 $69.55
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111787 96522 HCHG REFILL/MAINT IMPLANTABLE PUMP 289.00 $260.10 $115.60 $231.20 $161.84 $202.30 $184.96 $231.20 $225.42 $130.05 $118.49 $121.38 $115.60 $216.75 $187.85
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111788 97602 HCHG DEBRIDEMENT NON-SELECTIVE NON REHAB PROVIDER 211.00 $189.90 $84.40 $168.80 $118.16 $147.70 $135.04 $168.80 $164.58 $94.95 $86.51 $88.62 $84.40 $158.25 $137.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111789 97605 HCHG VAC/NPWT <= 50 SQ CM RN W DME 244.00 $219.60 $97.60 $195.20 $136.64 $170.80 $156.16 $195.20 $190.32 $109.80 $100.04 $102.48 $97.60 $183.00 $158.60
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111790 97606 HCHG VAC/NPWT > 50 SQ CM RN W DME 220.00 $198.00 $88.00 $176.00 $123.20 $154.00 $140.80 $176.00 $171.60 $99.00 $90.20 $92.40 $88.00 $165.00 $143.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111843 95806 HCHG HOME SLEEP APNEA MONITOR STUDY 757.00 $681.30 $302.80 $605.60 $423.92 $529.90 $484.48 $605.60 $590.46 $340.65 $310.37 $317.94 $302.80 $567.75 $492.05
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111847 99407 HCHG SMOKING & TOBACCO CESSATION >10 MIN VISIT 71.00 $63.90 $28.40 $56.80 $39.76 $49.70 $45.44 $56.80 $55.38 $31.95 $29.11 $29.82 $28.40 $53.25 $46.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111856 99406 HCHG SMOKING & TOBACCO CESSATION >3-10 MIN VISIT 56.00 $50.40 $22.40 $44.80 $31.36 $39.20 $35.84 $44.80 $43.68 $25.20 $22.96 $23.52 $22.40 $42.00 $36.40
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111870 96360 HCHG IV INFUSION HYDRATION INITIAL 31-60 MIN 433.00 $389.70 $173.20 $346.40 $242.48 $303.10 $277.12 $346.40 $337.74 $194.85 $177.53 $181.86 $173.20 $324.75 $281.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111871 96361 HCHG IV INFUSION HYDRATION EACH ADDL HOUR 99.00 $89.10 $39.60 $79.20 $55.44 $69.30 $63.36 $79.20 $77.22 $44.55 $40.59 $41.58 $39.60 $74.25 $64.35
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111872 96365 HCHG IV INF THERAPY/DX/PROPH INITIAL HR 363.00 $326.70 $145.20 $290.40 $203.28 $254.10 $232.32 $290.40 $283.14 $163.35 $148.83 $152.46 $145.20 $272.25 $235.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111873 96366 HCHG IV INF THERAPY/DX/PROPH EA ADDL HR 131.00 $117.90 $52.40 $104.80 $73.36 $91.70 $83.84 $104.80 $102.18 $58.95 $53.71 $55.02 $52.40 $98.25 $85.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111874 96367 HCHG TX/PROPH/DX ADDL SEQ IV INF 185.00 $166.50 $74.00 $148.00 $103.60 $129.50 $118.40 $148.00 $144.30 $83.25 $75.85 $77.70 $74.00 $138.75 $120.25
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111875 96375 HCHG IV INJECTION TX/DX/PROPHYLAXIS ADDL SEQUENTIAL 106.00 $95.40 $42.40 $84.80 $59.36 $74.20 $67.84 $84.80 $82.68 $47.70 $43.46 $44.52 $42.40 $79.50 $68.90
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111876 96409 HCHG CHEMO IV PUSH INITIAL 598.00 $538.20 $239.20 $478.40 $334.88 $418.60 $382.72 $478.40 $466.44 $269.10 $245.18 $251.16 $239.20 $448.50 $388.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111877 96411 HCHG CHEMO IV PUSH EACH ADDL 242.00 $217.80 $96.80 $193.60 $135.52 $169.40 $154.88 $193.60 $188.76 $108.90 $99.22 $101.64 $96.80 $181.50 $157.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111878 96413 HCHG CHEMO IV ADMIN INITIAL HOUR 757.00 $681.30 $302.80 $605.60 $423.92 $529.90 $484.48 $605.60 $590.46 $340.65 $310.37 $317.94 $302.80 $567.75 $492.05
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111879 96415 HCHG CHEMO IV ADMIN ADDL HOUR 177.00 $159.30 $70.80 $141.60 $99.12 $123.90 $113.28 $141.60 $138.06 $79.65 $72.57 $74.34 $70.80 $132.75 $115.05
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111880 96417 HCHG CHEMO IV ADMIN ADDL SEQUENTIAL INFUSION 460.00 $414.00 $184.00 $368.00 $257.60 $322.00 $294.40 $368.00 $358.80 $207.00 $188.60 $193.20 $184.00 $345.00 $299.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111881 28010 HCHG TENOTOMY PERC TOE SNGL 757.00 $681.30 $302.80 $605.60 $423.92 $529.90 $484.48 $605.60 $590.46 $340.65 $310.37 $317.94 $302.80 $567.75 $492.05
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111882 96368 HCHG IV INFUSION TX/DX/PROPHYLAXIS CONCURRENT 114.00 $102.60 $45.60 $91.20 $63.84 $79.80 $72.96 $91.20 $88.92 $51.30 $46.74 $47.88 $45.60 $85.50 $74.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111888 96361 HCHG ED IV INFUSION HYDRATION EACH ADDL HOUR 99.00 $89.10 $39.60 $79.20 $55.44 $69.30 $63.36 $79.20 $77.22 $44.55 $40.59 $41.58 $39.60 $74.25 $64.35
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111889 96367 HCHG ED TX/PROPH/DX ADDL SEQ IV INF 185.00 $166.50 $74.00 $148.00 $103.60 $129.50 $118.40 $148.00 $144.30 $83.25 $75.85 $77.70 $74.00 $138.75 $120.25
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111890 96360 HCHG ED IV INFUSION HYDRATION INITIAL 31-60 MIN 298.00 $268.20 $119.20 $238.40 $166.88 $208.60 $190.72 $238.40 $232.44 $134.10 $122.18 $125.16 $119.20 $223.50 $193.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111891 96365 HCHG ED IV INF THERAPY/DX/PROPH INITIAL HR 433.00 $389.70 $173.20 $346.40 $242.48 $303.10 $277.12 $346.40 $337.74 $194.85 $177.53 $181.86 $173.20 $324.75 $281.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111892 96366 HCHG ED IV INF THERAPY/DX/PROPH EA ADDL HR 131.00 $117.90 $52.40 $104.80 $73.36 $91.70 $83.84 $104.80 $102.18 $58.95 $53.71 $55.02 $52.40 $98.25 $85.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111906 97112 HCHG SLP NEUROMUSCULAR RE-ED 15 MIN 74.00 $66.60 $29.60 $59.20 $41.44 $51.80 $47.36 $59.20 $57.72 $33.30 $30.34 $31.08 $29.60 $55.50 $48.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111938 111938 HCHG PROCEDURE LEVEL 4 "2,252.00" " $2,026.80 " $900.80 " $1,801.60 " " $1,261.12 " " $1,576.40 " " $1,441.28 " " $1,801.60 " " $1,756.56 " " $1,013.40 " $923.32 $945.84 $900.80 " $1,689.00 " " $1,463.80 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111942 111942 HCHG PROCEDURE LEVEL 4 ADDL MIN 98.00 $88.20 $39.20 $78.40 $54.88 $68.60 $62.72 $78.40 $76.44 $44.10 $40.18 $41.16 $39.20 $73.50 $63.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111946 111946 HCHG PROCEDURE LEVEL 5 "4,937.00" " $4,443.30 " " $1,974.80 " " $3,949.60 " " $2,764.72 " " $3,455.90 " " $3,159.68 " " $3,949.60 " " $3,850.86 " " $2,221.65 " " $2,024.17 " " $2,073.54 " " $1,974.80 " " $3,702.75 " " $3,209.05 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111950 111950 HCHG PROCEDURE LEVEL 5 ADDL MIN 50.00 $45.00 $20.00 $40.00 $28.00 $35.00 $32.00 $40.00 $39.00 $22.50 $20.50 $21.00 $20.00 $37.50 $32.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111954 111954 HCHG PROCEDURE LEVEL 6 "8,191.00" " $7,371.90 " " $3,276.40 " " $6,552.80 " " $4,586.96 " " $5,733.70 " " $5,242.24 " " $6,552.80 " " $6,388.98 " " $3,685.95 " " $3,358.31 " " $3,440.22 " " $3,276.40 " " $6,143.25 " " $5,324.15 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111958 111958 HCHG PROCEDURE LEVEL 6 ADDL MIN 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111964 88720 HCHG TRANSCUTANEOUS BILIRUBIN 32.00 $28.80 $12.80 $25.60 $17.92 $22.40 $20.48 $25.60 $24.96 $14.40 $13.12 $13.44 $12.80 $24.00 $20.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111991 96374 HCHG ED IV INJECTION TX/DX/PROPH INITIAL 466.00 $419.40 $186.40 $372.80 $260.96 $326.20 $298.24 $372.80 $363.48 $209.70 $191.06 $195.72 $186.40 $349.50 $302.90
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 111992 96375 HCHG ED IV INJECTION TX/DX/PROPH ADDL SEQUENTIAL 121.00 $108.90 $48.40 $96.80 $67.76 $84.70 $77.44 $96.80 $94.38 $54.45 $49.61 $50.82 $48.40 $90.75 $78.65
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112000 99465 HCHG NEWBORN DELIVERY PPV "1,052.00" $946.80 $420.80 $841.60 $589.12 $736.40 $673.28 $841.60 $820.56 $473.40 $431.32 $441.84 $420.80 $789.00 $683.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112026 96368 HCHG ED IV INFUSION TX/DX/PROPHYLAXIS CONCURRENT 114.00 $102.60 $45.60 $91.20 $63.84 $79.80 $72.96 $91.20 $88.92 $51.30 $46.74 $47.88 $45.60 $85.50 $74.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112027 112027 HCHG RECOVERY PER MINUTE 28.00 $25.20 $11.20 $22.40 $15.68 $19.60 $17.92 $22.40 $21.84 $12.60 $11.48 $11.76 $11.20 $21.00 $18.20
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112048 94002 HCHG RC VENTILATION ASSIST FIRST DAY 865.00 $778.50 $346.00 $692.00 $484.40 $605.50 $553.60 $692.00 $674.70 $389.25 $354.65 $363.30 $346.00 $648.75 $562.25
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112051 94003 HCHG RC VENTILATION ASSIST SUBSEQ DAY 298.00 $268.20 $119.20 $238.40 $166.88 $208.60 $190.72 $238.40 $232.44 $134.10 $122.18 $125.16 $119.20 $223.50 $193.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112123 51798 HCHG MEAS POST VOID RES US NON-IMAGING 99.00 $89.10 $39.60 $79.20 $55.44 $69.30 $63.36 $79.20 $77.22 $44.55 $40.59 $41.58 $39.60 $74.25 $64.35
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112157 P9612 HCHG CATHETERIZATION UA SPECIMEN COL 23.00 $20.70 $9.20 $18.40 $12.88 $16.10 $14.72 $18.40 $17.94 $10.35 $9.43 $9.66 $9.20 $17.25 $14.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112167 P9612 HCHG ED CATHETERIZATION UA SPECIMEN COL 22.00 $19.80 $8.80 $17.60 $12.32 $15.40 $14.08 $17.60 $17.16 $9.90 $9.02 $9.24 $8.80 $16.50 $14.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112209 96376 HCHG ED IV INJECTION TX/DX/PROPHYLACTIC EACH ADDL PUSH OF SAME DRUG 182.00 $163.80 $72.80 $145.60 $101.92 $127.40 $116.48 $145.60 $141.96 $81.90 $74.62 $76.44 $72.80 $136.50 $118.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112231 93017 HCHG RAD CV STRESS TEST EXERCISE OR PHARM TRACE ONLY "1,191.00" " $1,071.90 " $476.40 $952.80 $666.96 $833.70 $762.24 $952.80 $928.98 $535.95 $488.31 $500.22 $476.40 $893.25 $774.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112236 36592 HCHG ED BLOOD DRAW THROUGH CENTRAL OR PERIPHERAL VAD 174.00 $156.60 $69.60 $139.20 $97.44 $121.80 $111.36 $139.20 $135.72 $78.30 $71.34 $73.08 $69.60 $130.50 $113.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112249 96125 HCHG OT COGNITIVE TEST PER HR 332.00 $298.80 $132.80 $265.60 $185.92 $232.40 $212.48 $265.60 $258.96 $149.40 $136.12 $139.44 $132.80 $249.00 $215.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112255 76705 HCHG ED US ABDOMEN LIMITED 563.00 $506.70 $225.20 $450.40 $315.28 $394.10 $360.32 $450.40 $439.14 $253.35 $230.83 $236.46 $225.20 $422.25 $365.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112256 76775 HCHG ED US RETROPERITONEAL LIMITED 764.00 $687.60 $305.60 $611.20 $427.84 $534.80 $488.96 $611.20 $595.92 $343.80 $313.24 $320.88 $305.60 $573.00 $496.60
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112257 76815 HCHG ED US OB LIMITED 1 OR MORE FETUSES 595.00 $535.50 $238.00 $476.00 $333.20 $416.50 $380.80 $476.00 $464.10 $267.75 $243.95 $249.90 $238.00 $446.25 $386.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112259 76604 HCHG ED US CHEST LIMITED 461.00 $414.90 $184.40 $368.80 $258.16 $322.70 $295.04 $368.80 $359.58 $207.45 $189.01 $193.62 $184.40 $345.75 $299.65
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112269 G0390 HCHG ED LEVEL IV TRAUMA TEAM ACTIVATION "2,922.00" " $2,629.80 " " $1,168.80 " " $2,337.60 " " $1,636.32 " " $2,045.40 " " $1,870.08 " " $2,337.60 " " $2,279.16 " " $1,314.90 " " $1,198.02 " " $1,227.24 " " $1,168.80 " " $2,191.50 " " $1,899.30 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112270 96416 HCHG CHEMO INF >8 HRS W PUMP 677.00 $609.30 $270.80 $541.60 $379.12 $473.90 $433.28 $541.60 $528.06 $304.65 $277.57 $284.34 $270.80 $507.75 $440.05
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112271 96521 HCHG CHEMO PORTABLE PUMP FILL 748.00 $673.20 $299.20 $598.40 $418.88 $523.60 $478.72 $598.40 $583.44 $336.60 $306.68 $314.16 $299.20 $561.00 $486.20
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112273 96521 HCHG PORTABLE PUMP FILL NON-CHEMO 653.00 $587.70 $261.20 $522.40 $365.68 $457.10 $417.92 $522.40 $509.34 $293.85 $267.73 $274.26 $261.20 $489.75 $424.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112357 Q3014 HCHG TELEHEALTH ORIGINATING SITE 96.00 $86.40 $38.40 $76.80 $53.76 $67.20 $61.44 $76.80 $74.88 $43.20 $39.36 $40.32 $38.40 $72.00 $62.40
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112377 64405 HCHG INJ(S) ANES AGENT AND/OR STEROID OCCIPITAL NERVE UNILAT 460.00 $414.00 $184.00 $368.00 $257.60 $322.00 $294.40 $368.00 $358.80 $207.00 $188.60 $193.20 $184.00 $345.00 $299.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112386 20550 HCHG INJ SGL TENDON SHEATH LIGAMENT 247.00 $222.30 $98.80 $197.60 $138.32 $172.90 $158.08 $197.60 $192.66 $111.15 $101.27 $103.74 $98.80 $185.25 $160.55
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112448 112448 HCHG ENDO LEVEL 1 "1,245.00" " $1,120.50 " $498.00 $996.00 $697.20 $871.50 $796.80 $996.00 $971.10 $560.25 $510.45 $522.90 $498.00 $933.75 $809.25
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112449 112449 HCHG ENDO LEVEL 2 "2,441.00" " $2,196.90 " $976.40 " $1,952.80 " " $1,366.96 " " $1,708.70 " " $1,562.24 " " $1,952.80 " " $1,903.98 " " $1,098.45 " " $1,000.81 " " $1,025.22 " $976.40 " $1,830.75 " " $1,586.65 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112450 112450 HCHG ENDO LEVEL 3 "2,522.00" " $2,269.80 " " $1,008.80 " " $2,017.60 " " $1,412.32 " " $1,765.40 " " $1,614.08 " " $2,017.60 " " $1,967.16 " " $1,134.90 " " $1,034.02 " " $1,059.24 " " $1,008.80 " " $1,891.50 " " $1,639.30 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112451 112451 HCHG ENDO LEVEL 4 "2,602.00" " $2,341.80 " " $1,040.80 " " $2,081.60 " " $1,457.12 " " $1,821.40 " " $1,665.28 " " $2,081.60 " " $2,029.56 " " $1,170.90 " " $1,066.82 " " $1,092.84 " " $1,040.80 " " $1,951.50 " " $1,691.30 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112452 112452 HCHG ENDO LEVEL 5 "2,793.00" " $2,513.70 " " $1,117.20 " " $2,234.40 " " $1,564.08 " " $1,955.10 " " $1,787.52 " " $2,234.40 " " $2,178.54 " " $1,256.85 " " $1,145.13 " " $1,173.06 " " $1,117.20 " " $2,094.75 " " $1,815.45 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112453 112453 HCHG ENDO LEVEL 6 "2,990.00" " $2,691.00 " " $1,196.00 " " $2,392.00 " " $1,674.40 " " $2,093.00 " " $1,913.60 " " $2,392.00 " " $2,332.20 " " $1,345.50 " " $1,225.90 " " $1,255.80 " " $1,196.00 " " $2,242.50 " " $1,943.50 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112463 11900 HCHG INJ INTRALESIONAL <=7 LESIONS 190.00 $171.00 $76.00 $152.00 $106.40 $133.00 $121.60 $152.00 $148.20 $85.50 $77.90 $79.80 $76.00 $142.50 $123.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112523 95992 HCHG PT CANALITH REPOSITIONING PER DAY 173.00 $155.70 $69.20 $138.40 $96.88 $121.10 $110.72 $138.40 $134.94 $77.85 $70.93 $72.66 $69.20 $129.75 $112.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112532 36430 HCHG BLOOD/BLOOD PRODUCT ADMIN PER UNIT 433.00 $389.70 $173.20 $346.40 $242.48 $303.10 $277.12 $346.40 $337.74 $194.85 $177.53 $181.86 $173.20 $324.75 $281.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112577 97016 HCHG OT VASOPNEUMATIC DEVICE 40.00 $36.00 $16.00 $32.00 $22.40 $28.00 $25.60 $32.00 $31.20 $18.00 $16.40 $16.80 $16.00 $30.00 $26.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112599 93308 HCHG ED US CARDIAC ECHO "1,094.00" $984.60 $437.60 $875.20 $612.64 $765.80 $700.16 $875.20 $853.32 $492.30 $448.54 $459.48 $437.60 $820.50 $711.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112620 93351 HCHG STRESS ECHO 2D EXERCISE W STRESS TEST WO CONTRAST 917.00 $825.30 $366.80 $733.60 $513.52 $641.90 $586.88 $733.60 $715.26 $412.65 $375.97 $385.14 $366.80 $687.75 $596.05
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112623 C8930 HCHG RAD STRESS ECHO 2D EXERCISE W STRESS TEST W CONTRAST 848.00 $763.20 $339.20 $678.40 $474.88 $593.60 $542.72 $678.40 $661.44 $381.60 $347.68 $356.16 $339.20 $636.00 $551.20
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112634 51798 HCHG MEAS POST VOID RESID US NON-IMAGING 150.00 $135.00 $60.00 $120.00 $84.00 $105.00 $96.00 $120.00 $117.00 $67.50 $61.50 $63.00 $60.00 $112.50 $97.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112635 G0390 HCHG ED LEVEL II TRAUMA TEAM ACTIVATION "2,192.00" " $1,972.80 " $876.80 " $1,753.60 " " $1,227.52 " " $1,534.40 " " $1,402.88 " " $1,753.60 " " $1,709.76 " $986.40 $898.72 $920.64 $876.80 " $1,644.00 " " $1,424.80 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112636 69210 HCHG REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT 162.00 $145.80 $64.80 $129.60 $90.72 $113.40 $103.68 $129.60 $126.36 $72.90 $66.42 $68.04 $64.80 $121.50 $105.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112673 92550 HCHG TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS 153.00 $137.70 $61.20 $122.40 $85.68 $107.10 $97.92 $122.40 $119.34 $68.85 $62.73 $64.26 $61.20 $114.75 $99.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112674 92570 HCHG ACOUSTIC IMMITTANCE TESTING W TYMPANOMETRY/ACOUSTIC REFLEX THRESHOLD/DECAY TESTING 98.00 $88.20 $39.20 $78.40 $54.88 $68.60 $62.72 $78.40 $76.44 $44.10 $40.18 $41.16 $39.20 $73.50 $63.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112705 29581 HCHG RN APPL MULTLAY COMPRS LWR LEG UNILATERAL 260.00 $234.00 $104.00 $208.00 $145.60 $182.00 $166.40 $208.00 $202.80 $117.00 $106.60 $109.20 $104.00 $195.00 $169.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112706 29581 HCHG PT APPL MULTLAY COMPRS LWR LEG 286.00 $257.40 $114.40 $228.80 $160.16 $200.20 $183.04 $228.80 $223.08 $128.70 $117.26 $120.12 $114.40 $214.50 $185.90
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112715 92610 HCHG OT EVAL ORAL/PHAR SWALLOWING 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112720 31500 HCHG INTUBATION ENDOTRACHEAL EMERGENCY 590.00 $531.00 $236.00 $472.00 $330.40 $413.00 $377.60 $472.00 $460.20 $265.50 $241.90 $247.80 $236.00 $442.50 $383.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112772 G0424 (IA) HCHG PULMONARY REHAB W EXERCISE 1 HOUR SESSION 273.00 $245.70 $109.20 $218.40 $152.88 $191.10 $174.72 $218.40 $212.94 $122.85 $111.93 $114.66 $109.20 $204.75 $177.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112776 96375 HCHG IV INJECTION TX/DX/PROPH SEQUENTIAL NEW DRUG 125.00 $112.50 $50.00 $100.00 $70.00 $87.50 $80.00 $100.00 $97.50 $56.25 $51.25 $52.50 $50.00 $93.75 $81.25
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112777 96374 HCHG IV INJECTION TX/DX/PROPH INITIAL 460.00 $414.00 $184.00 $368.00 $257.60 $322.00 $294.40 $368.00 $358.80 $207.00 $188.60 $193.20 $184.00 $345.00 $299.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112778 96376 HCHG IV INJECTION TX/DX/PROPH EACH ADDL PUSH OF SAME DRUG 182.00 $163.80 $72.80 $145.60 $101.92 $127.40 $116.48 $145.60 $141.96 $81.90 $74.62 $76.44 $72.80 $136.50 $118.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112848 97110 HCHG SLP THERAPEUTIC EXERCISE 15MIN 72.00 $64.80 $28.80 $57.60 $40.32 $50.40 $46.08 $57.60 $56.16 $32.40 $29.52 $30.24 $28.80 $54.00 $46.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112851 99202 HCHG NEW PT FAC VISIT LEVEL II AFFILIATE AND CK ONLY 198.00 $178.20 $79.20 $158.40 $110.88 $138.60 $126.72 $158.40 $154.44 $89.10 $81.18 $83.16 $79.20 $148.50 $128.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112852 99203 HCHG NEW PT FAC VISIT LEVEL III AFFILIATE AND CK ONLY 290.00 $261.00 $116.00 $232.00 $162.40 $203.00 $185.60 $232.00 $226.20 $130.50 $118.90 $121.80 $116.00 $217.50 $188.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112854 99204 HCHG NEW PT FAC VISIT LEVEL IV AFFILIATE CK AND HBC ONLY 417.00 $375.30 $166.80 $333.60 $233.52 $291.90 $266.88 $333.60 $325.26 $187.65 $170.97 $175.14 $166.80 $312.75 $271.05
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112866 76937 HCHG ED US GUIDANCE VASCULAR ACCESS 156.00 $140.40 $62.40 $124.80 $87.36 $109.20 $99.84 $124.80 $121.68 $70.20 $63.96 $65.52 $62.40 $117.00 $101.40
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112966 11046 HCHG DBRDMT MUSC/FASCIA EA ADDL 20 SQ CM OR PART THEREOF 276.00 $248.40 $110.40 $220.80 $154.56 $193.20 $176.64 $220.80 $215.28 $124.20 $113.16 $115.92 $110.40 $207.00 $179.40
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 112996 G0127 HCHG TRIM DYSTROPHIC NAILS ANY NUMBER 164.00 $147.60 $65.60 $131.20 $91.84 $114.80 $104.96 $131.20 $127.92 $73.80 $67.24 $68.88 $65.60 $123.00 $106.60
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 113021 82948 HCHG POC GLUCOSE AFFILIATE ONLY 40.00 $36.00 $16.00 $32.00 $22.40 $28.00 $25.60 $32.00 $31.20 $18.00 $16.40 $16.80 $16.00 $30.00 $26.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 113050 59414 HCHG DELIVER PLACENTA "1,044.00" $939.60 $417.60 $835.20 $584.64 $730.80 $668.16 $835.20 $814.32 $469.80 $428.04 $438.48 $417.60 $783.00 $678.60
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 113060 94799 HCHG RC META NEB THERAPY PER TREATMENT 221.00 $198.90 $88.40 $176.80 $123.76 $154.70 $141.44 $176.80 $172.38 $99.45 $90.61 $92.82 $88.40 $165.75 $143.65
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 113109 92558 HCHG EVOKED OTOACOUSTIC EMISSIONS SCREEN AUTO ANALYSIS 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 113111 15271 HCHG SKIN SUB GRAFT TRNK/ARM/LEG "1,191.00" " $1,071.90 " $476.40 $952.80 $666.96 $833.70 $762.24 $952.80 $928.98 $535.95 $488.31 $500.22 $476.40 $893.25 $774.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 113112 15272 HCHG SKIN SUB GRAFT T/A/L EA ADDL 25 SQ CM 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 113113 15273 HCHG SKN SUB GRFT T/A/L ADULT 100 SQ CM CHILD 1 PERCENT "2,327.00" " $2,094.30 " $930.80 " $1,861.60 " " $1,303.12 " " $1,628.90 " " $1,489.28 " " $1,861.60 " " $1,815.06 " " $1,047.15 " $954.07 $977.34 $930.80 " $1,745.25 " " $1,512.55 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 113114 15274 HCHG SKN SUB GRFT T/A/L ADULT 100 SQ CM CHILD 1 PERCENT EA ADDL 236.00 $212.40 $94.40 $188.80 $132.16 $165.20 $151.04 $188.80 $184.08 $106.20 $96.76 $99.12 $94.40 $177.00 $153.40
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 113115 15275 HCHG SKIN SUB GRAFT FACE/NK/HF/G "1,785.00" " $1,606.50 " $714.00 " $1,428.00 " $999.60 " $1,249.50 " " $1,142.40 " " $1,428.00 " " $1,392.30 " $803.25 $731.85 $749.70 $714.00 " $1,338.75 " " $1,160.25 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 113116 15276 HCHG SKIN SUB GRAFT F/N/HF/G 25 SQ CM 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 113120 94726 HCHG PFT PLETHYSMOGRAP 346.00 $311.40 $138.40 $276.80 $193.76 $242.20 $221.44 $276.80 $269.88 $155.70 $141.86 $145.32 $138.40 $259.50 $224.90
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 113121 94780 HCHG RC CAR SEAT/BED TEST 60 MIN 211.00 $189.90 $84.40 $168.80 $118.16 $147.70 $135.04 $168.80 $164.58 $94.95 $86.51 $88.62 $84.40 $158.25 $137.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 113122 94781 HCHG RC CAR SEAT/BED TEST EA ADDL 30 MIN 75.00 $67.50 $30.00 $60.00 $42.00 $52.50 $48.00 $60.00 $58.50 $33.75 $30.75 $31.50 $30.00 $56.25 $48.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 113143 92610 HCHG SLP EVAL ORAL/PHAR SWALLOWING 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 113165 97113 HCHG OT AQUATIC THERAPY 75.00 $67.50 $30.00 $60.00 $42.00 $52.50 $48.00 $60.00 $58.50 $33.75 $30.75 $31.50 $30.00 $56.25 $48.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 113245 94761 HCHG CCHD SCREEN 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 113259 G0281 HCHG ELEC STIM UNATTND ULCERS 1/MORE AREA AFFILIATE ONLY 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 113372 97607 HCHG NEG PRESS WOUND TX <= 50 SQ CM UTILIZING NON DME RN 315.00 $283.50 $126.00 $252.00 $176.40 $220.50 $201.60 $252.00 $245.70 $141.75 $129.15 $132.30 $126.00 $236.25 $204.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 113373 97608 HCHG NEG PRESS WOUND TX > 50 SQ CM UTILIZING NON DME RN 255.00 $229.50 $102.00 $204.00 $142.80 $178.50 $163.20 $204.00 $198.90 $114.75 $104.55 $107.10 $102.00 $191.25 $165.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114023 64633 HCHG RAD DSTR NROLYTC AGNT PARVERTEB FACET SNGL CRVCL/THORA "4,729.00" " $4,256.10 " " $1,891.60 " " $3,783.20 " " $2,648.24 " " $3,310.30 " " $3,026.56 " " $3,783.20 " " $3,688.62 " " $2,128.05 " " $1,938.89 " " $1,986.18 " " $1,891.60 " " $3,546.75 " " $3,073.85 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114025 64635 HCHG RAD DSTR NROLYTC AGNT PARVERTEB FACET SNGL LMBR/SACRAL "4,729.00" " $4,256.10 " " $1,891.60 " " $3,783.20 " " $2,648.24 " " $3,310.30 " " $3,026.56 " " $3,783.20 " " $3,688.62 " " $2,128.05 " " $1,938.89 " " $1,986.18 " " $1,891.60 " " $3,546.75 " " $3,073.85 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114135 36000 HCHG IV START AFFILIATE ONLY 138.00 $124.20 $55.20 $110.40 $77.28 $96.60 $88.32 $110.40 $107.64 $62.10 $56.58 $57.96 $55.20 $103.50 $89.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114136 91110 HCHG CAPSULE ENDOSCOPY AFFILIATE ONLY "3,084.00" " $2,775.60 " " $1,233.60 " " $2,467.20 " " $1,727.04 " " $2,158.80 " " $1,973.76 " " $2,467.20 " " $2,405.52 " " $1,387.80 " " $1,264.44 " " $1,295.28 " " $1,233.60 " " $2,313.00 " " $2,004.60 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114144 93798 HCHG O/P CARDIAC REHAB EVAL W/CONT MONT KX 263.00 $236.70 $105.20 $210.40 $147.28 $184.10 $168.32 $210.40 $205.14 $118.35 $107.83 $110.46 $105.20 $197.25 $170.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114145 93798 HCHG O/P CARDIAC REHAB W/CONT MONITOR KX 263.00 $236.70 $105.20 $210.40 $147.28 $184.10 $168.32 $210.40 $205.14 $118.35 $107.83 $110.46 $105.20 $197.25 $170.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114313 11044 HCHG DEBRIDE TO BONE FIRST 20 SQ CM "1,152.00" " $1,036.80 " $460.80 $921.60 $645.12 $806.40 $737.28 $921.60 $898.56 $518.40 $472.32 $483.84 $460.80 $864.00 $748.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114315 11046 HCHG DEBRIDE TO MUSCLE OR FASCIA EA ADDL 20 SQ CM 244.00 $219.60 $97.60 $195.20 $136.64 $170.80 $156.16 $195.20 $190.32 $109.80 $100.04 $102.48 $97.60 $183.00 $158.60
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114320 92521 HCHG SLP EVAL SPEECH FLUENCY 358.00 $322.20 $143.20 $286.40 $200.48 $250.60 $229.12 $286.40 $279.24 $161.10 $146.78 $150.36 $143.20 $268.50 $232.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114324 92522 HCHG SLP EVAL SPEECH SOUND PROD 290.00 $261.00 $116.00 $232.00 $162.40 $203.00 $185.60 $232.00 $226.20 $130.50 $118.90 $121.80 $116.00 $217.50 $188.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114328 92523 HCHG SLP EVAL SPEECH SOUND W LANGUAGE COMP 433.00 $389.70 $173.20 $346.40 $242.48 $303.10 $277.12 $346.40 $337.74 $194.85 $177.53 $181.86 $173.20 $324.75 $281.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114332 92524 HCHG SLP BEHAVIORAL QUAL ANLYS VOICE RESONANCE 305.00 $274.50 $122.00 $244.00 $170.80 $213.50 $195.20 $244.00 $237.90 $137.25 $125.05 $128.10 $122.00 $228.75 $198.25
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114336 94669 HCHG MECHANICAL CHEST WALL OSCILLATION PER SESSION 106.00 $95.40 $42.40 $84.80 $59.36 $74.20 $67.84 $84.80 $82.68 $47.70 $43.46 $44.52 $42.40 $79.50 $68.90
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114373 G0400 HCHG HOME SLEEP TEST TYPE IV PORTABLE AFFILIATE ONLY 855.00 $769.50 $342.00 $684.00 $478.80 $598.50 $547.20 $684.00 $666.90 $384.75 $350.55 $359.10 $342.00 $641.25 $555.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114380 92523 HCHG SLP EVAL SPEECH SOUND W LANGUAGE COMP 52 478.00 $430.20 $191.20 $382.40 $267.68 $334.60 $305.92 $382.40 $372.84 $215.10 $195.98 $200.76 $191.20 $358.50 $310.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114382 93797 HCHG OP CARDIAC REHAB EVAL WITHOUT CONT MONITOR KX 99.00 $89.10 $39.60 $79.20 $55.44 $69.30 $63.36 $79.20 $77.22 $44.55 $40.59 $41.58 $39.60 $74.25 $64.35
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114426 93797 HCHG CARDIAC REHAB PHASE 3 AFFILIATE ONLY 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114680 97140 HCHG PT MANUAL THERAPY XE 98.00 $88.20 $39.20 $78.40 $54.88 $68.60 $62.72 $78.40 $76.44 $44.10 $40.18 $41.16 $39.20 $73.50 $63.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114681 97140 HCHG PT MANUAL THERAPY XS 75.00 $67.50 $30.00 $60.00 $42.00 $52.50 $48.00 $60.00 $58.50 $33.75 $30.75 $31.50 $30.00 $56.25 $48.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114682 97140 HCHG PT MANUAL THERAPY XP 75.00 $67.50 $30.00 $60.00 $42.00 $52.50 $48.00 $60.00 $58.50 $33.75 $30.75 $31.50 $30.00 $56.25 $48.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114683 97140 HCHG PT MANUAL THERAPY XU 75.00 $67.50 $30.00 $60.00 $42.00 $52.50 $48.00 $60.00 $58.50 $33.75 $30.75 $31.50 $30.00 $56.25 $48.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114684 97140 HCHG OT MANUAL THERAPY XE 75.00 $67.50 $30.00 $60.00 $42.00 $52.50 $48.00 $60.00 $58.50 $33.75 $30.75 $31.50 $30.00 $56.25 $48.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114685 97140 HCHG OT MANUAL THERAPY XS 75.00 $67.50 $30.00 $60.00 $42.00 $52.50 $48.00 $60.00 $58.50 $33.75 $30.75 $31.50 $30.00 $56.25 $48.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114686 97140 HCHG OT MANUAL THERAPY XP 75.00 $67.50 $30.00 $60.00 $42.00 $52.50 $48.00 $60.00 $58.50 $33.75 $30.75 $31.50 $30.00 $56.25 $48.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114687 97140 HCHG OT MANUAL THERAPY XU 95.00 $85.50 $38.00 $76.00 $53.20 $66.50 $60.80 $76.00 $74.10 $42.75 $38.95 $39.90 $38.00 $71.25 $61.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114688 97530 HCHG OT THERAPEUTIC ACTIVITIES XE 63.00 $56.70 $25.20 $50.40 $35.28 $44.10 $40.32 $50.40 $49.14 $28.35 $25.83 $26.46 $25.20 $47.25 $40.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114689 97530 HCHG OT THERAPEUTIC ACTIVITIES XS 63.00 $56.70 $25.20 $50.40 $35.28 $44.10 $40.32 $50.40 $49.14 $28.35 $25.83 $26.46 $25.20 $47.25 $40.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114690 97530 HCHG OT THERAPEUTIC ACTIVITIES XP 63.00 $56.70 $25.20 $50.40 $35.28 $44.10 $40.32 $50.40 $49.14 $28.35 $25.83 $26.46 $25.20 $47.25 $40.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114691 97530 HCHG OT THERAPEUTIC ACTIVITIES XU 63.00 $56.70 $25.20 $50.40 $35.28 $44.10 $40.32 $50.40 $49.14 $28.35 $25.83 $26.46 $25.20 $47.25 $40.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114692 97530 HCHG PT THERAPEUTIC ACTIVITIES XE 103.00 $92.70 $41.20 $82.40 $57.68 $72.10 $65.92 $82.40 $80.34 $46.35 $42.23 $43.26 $41.20 $77.25 $66.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114693 97530 HCHG PT THERAPEUTIC ACTIVITIES XS 63.00 $56.70 $25.20 $50.40 $35.28 $44.10 $40.32 $50.40 $49.14 $28.35 $25.83 $26.46 $25.20 $47.25 $40.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114694 97530 HCHG PT THERAPEUTIC ACTIVITIES XP 63.00 $56.70 $25.20 $50.40 $35.28 $44.10 $40.32 $50.40 $49.14 $28.35 $25.83 $26.46 $25.20 $47.25 $40.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114695 97530 HCHG PT THERAPEUTIC ACTIVITIES XU 63.00 $56.70 $25.20 $50.40 $35.28 $44.10 $40.32 $50.40 $49.14 $28.35 $25.83 $26.46 $25.20 $47.25 $40.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114696 97535 HCHG PT SELFCARE/HOME MGMT XE 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114697 97535 HCHG PT SELFCARE/HOME MGMT XS 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114698 97535 HCHG PT SELFCARE/HOME MGMT XP 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114699 97535 HCHG PT SELFCARE/HOME MGMT XU 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114700 97535 HCHG OT SELFCARE/HOME MGMT XE 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114701 97535 HCHG OT SELFCARE/HOME MGMT XS 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114702 97535 HCHG OT SELFCARE/HOME MGMT XP 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114703 97535 HCHG OT SELFCARE/HOME MGMT XU 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114704 97110 HCHG OT THERAPEUTIC EXERCISE XE 72.00 $64.80 $28.80 $57.60 $40.32 $50.40 $46.08 $57.60 $56.16 $32.40 $29.52 $30.24 $28.80 $54.00 $46.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114705 97110 HCHG OT THERAPEUTIC EXERCISE XS 102.00 $91.80 $40.80 $81.60 $57.12 $71.40 $65.28 $81.60 $79.56 $45.90 $41.82 $42.84 $40.80 $76.50 $66.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114706 97110 HCHG OT THERAPEUTIC EXERCISE XP 72.00 $64.80 $28.80 $57.60 $40.32 $50.40 $46.08 $57.60 $56.16 $32.40 $29.52 $30.24 $28.80 $54.00 $46.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114707 97110 HCHG OT THERAPEUTIC EXERCISE XU 98.00 $88.20 $39.20 $78.40 $54.88 $68.60 $62.72 $78.40 $76.44 $44.10 $40.18 $41.16 $39.20 $73.50 $63.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114708 97110 HCHG PT THERAPEUTIC EXERCISE XE 103.00 $92.70 $41.20 $82.40 $57.68 $72.10 $65.92 $82.40 $80.34 $46.35 $42.23 $43.26 $41.20 $77.25 $66.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114709 97110 HCHG PT THERAPEUTIC EXERCISE XS 72.00 $64.80 $28.80 $57.60 $40.32 $50.40 $46.08 $57.60 $56.16 $32.40 $29.52 $30.24 $28.80 $54.00 $46.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114710 97110 HCHG PT THERAPEUTIC EXERCISE XP 72.00 $64.80 $28.80 $57.60 $40.32 $50.40 $46.08 $57.60 $56.16 $32.40 $29.52 $30.24 $28.80 $54.00 $46.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114711 97110 HCHG PT THERAPEUTIC EXERCISE XU 72.00 $64.80 $28.80 $57.60 $40.32 $50.40 $46.08 $57.60 $56.16 $32.40 $29.52 $30.24 $28.80 $54.00 $46.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114712 97110 HCHG SLP THERAPEUTIC EXERCISE XE 72.00 $64.80 $28.80 $57.60 $40.32 $50.40 $46.08 $57.60 $56.16 $32.40 $29.52 $30.24 $28.80 $54.00 $46.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114713 97110 HCHG SLP THERAPEUTIC EXERCISE XS 72.00 $64.80 $28.80 $57.60 $40.32 $50.40 $46.08 $57.60 $56.16 $32.40 $29.52 $30.24 $28.80 $54.00 $46.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114714 97110 HCHG SLP THERAPEUTIC EXERCISE XP 72.00 $64.80 $28.80 $57.60 $40.32 $50.40 $46.08 $57.60 $56.16 $32.40 $29.52 $30.24 $28.80 $54.00 $46.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114715 97110 HCHG SLP THERAPEUTIC EXERCISE XU 72.00 $64.80 $28.80 $57.60 $40.32 $50.40 $46.08 $57.60 $56.16 $32.40 $29.52 $30.24 $28.80 $54.00 $46.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114716 97116 HCHG PT GAIT TRAINING XE 88.00 $79.20 $35.20 $70.40 $49.28 $61.60 $56.32 $70.40 $68.64 $39.60 $36.08 $36.96 $35.20 $66.00 $57.20
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114717 97116 HCHG PT GAIT TRAINING XS 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114718 97116 HCHG PT GAIT TRAINING XP 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114719 97116 HCHG PT GAIT TRAINING XU 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114720 97112 HCHG PT NEUROMUSCULAR RE-ED XE 106.00 $95.40 $42.40 $84.80 $59.36 $74.20 $67.84 $84.80 $82.68 $47.70 $43.46 $44.52 $42.40 $79.50 $68.90
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114721 97112 HCHG PT NEUROMUSCULAR RE-ED XS 74.00 $66.60 $29.60 $59.20 $41.44 $51.80 $47.36 $59.20 $57.72 $33.30 $30.34 $31.08 $29.60 $55.50 $48.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114722 97112 HCHG PT NEUROMUSCULAR RE-ED XP 74.00 $66.60 $29.60 $59.20 $41.44 $51.80 $47.36 $59.20 $57.72 $33.30 $30.34 $31.08 $29.60 $55.50 $48.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114723 97112 HCHG PT NEUROMUSCULAR RE-ED XU 74.00 $66.60 $29.60 $59.20 $41.44 $51.80 $47.36 $59.20 $57.72 $33.30 $30.34 $31.08 $29.60 $55.50 $48.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114724 97112 HCHG OT NEUROMUSCULAR RE-ED XE 74.00 $66.60 $29.60 $59.20 $41.44 $51.80 $47.36 $59.20 $57.72 $33.30 $30.34 $31.08 $29.60 $55.50 $48.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114725 97112 HCHG OT NEUROMUSCULAR RE-ED XS 74.00 $66.60 $29.60 $59.20 $41.44 $51.80 $47.36 $59.20 $57.72 $33.30 $30.34 $31.08 $29.60 $55.50 $48.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114726 97112 HCHG OT NEUROMUSCULAR RE-ED XP 74.00 $66.60 $29.60 $59.20 $41.44 $51.80 $47.36 $59.20 $57.72 $33.30 $30.34 $31.08 $29.60 $55.50 $48.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114727 97112 HCHG OT NEUROMUSCULAR RE-ED XU 74.00 $66.60 $29.60 $59.20 $41.44 $51.80 $47.36 $59.20 $57.72 $33.30 $30.34 $31.08 $29.60 $55.50 $48.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114728 97113 HCHG PT AQUATIC THERAPY XE 98.00 $88.20 $39.20 $78.40 $54.88 $68.60 $62.72 $78.40 $76.44 $44.10 $40.18 $41.16 $39.20 $73.50 $63.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114729 97113 HCHG PT AQUATIC THERAPY XS 75.00 $67.50 $30.00 $60.00 $42.00 $52.50 $48.00 $60.00 $58.50 $33.75 $30.75 $31.50 $30.00 $56.25 $48.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114730 97113 HCHG PT AQUATIC THERAPY XP 75.00 $67.50 $30.00 $60.00 $42.00 $52.50 $48.00 $60.00 $58.50 $33.75 $30.75 $31.50 $30.00 $56.25 $48.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114731 97113 HCHG PT AQUATIC THERAPY XU 75.00 $67.50 $30.00 $60.00 $42.00 $52.50 $48.00 $60.00 $58.50 $33.75 $30.75 $31.50 $30.00 $56.25 $48.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114744 97164 HCHG PT RE-EVALUATION XE 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114745 97164 HCHG PT RE-EVALUATION XS 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114746 97164 HCHG PT RE-EVALUATION XP 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114747 97164 HCHG PT RE-EVALUATION XU 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114748 97168 HCHG OT RE-EVALUATION XE 142.00 $127.80 $56.80 $113.60 $79.52 $99.40 $90.88 $113.60 $110.76 $63.90 $58.22 $59.64 $56.80 $106.50 $92.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114749 97168 HCHG OT RE-EVALUATION XS 142.00 $127.80 $56.80 $113.60 $79.52 $99.40 $90.88 $113.60 $110.76 $63.90 $58.22 $59.64 $56.80 $106.50 $92.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114750 97168 HCHG OT RE-EVALUATION XP 142.00 $127.80 $56.80 $113.60 $79.52 $99.40 $90.88 $113.60 $110.76 $63.90 $58.22 $59.64 $56.80 $106.50 $92.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114751 97168 HCHG OT RE-EVALUATION XU 142.00 $127.80 $56.80 $113.60 $79.52 $99.40 $90.88 $113.60 $110.76 $63.90 $58.22 $59.64 $56.80 $106.50 $92.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114752 97018 HCHG OT PARAFFIN BATH XE 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114753 97018 HCHG OT PARAFFIN BATH XS 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114754 97018 HCHG OT PARAFFIN BATH XP 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114755 97018 HCHG OT PARAFFIN BATH XU 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114756 97018 HCHG PT PARAFFIN BATH XE 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114757 97018 HCHG PT PARAFFIN BATH XS 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114758 97018 HCHG PT PARAFFIN BATH XP 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114759 97018 HCHG PT PARAFFIN BATH XU 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114760 97022 HCHG PT WHIRLPOOL XE 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114761 97022 HCHG PT WHIRLPOOL XS 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114762 97022 HCHG PT WHIRLPOOL XP 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114763 97022 HCHG PT WHIRLPOOL XU 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114764 97022 HCHG OT WHIRLPOOL XE 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114765 97022 HCHG OT WHIRLPOOL XS 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114766 97022 HCHG OT WHIRLPOOL XP 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114767 97022 HCHG OT WHIRLPOOL XU 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114780 97542 HCHG OT WHEELCHAIR MGT/PROPUL 15 MIN XE 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114781 97542 HCHG OT WHEELCHAIR MGT/PROPUL 15 MIN XS 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114782 97542 HCHG OT WHEELCHAIR MGT/PROPUL 15 MIN XP 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114783 97542 HCHG OT WHEELCHAIR MGT/PROPUL 15 MIN XU 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114784 97750 HCHG OT PHY PERF TEST/MEASURE 15 MIN XE 160.00 $144.00 $64.00 $128.00 $89.60 $112.00 $102.40 $128.00 $124.80 $72.00 $65.60 $67.20 $64.00 $120.00 $104.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114785 97750 HCHG OT PHY PERF TEST/MEASURE 15 MIN XS 160.00 $144.00 $64.00 $128.00 $89.60 $112.00 $102.40 $128.00 $124.80 $72.00 $65.60 $67.20 $64.00 $120.00 $104.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114786 97750 HCHG OT PHY PERF TEST/MEASURE 15 MIN XP 160.00 $144.00 $64.00 $128.00 $89.60 $112.00 $102.40 $128.00 $124.80 $72.00 $65.60 $67.20 $64.00 $120.00 $104.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114787 97750 HCHG OT PHY PERF TEST/MEASURE 15 MIN XU 160.00 $144.00 $64.00 $128.00 $89.60 $112.00 $102.40 $128.00 $124.80 $72.00 $65.60 $67.20 $64.00 $120.00 $104.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114796 97537 HCHG OT COMM/WORK REINTEGRATION 15 MIN XE 54.00 $48.60 $21.60 $43.20 $30.24 $37.80 $34.56 $43.20 $42.12 $24.30 $22.14 $22.68 $21.60 $40.50 $35.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114797 97537 HCHG OT COMM/WORK REINTEGRATION 15 MIN XS 54.00 $48.60 $21.60 $43.20 $30.24 $37.80 $34.56 $43.20 $42.12 $24.30 $22.14 $22.68 $21.60 $40.50 $35.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114798 97537 HCHG OT COMM/WORK REINTEGRATION 15 MIN XP 54.00 $48.60 $21.60 $43.20 $30.24 $37.80 $34.56 $43.20 $42.12 $24.30 $22.14 $22.68 $21.60 $40.50 $35.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114799 97537 HCHG OT COMM/WORK REINTEGRATION 15 MIN XU 54.00 $48.60 $21.60 $43.20 $30.24 $37.80 $34.56 $43.20 $42.12 $24.30 $22.14 $22.68 $21.60 $40.50 $35.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114812 92611 HCHG SLP EVAL VIDEO SWALLOW XE 500.00 $450.00 $200.00 $400.00 $280.00 $350.00 $320.00 $400.00 $390.00 $225.00 $205.00 $210.00 $200.00 $375.00 $325.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114813 92611 HCHG SLP EVAL VIDEO SWALLOW XS 500.00 $450.00 $200.00 $400.00 $280.00 $350.00 $320.00 $400.00 $390.00 $225.00 $205.00 $210.00 $200.00 $375.00 $325.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114814 92611 HCHG SLP EVAL VIDEO SWALLOW XP 500.00 $450.00 $200.00 $400.00 $280.00 $350.00 $320.00 $400.00 $390.00 $225.00 $205.00 $210.00 $200.00 $375.00 $325.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114815 92611 HCHG SLP EVAL VIDEO SWALLOW XU 500.00 $450.00 $200.00 $400.00 $280.00 $350.00 $320.00 $400.00 $390.00 $225.00 $205.00 $210.00 $200.00 $375.00 $325.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114820 97032 HCHG PT E-STIM ATTENDED 15 MIN XE 48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114821 97032 HCHG PT E-STIM ATTENDED 15 MIN XS 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114822 97032 HCHG PT E-STIM ATTENDED 15 MIN XP 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114823 97032 HCHG PT E-STIM ATTENDED 15 MIN XU 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114824 97032 HCHG OT E-STIM ATTENDED 15 MIN XE 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114825 97032 HCHG OT E-STIM ATTENDED 15 MIN XS 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114826 97032 HCHG OT E-STIM ATTENDED 15 MIN XP 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114827 97032 HCHG OT E-STIM ATTENDED 15 MIN XU 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114828 92610 HCHG SLP EVAL ORAL/PHAR SWALLOWING XE 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114829 92610 HCHG SLP EVAL ORAL/PHAR SWALLOWING XS 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114830 92610 HCHG SLP EVAL ORAL/PHAR SWALLOWING XP 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114831 92610 HCHG SLP EVAL ORAL/PHAR SWALLOWING XU 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114864 97605 HCHG PT VAC/NPWT <= 50 SQ CM XE 119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114865 97605 HCHG PT VAC/NPWT <= 50 SQ CM XS 119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114866 97605 HCHG PT VAC/NPWT <= 50 SQ CM XP 119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114867 97605 HCHG PT VAC/NPWT <= 50 SQ CM XU 119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114872 97606 HCHG PT VAC/NPWT > 50 SQ CM XE 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114873 97606 HCHG PT VAC/NPWT > 50 SQ CM XS 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114874 97606 HCHG PT VAC/NPWT > 50 SQ CM XP 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114875 97606 HCHG PT VAC/NPWT > 50 SQ CM XU 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114880 92507 HCHG SLP INDIV TX COMMUNICATION XE 208.00 $187.20 $83.20 $166.40 $116.48 $145.60 $133.12 $166.40 $162.24 $93.60 $85.28 $87.36 $83.20 $156.00 $135.20
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114881 92507 HCHG SLP INDIV TX COMMUNICATION XS 208.00 $187.20 $83.20 $166.40 $116.48 $145.60 $133.12 $166.40 $162.24 $93.60 $85.28 $87.36 $83.20 $156.00 $135.20
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114882 92507 HCHG SLP INDIV TX COMMUNICATION XP 208.00 $187.20 $83.20 $166.40 $116.48 $145.60 $133.12 $166.40 $162.24 $93.60 $85.28 $87.36 $83.20 $156.00 $135.20
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114883 92507 HCHG SLP INDIV TX COMMUNICATION XU 208.00 $187.20 $83.20 $166.40 $116.48 $145.60 $133.12 $166.40 $162.24 $93.60 $85.28 $87.36 $83.20 $156.00 $135.20
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114896 97598 HCHG PT SELECTIVE DEBRIDE > 20 SQ CM XE 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114897 97598 HCHG PT SELECTIVE DEBRIDE > 20 SQ CM XS 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114898 97598 HCHG PT SELECTIVE DEBRIDE > 20 SQ CM XP 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114899 97598 HCHG PT SELECTIVE DEBRIDE > 20 SQ CM XU 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114912 97597 HCHG PT SELECT DEBRIDE 20 SQ CM OR LESS XE 157.00 $141.30 $62.80 $125.60 $87.92 $109.90 $100.48 $125.60 $122.46 $70.65 $64.37 $65.94 $62.80 $117.75 $102.05
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114913 97597 HCHG PT SELECT DEBRIDE 20 SQ CM OR LESS XS 157.00 $141.30 $62.80 $125.60 $87.92 $109.90 $100.48 $125.60 $122.46 $70.65 $64.37 $65.94 $62.80 $117.75 $102.05
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114914 97597 HCHG PT SELECT DEBRIDE 20 SQ CM OR LESS XP 157.00 $141.30 $62.80 $125.60 $87.92 $109.90 $100.48 $125.60 $122.46 $70.65 $64.37 $65.94 $62.80 $117.75 $102.05
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114915 97597 HCHG PT SELECT DEBRIDE 20 SQ CM OR LESS XU 157.00 $141.30 $62.80 $125.60 $87.92 $109.90 $100.48 $125.60 $122.46 $70.65 $64.37 $65.94 $62.80 $117.75 $102.05
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114920 97602 HCHG PT NONSELECTIVE DEBRIDEMENT SLOUGH WOUNDS XE 118.00 $106.20 $47.20 $94.40 $66.08 $82.60 $75.52 $94.40 $92.04 $53.10 $48.38 $49.56 $47.20 $88.50 $76.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114921 97602 HCHG PT NONSELECTIVE DEBRIDEMENT SLOUGH WOUNDS XS 118.00 $106.20 $47.20 $94.40 $66.08 $82.60 $75.52 $94.40 $92.04 $53.10 $48.38 $49.56 $47.20 $88.50 $76.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114922 97602 HCHG PT NONSELECTIVE DEBRIDEMENT SLOUGH WOUNDS XP 118.00 $106.20 $47.20 $94.40 $66.08 $82.60 $75.52 $94.40 $92.04 $53.10 $48.38 $49.56 $47.20 $88.50 $76.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114923 97602 HCHG PT NONSELECTIVE DEBRIDEMENT SLOUGH WOUNDS XU 118.00 $106.20 $47.20 $94.40 $66.08 $82.60 $75.52 $94.40 $92.04 $53.10 $48.38 $49.56 $47.20 $88.50 $76.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114932 97150 HCHG PT GROUP THERAPY XE 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114933 97150 HCHG PT GROUP THERAPY XS 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114934 97150 HCHG PT GROUP THERAPY XP 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114935 97150 HCHG PT GROUP THERAPY XU 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114960 96105 HCHG SLP ASSESSMENT OF APHASIA W REPORT PER HR XE 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114961 96105 HCHG SLP ASSESSMENT OF APHASIA W REPORT PER HR XS 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114962 96105 HCHG SLP ASSESSMENT OF APHASIA W REPORT PER HR XP 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114963 96105 HCHG SLP ASSESSMENT OF APHASIA W REPORT PER HR XU 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114964 92521 HCHG SLP EVAL SPEECH FLUENCY XE 358.00 $322.20 $143.20 $286.40 $200.48 $250.60 $229.12 $286.40 $279.24 $161.10 $146.78 $150.36 $143.20 $268.50 $232.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114965 92521 HCHG SLP EVAL SPEECH FLUENCY XS 358.00 $322.20 $143.20 $286.40 $200.48 $250.60 $229.12 $286.40 $279.24 $161.10 $146.78 $150.36 $143.20 $268.50 $232.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114966 92521 HCHG SLP EVAL SPEECH FLUENCY XP 358.00 $322.20 $143.20 $286.40 $200.48 $250.60 $229.12 $286.40 $279.24 $161.10 $146.78 $150.36 $143.20 $268.50 $232.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114967 92521 HCHG SLP EVAL SPEECH FLUENCY XU 358.00 $322.20 $143.20 $286.40 $200.48 $250.60 $229.12 $286.40 $279.24 $161.10 $146.78 $150.36 $143.20 $268.50 $232.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114972 92522 HCHG SLP EVAL SPEECH SOUND PROD XE 290.00 $261.00 $116.00 $232.00 $162.40 $203.00 $185.60 $232.00 $226.20 $130.50 $118.90 $121.80 $116.00 $217.50 $188.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114973 92522 HCHG SLP EVAL SPEECH SOUND PROD XS 290.00 $261.00 $116.00 $232.00 $162.40 $203.00 $185.60 $232.00 $226.20 $130.50 $118.90 $121.80 $116.00 $217.50 $188.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114974 92522 HCHG SLP EVAL SPEECH SOUND PROD XP 290.00 $261.00 $116.00 $232.00 $162.40 $203.00 $185.60 $232.00 $226.20 $130.50 $118.90 $121.80 $116.00 $217.50 $188.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114975 92522 HCHG SLP EVAL SPEECH SOUND PROD XU 290.00 $261.00 $116.00 $232.00 $162.40 $203.00 $185.60 $232.00 $226.20 $130.50 $118.90 $121.80 $116.00 $217.50 $188.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114980 92523 HCHG SLP EVAL SPEECH SOUND W LANGUAGE COMP XE 313.00 $281.70 $125.20 $250.40 $175.28 $219.10 $200.32 $250.40 $244.14 $140.85 $128.33 $131.46 $125.20 $234.75 $203.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114981 92523 HCHG SLP EVAL SPEECH SOUND W LANGUAGE COMP XS 313.00 $281.70 $125.20 $250.40 $175.28 $219.10 $200.32 $250.40 $244.14 $140.85 $128.33 $131.46 $125.20 $234.75 $203.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114982 92523 HCHG SLP EVAL SPEECH SOUND W LANGUAGE COMP XP 313.00 $281.70 $125.20 $250.40 $175.28 $219.10 $200.32 $250.40 $244.14 $140.85 $128.33 $131.46 $125.20 $234.75 $203.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114983 92523 HCHG SLP EVAL SPEECH SOUND W LANGUAGE COMP XU 313.00 $281.70 $125.20 $250.40 $175.28 $219.10 $200.32 $250.40 $244.14 $140.85 $128.33 $131.46 $125.20 $234.75 $203.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114988 92524 HCHG SLP BEHAVIORAL QUAL ANLYS VOICE RESONANCE XE 305.00 $274.50 $122.00 $244.00 $170.80 $213.50 $195.20 $244.00 $237.90 $137.25 $125.05 $128.10 $122.00 $228.75 $198.25
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114989 92524 HCHG SLP BEHAVIORAL QUAL ANLYS VOICE RESONANCE XS 305.00 $274.50 $122.00 $244.00 $170.80 $213.50 $195.20 $244.00 $237.90 $137.25 $125.05 $128.10 $122.00 $228.75 $198.25
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114990 92524 HCHG SLP BEHAVIORAL QUAL ANLYS VOICE RESONANCE XP 305.00 $274.50 $122.00 $244.00 $170.80 $213.50 $195.20 $244.00 $237.90 $137.25 $125.05 $128.10 $122.00 $228.75 $198.25
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 114991 92524 HCHG SLP BEHAVIORAL QUAL ANLYS VOICE RESONANCE XU 305.00 $274.50 $122.00 $244.00 $170.80 $213.50 $195.20 $244.00 $237.90 $137.25 $125.05 $128.10 $122.00 $228.75 $198.25
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115050 36680 HCHG ED INSERT NEEDLE INTRAOSSEOUS INFUSION AFFILIATE ONLY 493.00 $443.70 $197.20 $394.40 $276.08 $345.10 $315.52 $394.40 $384.54 $221.85 $202.13 $207.06 $197.20 $369.75 $320.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115058 20550 HCHG US INJ SINGLE TENDON SHEATH LIGAMENT 247.00 $222.30 $98.80 $197.60 $138.32 $172.90 $158.08 $197.60 $192.66 $111.15 $101.27 $103.74 $98.80 $185.25 $160.55
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115087 93799 HCHG CHF PROGRAM 4 WEEK PKG AFFILIATE ONLY 97.00 $87.30 $38.80 $77.60 $54.32 $67.90 $62.08 $77.60 $75.66 $43.65 $39.77 $40.74 $38.80 $72.75 $63.05
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115088 115088 HCHG BEDSIDE PROCEDURE TIME >= 60 MINS AFFILIATE ONLY 128.00 $115.20 $51.20 $102.40 $71.68 $89.60 $81.92 $102.40 $99.84 $57.60 $52.48 $53.76 $51.20 $96.00 $83.20
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115089 115089 HCHG BEDSIDE PROCEDURE TIME 45 MIN AFFILIATE ONLY 179.00 $161.10 $71.60 $143.20 $100.24 $125.30 $114.56 $143.20 $139.62 $80.55 $73.39 $75.18 $71.60 $134.25 $116.35
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115090 115090 HCHG BEDSIDE PROCEDURE TIME 30 MIN AFFILIATE ONLY 266.00 $239.40 $106.40 $212.80 $148.96 $186.20 $170.24 $212.80 $207.48 $119.70 $109.06 $111.72 $106.40 $199.50 $172.90
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115091 115091 HCHG BEDSIDE PROCEDURE TIME 15 MIN AFFILIATE ONLY 309.00 $278.10 $123.60 $247.20 $173.04 $216.30 $197.76 $247.20 $241.02 $139.05 $126.69 $129.78 $123.60 $231.75 $200.85
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115092 37195 HCHG ED THROMBOLYTIC IV THERAPY STROKE AFFILIATE ONLY "1,374.00" " $1,236.60 " $549.60 " $1,099.20 " $769.44 $961.80 $879.36 " $1,099.20 " " $1,071.72 " $618.30 $563.34 $577.08 $549.60 " $1,030.50 " $893.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115093 51798 HCHG ED MEAS POST VOID RESID US NON-IMAGING AFFILIATE ONLY 150.00 $135.00 $60.00 $120.00 $84.00 $105.00 $96.00 $120.00 $117.00 $67.50 $61.50 $63.00 $60.00 $112.50 $97.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115095 69210 HCHG ED REMOVE IMPACTED CERUMEN INSTRUMENT UNI AFFILIATE ONLY 162.00 $145.80 $64.80 $129.60 $90.72 $113.40 $103.68 $129.60 $126.36 $72.90 $66.42 $68.04 $64.80 $121.50 $105.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115096 51700 HCHG ED BLADDER IRRIGATION SIMPLE AFFILIATE ONLY 630.00 $567.00 $252.00 $504.00 $352.80 $441.00 $403.20 $504.00 $491.40 $283.50 $258.30 $264.60 $252.00 $472.50 $409.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115110 99211 HCHG OUTPATIENT OB LEVEL 1 AFFILIATE ONLY 678.00 $610.20 $271.20 $542.40 $379.68 $474.60 $433.92 $542.40 $528.84 $305.10 $277.98 $284.76 $271.20 $508.50 $440.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115111 99212 HCHG OUTPATIENT OB LEVEL 2 AFFILIATE ONLY 839.00 $755.10 $335.60 $671.20 $469.84 $587.30 $536.96 $671.20 $654.42 $377.55 $343.99 $352.38 $335.60 $629.25 $545.35
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115112 99213 HCHG OUTPATIENT OB LEVEL 3 AFFILIATE ONLY "1,083.00" $974.70 $433.20 $866.40 $606.48 $758.10 $693.12 $866.40 $844.74 $487.35 $444.03 $454.86 $433.20 $812.25 $703.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115113 99214 HCHG OUTPATIENT OB LEVEL 4 AFFILIATE ONLY "1,921.00" " $1,728.90 " $768.40 " $1,536.80 " " $1,075.76 " " $1,344.70 " " $1,229.44 " " $1,536.80 " " $1,498.38 " $864.45 $787.61 $806.82 $768.40 " $1,440.75 " " $1,248.65 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115114 99215 HCHG OUTPATIENT OB LEVEL 5 AFFILIATE ONLY 403.00 $362.70 $161.20 $322.40 $225.68 $282.10 $257.92 $322.40 $314.34 $181.35 $165.23 $169.26 $161.20 $302.25 $261.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115115 115115 HCHG 90 MINUTE MASSAGE RETAIL 103.00 $92.70 $41.20 $82.40 $57.68 $72.10 $65.92 $82.40 $80.34 $46.35 $42.23 $43.26 $41.20 $77.25 $66.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115116 115116 HCHG 60 MINUTE MASSAGE RETAIL 82.00 $73.80 $32.80 $65.60 $45.92 $57.40 $52.48 $65.60 $63.96 $36.90 $33.62 $34.44 $32.80 $61.50 $53.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115117 115117 HCHG 30 MINUTE MASSAGE RETAIL 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115118 115118 HCHG ACUPUNCTURE INITIAL CONSULT RETAIL 88.00 $79.20 $35.20 $70.40 $49.28 $61.60 $56.32 $70.40 $68.64 $39.60 $36.08 $36.96 $35.20 $66.00 $57.20
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115119 115119 HCHG ACUPUNCTURE FOLLOW UP VISIT RETAIL 62.00 $55.80 $24.80 $49.60 $34.72 $43.40 $39.68 $49.60 $48.36 $27.90 $25.42 $26.04 $24.80 $46.50 $40.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115125 93224 HCHG HOLTER COMPLETE UP TO 48 HR AFFILIATE ONLY "1,182.00" " $1,063.80 " $472.80 $945.60 $661.92 $827.40 $756.48 $945.60 $921.96 $531.90 $484.62 $496.44 $472.80 $886.50 $768.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115126 115126 HCHG FREE CLINIC DSMT GROUP AFFILIATE ONLY 57.00 $51.30 $22.80 $45.60 $31.92 $39.90 $36.48 $45.60 $44.46 $25.65 $23.37 $23.94 $22.80 $42.75 $37.05
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115127 115127 HCHG FREE CLINIC DSMT INDIV AFFILIATE ONLY 106.00 $95.40 $42.40 $84.80 $59.36 $74.20 $67.84 $84.80 $82.68 $47.70 $43.46 $44.52 $42.40 $79.50 $68.90
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115128 115128 HCHG FREE CLINIC MNT GROUP AFFILIATE ONLY 74.00 $66.60 $29.60 $59.20 $41.44 $51.80 $47.36 $59.20 $57.72 $33.30 $30.34 $31.08 $29.60 $55.50 $48.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115129 115129 HCHG FREE CLINIC MNT INDIV AFFILIATE ONLY 70.00 $63.00 $28.00 $56.00 $39.20 $49.00 $44.80 $56.00 $54.60 $31.50 $28.70 $29.40 $28.00 $52.50 $45.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115137 115137 HCHG MINOR PROCEDURE LEVEL I AFFILIATE ONLY "1,505.00" " $1,354.50 " $602.00 " $1,204.00 " $842.80 " $1,053.50 " $963.20 " $1,204.00 " " $1,173.90 " $677.25 $617.05 $632.10 $602.00 " $1,128.75 " $978.25
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115138 115138 HCHG MINOR PROCEDURE LEVEL II AFFILIATE ONLY "2,809.00" " $2,528.10 " " $1,123.60 " " $2,247.20 " " $1,573.04 " " $1,966.30 " " $1,797.76 " " $2,247.20 " " $2,191.02 " " $1,264.05 " " $1,151.69 " " $1,179.78 " " $1,123.60 " " $2,106.75 " " $1,825.85 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115139 115139 HCHG MINOR PROCEDURE LEVEL III AFFILIATE ONLY "4,004.00" " $3,603.60 " " $1,601.60 " " $3,203.20 " " $2,242.24 " " $2,802.80 " " $2,562.56 " " $3,203.20 " " $3,123.12 " " $1,801.80 " " $1,641.64 " " $1,681.68 " " $1,601.60 " " $3,003.00 " " $2,602.60 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115140 115140 HCHG MINOR PROCEDURE LEVEL III ADDL MIN AFFILIATE ONLY 13.00 $11.70 $5.20 $10.40 $7.28 $9.10 $8.32 $10.40 $10.14 $5.85 $5.33 $5.46 $5.20 $9.75 $8.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115220 G0424 (IA) HCHG PULMONARY REHAB W EXERCISE 1 HOUR SESSION >36 KX 273.00 $245.70 $109.20 $218.40 $152.88 $191.10 $174.72 $218.40 $212.94 $122.85 $111.93 $114.66 $109.20 $204.75 $177.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115345 94640 HCHG RC AIRWAY INHALATION TX EZPAP W NEB 115.00 $103.50 $46.00 $92.00 $64.40 $80.50 $73.60 $92.00 $89.70 $51.75 $47.15 $48.30 $46.00 $86.25 $74.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115410 69209 HCHG REMOVE IMPACTED CERUMEN USING IRRIGATION LAVAGE UNILATERAL 109.00 $98.10 $43.60 $87.20 $61.04 $76.30 $69.76 $87.20 $85.02 $49.05 $44.69 $45.78 $43.60 $81.75 $70.85
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115432 59899 HCHG UNLISTED PROCEDURE AMNIOTOMY AFFILIATE ONLY 351.00 $315.90 $140.40 $280.80 $196.56 $245.70 $224.64 $280.80 $273.78 $157.95 $143.91 $147.42 $140.40 $263.25 $228.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115483 115483 HCHG FIT TESTING WITH RESP ASSESSMENT 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115506 99213 HCHG URGENT CARE WWH ONLY 177.00 $159.30 $70.80 $141.60 $99.12 $123.90 $113.28 $141.60 $138.06 $79.65 $72.57 $74.34 $70.80 $132.75 $115.05
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115539 64625 HCHG RAD RADIOFREQUENCY ABLTJ NERVES NRVTG SI JT W/IMG GDN "4,729.00" " $4,256.10 " " $1,891.60 " " $3,783.20 " " $2,648.24 " " $3,310.30 " " $3,026.56 " " $3,783.20 " " $3,688.62 " " $2,128.05 " " $1,938.89 " " $1,986.18 " " $1,891.60 " " $3,546.75 " " $3,073.85 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115543 92551 HCHG PURE TONE SCREEN HEARING TEST AIR AFFILIATE ONLY 63.00 $56.70 $25.20 $50.40 $35.28 $44.10 $40.32 $50.40 $49.14 $28.35 $25.83 $26.46 $25.20 $47.25 $40.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115544 92579 HCHG VISUAL AUDIOMETRY VRA AFFILIATE ONLY 148.00 $133.20 $59.20 $118.40 $82.88 $103.60 $94.72 $118.40 $115.44 $66.60 $60.68 $62.16 $59.20 $111.00 $96.20
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115545 92582 HCHG CONDITIONING PLAY AUDIOMETRY AFFILIATE ONLY 193.00 $173.70 $77.20 $154.40 $108.08 $135.10 $123.52 $154.40 $150.54 $86.85 $79.13 $81.06 $77.20 $144.75 $125.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115546 92583 HCHG SELECT PICTURE AUDIOMETRY AFFILIATE ONLY 105.00 $94.50 $42.00 $84.00 $58.80 $73.50 $67.20 $84.00 $81.90 $47.25 $43.05 $44.10 $42.00 $78.75 $68.25
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115595 97161 HCHG PT EVAL LOW COMPLEXITY 253.00 $227.70 $101.20 $202.40 $141.68 $177.10 $161.92 $202.40 $197.34 $113.85 $103.73 $106.26 $101.20 $189.75 $164.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115597 97161 HCHG PT EVAL LOW COMPLEXITY XE 253.00 $227.70 $101.20 $202.40 $141.68 $177.10 $161.92 $202.40 $197.34 $113.85 $103.73 $106.26 $101.20 $189.75 $164.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115598 97161 HCHG PT EVAL LOW COMPLEXITY XP 209.00 $188.10 $83.60 $167.20 $117.04 $146.30 $133.76 $167.20 $163.02 $94.05 $85.69 $87.78 $83.60 $156.75 $135.85
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115599 97161 HCHG PT EVAL LOW COMPLEXITY XS 209.00 $188.10 $83.60 $167.20 $117.04 $146.30 $133.76 $167.20 $163.02 $94.05 $85.69 $87.78 $83.60 $156.75 $135.85
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115600 97161 HCHG PT EVAL LOW COMPLEXITY XU 209.00 $188.10 $83.60 $167.20 $117.04 $146.30 $133.76 $167.20 $163.02 $94.05 $85.69 $87.78 $83.60 $156.75 $135.85
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115603 97162 HCHG PT EVAL MOD COMPLEXITY 253.00 $227.70 $101.20 $202.40 $141.68 $177.10 $161.92 $202.40 $197.34 $113.85 $103.73 $106.26 $101.20 $189.75 $164.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115605 97162 HCHG PT EVAL MOD COMPLEXITY XE 253.00 $227.70 $101.20 $202.40 $141.68 $177.10 $161.92 $202.40 $197.34 $113.85 $103.73 $106.26 $101.20 $189.75 $164.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115606 97162 HCHG PT EVAL MOD COMPLEXITY XP 253.00 $227.70 $101.20 $202.40 $141.68 $177.10 $161.92 $202.40 $197.34 $113.85 $103.73 $106.26 $101.20 $189.75 $164.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115607 97162 HCHG PT EVAL MOD COMPLEXITY XS 253.00 $227.70 $101.20 $202.40 $141.68 $177.10 $161.92 $202.40 $197.34 $113.85 $103.73 $106.26 $101.20 $189.75 $164.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115608 97162 HCHG PT EVAL MOD COMPLEXITY XU 253.00 $227.70 $101.20 $202.40 $141.68 $177.10 $161.92 $202.40 $197.34 $113.85 $103.73 $106.26 $101.20 $189.75 $164.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115611 97163 HCHG PT EVAL HIGH COMPLEXITY 253.00 $227.70 $101.20 $202.40 $141.68 $177.10 $161.92 $202.40 $197.34 $113.85 $103.73 $106.26 $101.20 $189.75 $164.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115613 97163 HCHG PT EVAL HIGH COMPLEXITY XE 253.00 $227.70 $101.20 $202.40 $141.68 $177.10 $161.92 $202.40 $197.34 $113.85 $103.73 $106.26 $101.20 $189.75 $164.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115614 97163 HCHG PT EVAL HIGH COMPLEXITY XP 172.00 $154.80 $68.80 $137.60 $96.32 $120.40 $110.08 $137.60 $134.16 $77.40 $70.52 $72.24 $68.80 $129.00 $111.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115615 97163 HCHG PT EVAL HIGH COMPLEXITY XS 172.00 $154.80 $68.80 $137.60 $96.32 $120.40 $110.08 $137.60 $134.16 $77.40 $70.52 $72.24 $68.80 $129.00 $111.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115616 97163 HCHG PT EVAL HIGH COMPLEXITY XU 172.00 $154.80 $68.80 $137.60 $96.32 $120.40 $110.08 $137.60 $134.16 $77.40 $70.52 $72.24 $68.80 $129.00 $111.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115620 97165 HCHG OT EVAL LOW COMPLEXITY 262.00 $235.80 $104.80 $209.60 $146.72 $183.40 $167.68 $209.60 $204.36 $117.90 $107.42 $110.04 $104.80 $196.50 $170.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115621 97165 HCHG OT EVAL LOW COMPLEXITY XE 262.00 $235.80 $104.80 $209.60 $146.72 $183.40 $167.68 $209.60 $204.36 $117.90 $107.42 $110.04 $104.80 $196.50 $170.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115622 97165 HCHG OT EVAL LOW COMPLEXITY XP 262.00 $235.80 $104.80 $209.60 $146.72 $183.40 $167.68 $209.60 $204.36 $117.90 $107.42 $110.04 $104.80 $196.50 $170.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115623 97165 HCHG OT EVAL LOW COMPLEXITY XS 262.00 $235.80 $104.80 $209.60 $146.72 $183.40 $167.68 $209.60 $204.36 $117.90 $107.42 $110.04 $104.80 $196.50 $170.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115624 97165 HCHG OT EVAL LOW COMPLEXITY XU 262.00 $235.80 $104.80 $209.60 $146.72 $183.40 $167.68 $209.60 $204.36 $117.90 $107.42 $110.04 $104.80 $196.50 $170.30
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115627 97166 HCHG OT EVAL MOD COMPLEXITY 269.00 $242.10 $107.60 $215.20 $150.64 $188.30 $172.16 $215.20 $209.82 $121.05 $110.29 $112.98 $107.60 $201.75 $174.85
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115628 97166 HCHG OT EVAL MOD COMPLEXITY XE 269.00 $242.10 $107.60 $215.20 $150.64 $188.30 $172.16 $215.20 $209.82 $121.05 $110.29 $112.98 $107.60 $201.75 $174.85
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115629 97166 HCHG OT EVAL MOD COMPLEXITY XP 269.00 $242.10 $107.60 $215.20 $150.64 $188.30 $172.16 $215.20 $209.82 $121.05 $110.29 $112.98 $107.60 $201.75 $174.85
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115630 97166 HCHG OT EVAL MOD COMPLEXITY XS 269.00 $242.10 $107.60 $215.20 $150.64 $188.30 $172.16 $215.20 $209.82 $121.05 $110.29 $112.98 $107.60 $201.75 $174.85
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115631 97166 HCHG OT EVAL MOD COMPLEXITY XU 269.00 $242.10 $107.60 $215.20 $150.64 $188.30 $172.16 $215.20 $209.82 $121.05 $110.29 $112.98 $107.60 $201.75 $174.85
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115634 97167 HCHG OT EVAL HIGH COMPLEXITY 291.00 $261.90 $116.40 $232.80 $162.96 $203.70 $186.24 $232.80 $226.98 $130.95 $119.31 $122.22 $116.40 $218.25 $189.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115635 97167 HCHG OT EVAL HIGH COMPLEXITY XE 291.00 $261.90 $116.40 $232.80 $162.96 $203.70 $186.24 $232.80 $226.98 $130.95 $119.31 $122.22 $116.40 $218.25 $189.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115636 97167 HCHG OT EVAL HIGH COMPLEXITY XP 291.00 $261.90 $116.40 $232.80 $162.96 $203.70 $186.24 $232.80 $226.98 $130.95 $119.31 $122.22 $116.40 $218.25 $189.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115637 97167 HCHG OT EVAL HIGH COMPLEXITY XS 291.00 $261.90 $116.40 $232.80 $162.96 $203.70 $186.24 $232.80 $226.98 $130.95 $119.31 $122.22 $116.40 $218.25 $189.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115638 97167 HCHG OT EVAL HIGH COMPLEXITY XU 291.00 $261.90 $116.40 $232.80 $162.96 $203.70 $186.24 $232.80 $226.98 $130.95 $119.31 $122.22 $116.40 $218.25 $189.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115640 97169 HCHG ATHLETIC TRAINING EVAL LOW COMPLEXITY AFFILIATE ONLY 192.00 $172.80 $76.80 $153.60 $107.52 $134.40 $122.88 $153.60 $149.76 $86.40 $78.72 $80.64 $76.80 $144.00 $124.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115641 97170 HCHG ATHLETIC TRAINING EVAL MOD COMPLEXITY AFFILIATE ONLY 193.00 $173.70 $77.20 $154.40 $108.08 $135.10 $123.52 $154.40 $150.54 $86.85 $79.13 $81.06 $77.20 $144.75 $125.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115642 97171 HCHG ATHLETIC TRAINING EVAL HIGH COMPLEXITY AFFILIATE ONLY 253.00 $227.70 $101.20 $202.40 $141.68 $177.10 $161.92 $202.40 $197.34 $113.85 $103.73 $106.26 $101.20 $189.75 $164.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115685 96377 HCHG APPLICATION OF ON BODY INJECTOR TIMED SUBQ INJ 57.00 $51.30 $22.80 $45.60 $31.92 $39.90 $36.48 $45.60 $44.46 $25.65 $23.37 $23.94 $22.80 $42.75 $37.05
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115687 99151 HCHG MODERATE SED SAME PROVIDER < 5 YRS 1ST 15 MINUTES 174.00 $156.60 $69.60 $139.20 $97.44 $121.80 $111.36 $139.20 $135.72 $78.30 $71.34 $73.08 $69.60 $130.50 $113.10
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115688 99152 HCHG MODERATE SED SAME PROVIDER > 5 YRS 1ST 15 MINUTES 139.00 $125.10 $55.60 $111.20 $77.84 $97.30 $88.96 $111.20 $108.42 $62.55 $56.99 $58.38 $55.60 $104.25 $90.35
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115689 99153 HCHG MODERATE SED SAME PROVIDER EACH ADDL 15 MINUTES 47.00 $42.30 $18.80 $37.60 $26.32 $32.90 $30.08 $37.60 $36.66 $21.15 $19.27 $19.74 $18.80 $35.25 $30.55
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115690 99155 HCHG MODERATE SED DIFF PROVIDER < 5 YRS 1ST 15 MINUTES 312.00 $280.80 $124.80 $249.60 $174.72 $218.40 $199.68 $249.60 $243.36 $140.40 $127.92 $131.04 $124.80 $234.00 $202.80
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115691 99156 HCHG MODERATE SED DIFF PROVIDER > 5 YRS 1ST 15 MINUTES 258.00 $232.20 $103.20 $206.40 $144.48 $180.60 $165.12 $206.40 $201.24 $116.10 $105.78 $108.36 $103.20 $193.50 $167.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115692 99157 HCHG MODERATE SED DIFF PROVIDER EACH ADDL 15 MINUTES 199.00 $179.10 $79.60 $159.20 $111.44 $139.30 $127.36 $159.20 $155.22 $89.55 $81.59 $83.58 $79.60 $149.25 $129.35
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115693 G0500 HCHG MODERATE SED ENDO SERVICE > 5 YRS 1ST 15 MIN 245.00 $220.50 $98.00 $196.00 $137.20 $171.50 $156.80 $196.00 $191.10 $110.25 $100.45 $102.90 $98.00 $183.75 $159.25
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115722 G0498 HCHG CHEMO ADMIN EXTENDED INFUSION W PUMP HOME 756.00 $680.40 $302.40 $604.80 $423.36 $529.20 $483.84 $604.80 $589.68 $340.20 $309.96 $317.52 $302.40 $567.00 $491.40
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115732 115732 HCHG 60 MINUTE INITIAL HEALING VISIT RETAIL 43.00 $38.70 $17.20 $34.40 $24.08 $30.10 $27.52 $34.40 $33.54 $19.35 $17.63 $18.06 $17.20 $32.25 $27.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115749 115749 HCHG PROCEDURE LEVEL IV EXT AFFILIATE ONLY "2,657.00" " $2,391.30 " " $1,062.80 " " $2,125.60 " " $1,487.92 " " $1,859.90 " " $1,700.48 " " $2,125.60 " " $2,072.46 " " $1,195.65 " " $1,089.37 " " $1,115.94 " " $1,062.80 " " $1,992.75 " " $1,727.05 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115750 115750 HCHG PROCEDURE LEVEL V EXT AFFILIATE ONLY "5,505.00" " $4,954.50 " " $2,202.00 " " $4,404.00 " " $3,082.80 " " $3,853.50 " " $3,523.20 " " $4,404.00 " " $4,293.90 " " $2,477.25 " " $2,257.05 " " $2,312.10 " " $2,202.00 " " $4,128.75 " " $3,578.25 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115751 115751 HCHG PROCEDURE LEVEL VI EXT AFFILIATE ONLY "8,765.00" " $7,888.50 " " $3,506.00 " " $7,012.00 " " $4,908.40 " " $6,135.50 " " $5,609.60 " " $7,012.00 " " $6,836.70 " " $3,944.25 " " $3,593.65 " " $3,681.30 " " $3,506.00 " " $6,573.75 " " $5,697.25 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115785 93668 HCHG PERIPHERAL ARTERAL DISEASE REHAB PER SESSION 118.00 $106.20 $47.20 $94.40 $66.08 $82.60 $75.52 $94.40 $92.04 $53.10 $48.38 $49.56 $47.20 $88.50 $76.70
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115805 94618 HCHG PULMONARY STRESS TEST 130.00 $117.00 $52.00 $104.00 $72.80 $91.00 $83.20 $104.00 $101.40 $58.50 $53.30 $54.60 $52.00 $97.50 $84.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115808 95249 HCHG CONT GLUCOSE MONITORING PT PROVIDED EQUIP 96.00 $86.40 $38.40 $76.80 $53.76 $67.20 $61.44 $76.80 $74.88 $43.20 $39.36 $40.32 $38.40 $72.00 $62.40
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115821 97763 HCHG OT ORTHO/PROSTHETIC TRAIN UPR/LWR EXT TRUNK SUBQ 15 MIN 171.00 $153.90 $68.40 $136.80 $95.76 $119.70 $109.44 $136.80 $133.38 $76.95 $70.11 $71.82 $68.40 $128.25 $111.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115871 29581 HCHG RN APPL MULTLAY COMPRS LWR LEG BILATERAL 287.00 $258.30 $114.80 $229.60 $160.72 $200.90 $183.68 $229.60 $223.86 $129.15 $117.67 $120.54 $114.80 $215.25 $186.55
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 115873 93668 HCHG PERIPHERAL ARTERIAL DISEASE REHAB ADDITIONAL SESSIONS KX 63.00 $56.70 $25.20 $50.40 $35.28 $44.10 $40.32 $50.40 $49.14 $28.35 $25.83 $26.46 $25.20 $47.25 $40.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 116004 11104 HCHG PUNCH BIOPSY SKIN SINGLE LESION 286.00 $257.40 $114.40 $228.80 $160.16 $200.20 $183.04 $228.80 $223.08 $128.70 $117.26 $120.12 $114.40 $214.50 $185.90
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 116005 11105 HCHG PUNCH BIOPSY SKIN LESION EA ADDL 106.00 $95.40 $42.40 $84.80 $59.36 $74.20 $67.84 $84.80 $82.68 $47.70 $43.46 $44.52 $42.40 $79.50 $68.90
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 116071 116071 HCHG SPOT TREATMENT MASSAGE RETAIL AFFILIATE ONLY 26.00 $23.40 $10.40 $20.80 $14.56 $18.20 $16.64 $20.80 $20.28 $11.70 $10.66 $10.92 $10.40 $19.50 $16.90
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 116072 116072 HCHG INFANT MASSAGE RETAIL AFFILIATE ONLY 36.00 $32.40 $14.40 $28.80 $20.16 $25.20 $23.04 $28.80 $28.08 $16.20 $14.76 $15.12 $14.40 $27.00 $23.40
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 116073 116073 HCHG HOT STONES ADDED TO MASSAGE RETAIL AFFILIATE ONLY 10.00 $9.00 $4.00 $8.00 $5.60 $7.00 $6.40 $8.00 $7.80 $4.50 $4.10 $4.20 $4.00 $7.50 $6.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 116074 116074 HCHG ACUPUNCTURE SPOT TREATEMENT RETAIL AFFILIATE ONLY 37.00 $33.30 $14.80 $29.60 $20.72 $25.90 $23.68 $29.60 $28.86 $16.65 $15.17 $15.54 $14.80 $27.75 $24.05
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 116075 116075 HCHG ACUENERGETIC 60 MINUTES RETAIL AFFILIATE ONLY 79.00 $71.10 $31.60 $63.20 $44.24 $55.30 $50.56 $63.20 $61.62 $35.55 $32.39 $33.18 $31.60 $59.25 $51.35
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 116076 116076 HCHG ACUENERGETIC 90 MINUTES RETAIL AFFILIATE ONLY 106.00 $95.40 $42.40 $84.80 $59.36 $74.20 $67.84 $84.80 $82.68 $47.70 $43.46 $44.52 $42.40 $79.50 $68.90
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 116077 116077 HCHG ACUENERGETIC MEDITATION COACHING RETAIL AFFILIATE ONLY 27.00 $24.30 $10.80 $21.60 $15.12 $18.90 $17.28 $21.60 $21.06 $12.15 $11.07 $11.34 $10.80 $20.25 $17.55
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 116078 116078 HCHG ACUENERGETIC FREE CONSULT RETAIL AFFILIATE ONLY 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 116079 116079 HCHG NO SHOW/CANCEL FEE INTERGRATIVE HLTH RETAIL AFFILIATE ONLY 47.00 $42.30 $18.80 $37.60 $26.32 $32.90 $30.08 $37.60 $36.66 $21.15 $19.27 $19.74 $18.80 $35.25 $30.55
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 116123 64451 HCHG XR INJ ANES STEROID INNERVATING SACROILIAC INC GUIDE "2,754.00" " $2,478.60 " " $1,101.60 " " $2,203.20 " " $1,542.24 " " $1,927.80 " " $1,762.56 " " $2,203.20 " " $2,148.12 " " $1,239.30 " " $1,129.14 " " $1,156.68 " " $1,101.60 " " $2,065.50 " " $1,790.10 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 116126 64454 HCHG RAD INJECTION ANES &/STRD GENICULAR NRV BRANCHES W/IMG "2,754.00" " $2,478.60 " " $1,101.60 " " $2,203.20 " " $1,542.24 " " $1,927.80 " " $1,762.56 " " $2,203.20 " " $2,148.12 " " $1,239.30 " " $1,129.14 " " $1,156.68 " " $1,101.60 " " $2,065.50 " " $1,790.10 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 116129 64624 (IA) HCHG XR DESTRUCTION GENICULAR NERVE BRANCH W NEUROLYTIC AGENT "4,729.00" " $4,256.10 " " $1,891.60 " " $3,783.20 " " $2,648.24 " " $3,310.30 " " $3,026.56 " " $3,783.20 " " $3,688.62 " " $2,128.05 " " $1,938.89 " " $1,986.18 " " $1,891.60 " " $3,546.75 " " $3,073.85 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 116184 97129 HCHG OT THER INTERVENT COGNITIVE FUNCT 1:1 INIT 15 MIN 75.00 $67.50 $30.00 $60.00 $42.00 $52.50 $48.00 $60.00 $58.50 $33.75 $30.75 $31.50 $30.00 $56.25 $48.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 116185 97130 HCHG OT THER INTERVENT COGNITIVE FUNCT 1:1 EA ADDL 15 MIN 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 116250 116250 HCHG DIETITIAN CONSULT FOR PACKAGED SERVICES RETAIL AFF ONLY 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 116253 G2061 HCHG PT QUAL NONMD ONLINE EST PT 7 DAYS OR LESS 5-10 MIN 48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 116254 G2062 HCHG PT QUAL NONMD ONLINE EST PT 7 DAYS OR LESS11-20 MIN 93.00 $83.70 $37.20 $74.40 $52.08 $65.10 $59.52 $74.40 $72.54 $41.85 $38.13 $39.06 $37.20 $69.75 $60.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 116255 G2063 HCHG PT QUAL NONMD ONLINE EST PT 7 DAYS OR LESS >21 MIN 150.00 $135.00 $60.00 $120.00 $84.00 $105.00 $96.00 $120.00 $117.00 $67.50 $61.50 $63.00 $60.00 $112.50 $97.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 116337 M0239 HCHG BAMLANIVIMAB INFUSION & POST ADMIN MONITORING 503.00 $452.70 $201.20 $402.40 $281.68 $352.10 $321.92 $402.40 $392.34 $226.35 $206.23 $211.26 $201.20 $377.25 $326.95
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 116348 93246 HCHG EXTERNAL ECG REC>7D<15D RECORDING 550.00 $495.00 $220.00 $440.00 $308.00 $385.00 $352.00 $440.00 $429.00 $247.50 $225.50 $231.00 $220.00 $412.50 $357.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 116379 64417 HCHG XR INJECTION AA&/STRD AXILLARY NERVE W/IMG GDN "2,754.00" " $2,478.60 " " $1,101.60 " " $2,203.20 " " $1,542.24 " " $1,927.80 " " $1,762.56 " " $2,203.20 " " $2,148.12 " " $1,239.30 " " $1,129.14 " " $1,156.68 " " $1,101.60 " " $2,065.50 " " $1,790.10 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 116380 64418 HCHG XR INJ NERVE BLOCK SUPRASCAPULAR NERVE "2,754.00" " $2,478.60 " " $1,101.60 " " $2,203.20 " " $1,542.24 " " $1,927.80 " " $1,762.56 " " $2,203.20 " " $2,148.12 " " $1,239.30 " " $1,129.14 " " $1,156.68 " " $1,101.60 " " $2,065.50 " " $1,790.10 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 116459 94625 HCHG PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR 267.00 $240.30 $106.80 $213.60 $149.52 $186.90 $170.88 $213.60 $208.26 $120.15 $109.47 $112.14 $106.80 $200.25 $173.55
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 116460 94626 HCHG PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR 267.00 $240.30 $106.80 $213.60 $149.52 $186.90 $170.88 $213.60 $208.26 $120.15 $109.47 $112.14 $106.80 $200.25 $173.55
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 117343 20550 HCHG RAD INJECTION SINGLE TENDON SHEATH LIGAMENT 247.00 $222.30 $98.80 $197.60 $138.32 $172.90 $158.08 $197.60 $192.66 $111.15 $101.27 $103.74 $98.80 $185.25 $160.55
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 117458 64405 HCHG RAD INJ ANES AGENT STEROID OCCIPITAL NERVE 460.00 $414.00 $184.00 $368.00 $257.60 $322.00 $294.40 $368.00 $358.80 $207.00 $188.60 $193.20 $184.00 $345.00 $299.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 117460 64417 HCHG RAD INJ ANES AGENT STEROID AXILLARY NERVE "2,754.00" " $2,478.60 " " $1,101.60 " " $2,203.20 " " $1,542.24 " " $1,927.80 " " $1,762.56 " " $2,203.20 " " $2,148.12 " " $1,239.30 " " $1,129.14 " " $1,156.68 " " $1,101.60 " " $2,065.50 " " $1,790.10 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 117461 64418 HCHG RAD INJ ANES AGENT STEROID SUPRASCAPULAR NERVE "2,754.00" " $2,478.60 " " $1,101.60 " " $2,203.20 " " $1,542.24 " " $1,927.80 " " $1,762.56 " " $2,203.20 " " $2,148.12 " " $1,239.30 " " $1,129.14 " " $1,156.68 " " $1,101.60 " " $2,065.50 " " $1,790.10 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 117467 64451 HCHG RAD INJ ANES STEROID INNERVATING SACROILIAC INC GUIDE "2,754.00" " $2,478.60 " " $1,101.60 " " $2,203.20 " " $1,542.24 " " $1,927.80 " " $1,762.56 " " $2,203.20 " " $2,148.12 " " $1,239.30 " " $1,129.14 " " $1,156.68 " " $1,101.60 " " $2,065.50 " " $1,790.10 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 117480 64624 HCHG RAD DESTRUCTION GENICULAR NERVE BRANCH W NEUROLYTIC AGENT "4,729.00" " $4,256.10 " " $1,891.60 " " $3,783.20 " " $2,648.24 " " $3,310.30 " " $3,026.56 " " $3,783.20 " " $3,688.62 " " $2,128.05 " " $1,938.89 " " $1,986.18 " " $1,891.60 " " $3,546.75 " " $3,073.85 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 15271 15271 PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25 559.00 $503.10 $223.60 $447.20 $313.04 $391.30 $357.76 $447.20 $436.02 $251.55 $229.19 $234.78 $223.60 $419.25 $363.35
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 24655 24655 PR CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION "1,865.00" " $1,678.50 " $746.00 " $1,492.00 " " $1,044.40 " " $1,305.50 " " $1,193.60 " " $1,492.00 " " $1,454.70 " $839.25 $764.65 $783.30 $746.00 " $1,398.75 " " $1,212.25 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 27138 27138 PR REVJ TOT HIP ARTHRP FEM ONLY W/WO ALGRFT "8,488.00" " $7,639.20 " " $3,395.20 " " $6,790.40 " " $4,753.28 " " $5,941.60 " " $5,432.32 " " $6,790.40 " " $6,620.64 " " $3,819.60 " " $3,480.08 " " $3,564.96 " " $3,395.20 " " $6,366.00 " " $5,517.20 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 27507 27507 PR OPTX FEM SHFT FX W/PLATE/SCREWS W/WO CERCLAGE "5,119.00" " $4,607.10 " " $2,047.60 " " $4,095.20 " " $2,866.64 " " $3,583.30 " " $3,276.16 " " $4,095.20 " " $3,992.82 " " $2,303.55 " " $2,098.79 " " $2,149.98 " " $2,047.60 " " $3,839.25 " " $3,327.35 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 42000 42000 PR DRAINAGE ABSCESS PALATE UVULA 684.00 $615.60 $273.60 $547.20 $383.04 $478.80 $437.76 $547.20 $533.52 $307.80 $280.44 $287.28 $273.60 $513.00 $444.60
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 43235 43235 PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC "1,273.00" " $1,145.70 " $509.20 " $1,018.40 " $712.88 $891.10 $814.72 " $1,018.40 " $992.94 $572.85 $521.93 $534.66 $509.20 $954.75 $827.45
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 43762 43762 PR PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC 809.00 $728.10 $323.60 $647.20 $453.04 $566.30 $517.76 $647.20 $631.02 $364.05 $331.69 $339.78 $323.60 $606.75 $525.85
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 59856 59856 PR INDUCED ABORT 1/> VAG SUPP DLVR FETUS D&C &/EVAC "3,145.00" " $2,830.50 " " $1,258.00 " " $2,516.00 " " $1,761.20 " " $2,201.50 " " $2,012.80 " " $2,516.00 " " $2,453.10 " " $1,415.25 " " $1,289.45 " " $1,320.90 " " $1,258.00 " " $2,358.75 " " $2,044.25 "
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 700032 700032 "RX-250, NON CHARGEABLE" 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 76946 76946 PR US GUIDANCE AMNIOCENTESIS IMG S&I 375.00 $337.50 $150.00 $300.00 $210.00 $262.50 $240.00 $300.00 $292.50 $168.75 $153.75 $157.50 $150.00 $281.25 $243.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 93005 93005 PR ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R 147.00 $132.30 $58.80 $117.60 $82.32 $102.90 $94.08 $117.60 $114.66 $66.15 $60.27 $61.74 $58.80 $110.25 $95.55
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 93242 93242 PR EXTERNAL ECG REC>48HR<7D RECORDING 527.00 $474.30 $210.80 $421.60 $295.12 $368.90 $337.28 $421.60 $411.06 $237.15 $216.07 $221.34 $210.80 $395.25 $342.55
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 93246 93246 PR EXTERNAL ECG REC>7D<15D RECORDING 550.00 $495.00 $220.00 $440.00 $308.00 $385.00 $352.00 $440.00 $429.00 $247.50 $225.50 $231.00 $220.00 $412.50 $357.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 99211.11 99211 PR INR OFFICE OUTPT ESTAB LEVEL 1 116.00 $104.40 $46.40 $92.80 $64.96 $81.20 $74.24 $92.80 $90.48 $52.20 $47.56 $48.72 $46.40 $87.00 $75.40
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 99253 99253 PR IP/OBS CONSLTJ NEW/EST PT LOW MDM 45 MINUTES 415.00 $373.50 $166.00 $332.00 $232.40 $290.50 $265.60 $332.00 $323.70 $186.75 $170.15 $174.30 $166.00 $311.25 $269.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 EM021 EM021 PR TRCK NO CHARGE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC1141 OC1141 PR OCH URINE DRUG SCREEN PROCESSING GENERAL 31.00 $27.90 $12.40 $24.80 $17.36 $21.70 $19.84 $24.80 $24.18 $13.95 $12.71 $13.02 $12.40 $23.25 $20.15
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC1150 OC1150 PR OCH MEDICAL REVIEW OFFICE POSITIVE ONLY 55.00 $49.50 $22.00 $44.00 $30.80 $38.50 $35.20 $44.00 $42.90 $24.75 $22.55 $23.10 $22.00 $41.25 $35.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC1156 OC1156 PR OCH HEP B VACCINE 70.00 $63.00 $28.00 $56.00 $39.20 $49.00 $44.80 $56.00 $54.60 $31.50 $28.70 $29.40 $28.00 $52.50 $45.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC1157 OC1157 PR OCH MMR VACCINE 170.50 $153.45 $68.20 $136.40 $95.48 $119.35 $109.12 $136.40 $132.99 $76.73 $69.91 $71.61 $68.20 $127.88 $110.83
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC1159 OC1159 PR OCH VARICELLA VACCINE 50.00 $45.00 $20.00 $40.00 $28.00 $35.00 $32.00 $40.00 $39.00 $22.50 $20.50 $21.00 $20.00 $37.50 $32.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC1161 OC1161 PR OCH PULMONARY FUNCTION TEST 150.00 $135.00 $60.00 $120.00 $84.00 $105.00 $96.00 $120.00 $117.00 $67.50 $61.50 $63.00 $60.00 $112.50 $97.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC1168 OC1168 PR OCH BACK SCREEN 60.00 $54.00 $24.00 $48.00 $33.60 $42.00 $38.40 $48.00 $46.80 $27.00 $24.60 $25.20 $24.00 $45.00 $39.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC1206 OC1206 PR OCH KIT DRAW HANDLING TRANPORT 45.00 $40.50 $18.00 $36.00 $25.20 $31.50 $28.80 $36.00 $35.10 $20.25 $18.45 $18.90 $18.00 $33.75 $29.25
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC1213 OC1213 PR OCH OCCUPATIONAL MEDICINE MISC SERVICE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC1223 OC1223 PR OCH MANTOUX 20.00 $18.00 $8.00 $16.00 $11.20 $14.00 $12.80 $16.00 $15.60 $9.00 $8.20 $8.40 $8.00 $15.00 $13.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC1225 OC1225 PR OCH URINE DRUG SCREEN COLLECTION 30.00 $27.00 $12.00 $24.00 $16.80 $21.00 $19.20 $24.00 $23.40 $13.50 $12.30 $12.60 $12.00 $22.50 $19.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC1226 OC1226 PR OCH URINE DRUG SCREEN PROCESSING 35.00 $31.50 $14.00 $28.00 $19.60 $24.50 $22.40 $28.00 $27.30 $15.75 $14.35 $14.70 $14.00 $26.25 $22.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC1227 OC1227 PR OCH MEDICAL REVIEW OFFICER 15.00 $13.50 $6.00 $12.00 $8.40 $10.50 $9.60 $12.00 $11.70 $6.75 $6.15 $6.30 $6.00 $11.25 $9.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC1233 OC1233 PR OCH RESPIRATOR FIT TEST ONLY 30.00 $27.00 $12.00 $24.00 $16.80 $21.00 $19.20 $24.00 $23.40 $13.50 $12.30 $12.60 $12.00 $22.50 $19.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC1240 OC1240 PR OCH DOT EXAM 90.00 $81.00 $36.00 $72.00 $50.40 $63.00 $57.60 $72.00 $70.20 $40.50 $36.90 $37.80 $36.00 $67.50 $58.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC1247 OC1247 PR OCH CHEST XRAY 100.00 $90.00 $40.00 $80.00 $56.00 $70.00 $64.00 $80.00 $78.00 $45.00 $41.00 $42.00 $40.00 $75.00 $65.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC1263 81003 PR OCH URINALYSIS AUTO 10.00 $9.00 $4.00 $8.00 $5.60 $7.00 $6.40 $8.00 $7.80 $4.50 $4.10 $4.20 $4.00 $7.50 $6.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC1293 86735 PR OCH MUMPS TITER 30.00 $27.00 $12.00 $24.00 $16.80 $21.00 $19.20 $24.00 $23.40 $13.50 $12.30 $12.60 $12.00 $22.50 $19.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC1294 86765 PR OCH RUBEOLA TITER 30.00 $27.00 $12.00 $24.00 $16.80 $21.00 $19.20 $24.00 $23.40 $13.50 $12.30 $12.60 $12.00 $22.50 $19.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC1295 86762 PR OCH RUBELLA TITER 35.00 $31.50 $14.00 $28.00 $19.60 $24.50 $22.40 $28.00 $27.30 $15.75 $14.35 $14.70 $14.00 $26.25 $22.75
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC1299 86706 PR OCH 8670600 25.00 $22.50 $10.00 $20.00 $14.00 $17.50 $16.00 $20.00 $19.50 $11.25 $10.25 $10.50 $10.00 $18.75 $16.25
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC1304 86787 PR OCH VARICELLA TITER 30.00 $27.00 $12.00 $24.00 $16.80 $21.00 $19.20 $24.00 $23.40 $13.50 $12.30 $12.60 $12.00 $22.50 $19.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC1331 OC1331 PR OCH STANDARD PRE EMP PHYSICAL ABILITY SCREEN 40.00 $36.00 $16.00 $32.00 $22.40 $28.00 $25.60 $32.00 $31.20 $18.00 $16.40 $16.80 $16.00 $30.00 $26.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC1333 OC1333 PR OCH CUSTOM PRE EMP PHYSICAL ABILITY SCREEN 80.00 $72.00 $32.00 $64.00 $44.80 $56.00 $51.20 $64.00 $62.40 $36.00 $32.80 $33.60 $32.00 $60.00 $52.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC1340 OC1340 PB OCH NURSE ONLY VISIT 25.00 $22.50 $10.00 $20.00 $14.00 $17.50 $16.00 $20.00 $19.50 $11.25 $10.25 $10.50 $10.00 $18.75 $16.25
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC1371 OC1371 (IA) PR OCH COVID 19 HIGH THROUGHPUT INHOUSE 77.00 $69.30 $30.80 $61.60 $43.12 $53.90 $49.28 $61.60 $60.06 $34.65 $31.57 $32.34 $30.80 $57.75 $50.05
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC345 OC345 PR OCH VISION SCREENING 30.00 $27.00 $12.00 $24.00 $16.80 $21.00 $19.20 $24.00 $23.40 $13.50 $12.30 $12.60 $12.00 $22.50 $19.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC500 OC500 PR OCH EKG WITH READING 30.00 $27.00 $12.00 $24.00 $16.80 $21.00 $19.20 $24.00 $23.40 $13.50 $12.30 $12.60 $12.00 $22.50 $19.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC510 OC510 PR OCH VENIPUNCTURE 20.00 $18.00 $8.00 $16.00 $11.20 $14.00 $12.80 $16.00 $15.60 $9.00 $8.20 $8.40 $8.00 $15.00 $13.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC513 OC513 PR OCH AUDIOGRAM 30.00 $27.00 $12.00 $24.00 $16.80 $21.00 $19.20 $24.00 $23.40 $13.50 $12.30 $12.60 $12.00 $22.50 $19.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC523 OC523 PR OCH SPIROMETRY 50.00 $45.00 $20.00 $40.00 $28.00 $35.00 $32.00 $40.00 $39.00 $22.50 $20.50 $21.00 $20.00 $37.50 $32.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC524 OC524 PR OCH FLU IMMUNIZATION 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC576 OC576 PR OCH TETANUS VACCINE 50.00 $45.00 $20.00 $40.00 $28.00 $35.00 $32.00 $40.00 $39.00 $22.50 $20.50 $21.00 $20.00 $37.50 $32.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC634 OC634 PR OCH LAB WELLNESS PROFILE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC676 OC676 PR OC WELLNESS PROGRAM - NURSE ONLY VISIT 25.00 $22.50 $10.00 $20.00 $14.00 $17.50 $16.00 $20.00 $19.50 $11.25 $10.25 $10.50 $10.00 $18.75 $16.25
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC993 OC993 PR OCH TDAP VACCINE 50.00 $45.00 $20.00 $40.00 $28.00 $35.00 $32.00 $40.00 $39.00 $22.50 $20.50 $21.00 $20.00 $37.50 $32.50
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 OC994 86480 PR OCH QUANTIFERON TB 100.00 $90.00 $40.00 $80.00 $56.00 $70.00 $64.00 $80.00 $78.00 $45.00 $41.00 $42.00 $40.00 $75.00 $65.00
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 S2900 S2900 PR ROBOTIC SURGICAL SYSTEM 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH HOSPITAL MAIN FEE SCHEDULE - 4200 SS522437 A6450 PR LT COMPRES BAND >=5IN PER YD PR1 AFFILIATE ONLY 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH LAB/RAD FEE SCHEDULE - 4206 110018 36415 HCHG LEGAL BLOOD ALCOHOL DRAW 147.00 $132.30 $58.80 $117.60 $82.32 $102.90 $94.08 $117.60 $114.66 $66.15 $60.27 $61.74 $58.80 $110.25 $95.55
WWH LAB/RAD FEE SCHEDULE - 4206 110478 93325 HCHG RAD DOPPPLER ECHOCARD COLOR FLOW VELOCITY MAPPING 330.00 $297.00 $132.00 $264.00 $184.80 $231.00 $211.20 $264.00 $257.40 $148.50 $135.30 $138.60 $132.00 $247.50 $214.50
WWH LAB/RAD FEE SCHEDULE - 4206 110479 93321 HCHG RAD DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD 252.00 $226.80 $100.80 $201.60 $141.12 $176.40 $161.28 $201.60 $196.56 $113.40 $103.32 $105.84 $100.80 $189.00 $163.80
WWH LAB/RAD FEE SCHEDULE - 4206 111012 50690 HCHG INJ PROC VIS ILEAL COND/URETEROPYELO 460.00 $414.00 $184.00 $368.00 $257.60 $322.00 $294.40 $368.00 $358.80 $207.00 $188.60 $193.20 $184.00 $345.00 $299.00
WWH LAB/RAD FEE SCHEDULE - 4206 111883 96374 HCHG IV INJECTION TX/DX/PROPHYLAXIS INITIAL 139.00 $125.10 $55.60 $111.20 $77.84 $97.30 $88.96 $111.20 $108.42 $62.55 $56.99 $58.38 $55.60 $104.25 $90.35
WWH LAB/RAD FEE SCHEDULE - 4206 112217 C8924 HCHG RAD ECHO 2D F-U OR LTD STUDY W CONT "1,302.00" " $1,171.80 " $520.80 " $1,041.60 " $729.12 $911.40 $833.28 " $1,041.60 " " $1,015.56 " $585.90 $533.82 $546.84 $520.80 $976.50 $846.30
WWH LAB/RAD FEE SCHEDULE - 4206 112226 93308 HCHG ECHO 2D F-U OR LTD STUDY WO CONT "1,094.00" $984.60 $437.60 $875.20 $612.64 $765.80 $700.16 $875.20 $853.32 $492.30 $448.54 $459.48 $437.60 $820.50 $711.10
WWH LAB/RAD FEE SCHEDULE - 4206 112228 93350 HCHG STRESS ECHO 2D EXERCISE WO CONTRAST 860.00 $774.00 $344.00 $688.00 $481.60 $602.00 $550.40 $688.00 $670.80 $387.00 $352.60 $361.20 $344.00 $645.00 $559.00
WWH LAB/RAD FEE SCHEDULE - 4206 112256 76775 HCHG ED US RETROPERITONEAL LIMITED 764.00 $687.60 $305.60 $611.20 $427.84 $534.80 $488.96 $611.20 $595.92 $343.80 $313.24 $320.88 $305.60 $573.00 $496.60
WWH LAB/RAD FEE SCHEDULE - 4206 112454 93306 HCHG ECHO 2D COMP WO CONT W SPECTRAL-COLOR "2,754.00" " $2,478.60 " " $1,101.60 " " $2,203.20 " " $1,542.24 " " $1,927.80 " " $1,762.56 " " $2,203.20 " " $2,148.12 " " $1,239.30 " " $1,129.14 " " $1,156.68 " " $1,101.60 " " $2,065.50 " " $1,790.10 "
WWH LAB/RAD FEE SCHEDULE - 4206 112455 93306 HCHG ECHO 2D COMP WO CONT W BUBBLE-SPECTRAL-COLOR "2,754.00" " $2,478.60 " " $1,101.60 " " $2,203.20 " " $1,542.24 " " $1,927.80 " " $1,762.56 " " $2,203.20 " " $2,148.12 " " $1,239.30 " " $1,129.14 " " $1,156.68 " " $1,101.60 " " $2,065.50 " " $1,790.10 "
WWH LAB/RAD FEE SCHEDULE - 4206 112456 C8929 HCHG ECHO 2D COMP W CONT-SPECTRAL-COLOR "2,754.00" " $2,478.60 " " $1,101.60 " " $2,203.20 " " $1,542.24 " " $1,927.80 " " $1,762.56 " " $2,203.20 " " $2,148.12 " " $1,239.30 " " $1,129.14 " " $1,156.68 " " $1,101.60 " " $2,065.50 " " $1,790.10 "
WWH LAB/RAD FEE SCHEDULE - 4206 112457 C8929 HCHG ECHO 2D COMP W CONT-BUBBLE-SPECTRAL-COLOR "2,754.00" " $2,478.60 " " $1,101.60 " " $2,203.20 " " $1,542.24 " " $1,927.80 " " $1,762.56 " " $2,203.20 " " $2,148.12 " " $1,239.30 " " $1,129.14 " " $1,156.68 " " $1,101.60 " " $2,065.50 " " $1,790.10 "
WWH LAB/RAD FEE SCHEDULE - 4206 112620 93351 HCHG STRESS ECHO 2D EXERCISE W STRESS TEST WO CONTRAST 917.00 $825.30 $366.80 $733.60 $513.52 $641.90 $586.88 $733.60 $715.26 $412.65 $375.97 $385.14 $366.80 $687.75 $596.05
WWH LAB/RAD FEE SCHEDULE - 4206 113436 10160 HCHG CT ASPIRATION PUNCTURE HEMATOMA BULLA CYST 375.00 $337.50 $150.00 $300.00 $210.00 $262.50 $240.00 $300.00 $292.50 $168.75 $153.75 $157.50 $150.00 $281.25 $243.75
WWH LAB/RAD FEE SCHEDULE - 4206 113438 20206 HCHG CT BIOPSY MUSCLE 788.00 $709.20 $315.20 $630.40 $441.28 $551.60 $504.32 $630.40 $614.64 $354.60 $323.08 $330.96 $315.20 $591.00 $512.20
WWH LAB/RAD FEE SCHEDULE - 4206 113439 20220 HCHG CT BIOPSY BONE SUPERFICIAL 713.00 $641.70 $285.20 $570.40 $399.28 $499.10 $456.32 $570.40 $556.14 $320.85 $292.33 $299.46 $285.20 $534.75 $463.45
WWH LAB/RAD FEE SCHEDULE - 4206 113440 20225 HCHG CT BIOPSY BONE DEEP "1,247.00" " $1,122.30 " $498.80 $997.60 $698.32 $872.90 $798.08 $997.60 $972.66 $561.15 $511.27 $523.74 $498.80 $935.25 $810.55
WWH LAB/RAD FEE SCHEDULE - 4206 113441 20610 HCHG CT INJECTION MAJOR JOINT BURSA 314.00 $282.60 $125.60 $251.20 $175.84 $219.80 $200.96 $251.20 $244.92 $141.30 $128.74 $131.88 $125.60 $235.50 $204.10
WWH LAB/RAD FEE SCHEDULE - 4206 113443 20999 HCHG CT MUSCULOSKELETAL SYSTEM 308.00 $277.20 $123.20 $246.40 $172.48 $215.60 $197.12 $246.40 $240.24 $138.60 $126.28 $129.36 $123.20 $231.00 $200.20
WWH LAB/RAD FEE SCHEDULE - 4206 113444 21550 HCHG CT BIOPSY SOFT TISSUE NECK OR CHEST 936.00 $842.40 $374.40 $748.80 $524.16 $655.20 $599.04 $748.80 $730.08 $421.20 $383.76 $393.12 $374.40 $702.00 $608.40
WWH LAB/RAD FEE SCHEDULE - 4206 113448 26990 HCHG RAD I&D DEEP ABSCESS OR HEMATOMA PELVIS OR HIP "2,846.00" " $2,561.40 " " $1,138.40 " " $2,276.80 " " $1,593.76 " " $1,992.20 " " $1,821.44 " " $2,276.80 " " $2,219.88 " " $1,280.70 " " $1,166.86 " " $1,195.32 " " $1,138.40 " " $2,134.50 " " $1,849.90 "
WWH LAB/RAD FEE SCHEDULE - 4206 113454 32408 HCHG CT CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG 930.00 $837.00 $372.00 $744.00 $520.80 $651.00 $595.20 $744.00 $725.40 $418.50 $381.30 $390.60 $372.00 $697.50 $604.50
WWH LAB/RAD FEE SCHEDULE - 4206 113456 32551 HCHG CT CHEST TUBE PLACEMENT 711.00 $639.90 $284.40 $568.80 $398.16 $497.70 $455.04 $568.80 $554.58 $319.95 $291.51 $298.62 $284.40 $533.25 $462.15
WWH LAB/RAD FEE SCHEDULE - 4206 113462 38220 HCHG RAD DIAGNOSTIC BONE MARROW ASPIRATIONS 726.00 $653.40 $290.40 $580.80 $406.56 $508.20 $464.64 $580.80 $566.28 $326.70 $297.66 $304.92 $290.40 $544.50 $471.90
WWH LAB/RAD FEE SCHEDULE - 4206 113463 38221 HCHG RAD DIAGNOSTIC BONE MARROW BIOPSIES 662.00 $595.80 $264.80 $529.60 $370.72 $463.40 $423.68 $529.60 $516.36 $297.90 $271.42 $278.04 $264.80 $496.50 $430.30
WWH LAB/RAD FEE SCHEDULE - 4206 113464 38505 HCHG CT BIOPSY LYMPH NODE 468.00 $421.20 $187.20 $374.40 $262.08 $327.60 $299.52 $374.40 $365.04 $210.60 $191.88 $196.56 $187.20 $351.00 $304.20
WWH LAB/RAD FEE SCHEDULE - 4206 113470 45999 HCHG CT DRAIN PRESACRAL 769.00 $692.10 $307.60 $615.20 $430.64 $538.30 $492.16 $615.20 $599.82 $346.05 $315.29 $322.98 $307.60 $576.75 $499.85
WWH LAB/RAD FEE SCHEDULE - 4206 113471 46999 HCHG RAD UNLISTED ANUS PROCEDURE 244.00 $219.60 $97.60 $195.20 $136.64 $170.80 $156.16 $195.20 $190.32 $109.80 $100.04 $102.48 $97.60 $183.00 $158.60
WWH LAB/RAD FEE SCHEDULE - 4206 113472 47000 HCHG CT BIOPSY LIVER 909.00 $818.10 $363.60 $727.20 $509.04 $636.30 $581.76 $727.20 $709.02 $409.05 $372.69 $381.78 $363.60 $681.75 $590.85
WWH LAB/RAD FEE SCHEDULE - 4206 113485 49083 HCHG CT PARACENTESIS ABDOMEN PELVIS ASPIRATION 979.00 $881.10 $391.60 $783.20 $548.24 $685.30 $626.56 $783.20 $763.62 $440.55 $401.39 $411.18 $391.60 $734.25 $636.35
WWH LAB/RAD FEE SCHEDULE - 4206 113487 49180 HCHG CT BIOPSY ABDOMEN OR RETROPERITONEAL 800.00 $720.00 $320.00 $640.00 $448.00 $560.00 $512.00 $640.00 $624.00 $360.00 $328.00 $336.00 $320.00 $600.00 $520.00
WWH LAB/RAD FEE SCHEDULE - 4206 113492 49999 HCHG RAD UNLISTED ABDOMEN PERITONEUM & OMENTUM PROCEDURE 469.00 $422.10 $187.60 $375.20 $262.64 $328.30 $300.16 $375.20 $365.82 $211.05 $192.29 $196.98 $187.60 $351.75 $304.85
WWH LAB/RAD FEE SCHEDULE - 4206 113494 50200 HCHG CT BIOPSY RENAL "1,188.00" " $1,069.20 " $475.20 $950.40 $665.28 $831.60 $760.32 $950.40 $926.64 $534.60 $487.08 $498.96 $475.20 $891.00 $772.20
WWH LAB/RAD FEE SCHEDULE - 4206 113495 50390 HCHG CT ASPIRATION RENAL CYST 968.00 $871.20 $387.20 $774.40 $542.08 $677.60 $619.52 $774.40 $755.04 $435.60 $396.88 $406.56 $387.20 $726.00 $629.20
WWH LAB/RAD FEE SCHEDULE - 4206 113499 55700 (IA) HCHG CT BIOPSY PROSTATE "1,102.00" $991.80 $440.80 $881.60 $617.12 $771.40 $705.28 $881.60 $859.56 $495.90 $451.82 $462.84 $440.80 $826.50 $716.30
WWH LAB/RAD FEE SCHEDULE - 4206 113502 58999 HCHG RAD UNLISTED FEMALE GENITAL SYSTEM NONOBSTETRICAL PX 390.00 $351.00 $156.00 $312.00 $218.40 $273.00 $249.60 $312.00 $304.20 $175.50 $159.90 $163.80 $156.00 $292.50 $253.50
WWH LAB/RAD FEE SCHEDULE - 4206 113503 60100 (IA) HCHG CT BIOPSY THYROID 523.00 $470.70 $209.20 $418.40 $292.88 $366.10 $334.72 $418.40 $407.94 $235.35 $214.43 $219.66 $209.20 $392.25 $339.95
WWH LAB/RAD FEE SCHEDULE - 4206 113511 64483 HCHG CT TRANSFORAMINAL LUMB OR SACRAL SNGL W CT GUIDE "1,422.00" " $1,279.80 " $568.80 " $1,137.60 " $796.32 $995.40 $910.08 " $1,137.60 " " $1,109.16 " $639.90 $583.02 $597.24 $568.80 " $1,066.50 " $924.30
WWH LAB/RAD FEE SCHEDULE - 4206 113513 64490 HCHG CT FACET JOINT INJ CERV/THOR SNGL LEVEL W CT GUIDE 869.00 $782.10 $347.60 $695.20 $486.64 $608.30 $556.16 $695.20 $677.82 $391.05 $356.29 $364.98 $347.60 $651.75 $564.85
WWH LAB/RAD FEE SCHEDULE - 4206 113514 64491 HCHG CT FACET JOINT INJ CERV/THOR SECOND LEVEL W CT GUIDE 543.00 $488.70 $217.20 $434.40 $304.08 $380.10 $347.52 $434.40 $423.54 $244.35 $222.63 $228.06 $217.20 $407.25 $352.95
WWH LAB/RAD FEE SCHEDULE - 4206 113516 64493 HCHG CT FACET JOINT INJ LUMBAR/SACRAL SNGL LEVEL W CT GUIDE "1,332.00" " $1,198.80 " $532.80 " $1,065.60 " $745.92 $932.40 $852.48 " $1,065.60 " " $1,038.96 " $599.40 $546.12 $559.44 $532.80 $999.00 $865.80
WWH LAB/RAD FEE SCHEDULE - 4206 113517 64494 HCHG CT FACET JOINT INJ LUMBAR/SACRAL SECOND LEVEL W CT GUIDE 414.00 $372.60 $165.60 $331.20 $231.84 $289.80 $264.96 $331.20 $322.92 $186.30 $169.74 $173.88 $165.60 $310.50 $269.10
WWH LAB/RAD FEE SCHEDULE - 4206 113521 64999 HCHG CT ASPIRATION SYNOVIAL CYST FACET JT 490.00 $441.00 $196.00 $392.00 $274.40 $343.00 $313.60 $392.00 $382.20 $220.50 $200.90 $205.80 $196.00 $367.50 $318.50
WWH LAB/RAD FEE SCHEDULE - 4206 113524 G0260 HCHG CT INJ SACROILIAC JOINT "1,749.00" " $1,574.10 " $699.60 " $1,399.20 " $979.44 " $1,224.30 " " $1,119.36 " " $1,399.20 " " $1,364.22 " $787.05 $717.09 $734.58 $699.60 " $1,311.75 " " $1,136.85 "
WWH LAB/RAD FEE SCHEDULE - 4206 113706 42550 (IA) HCHG IR SIALOGRAM INJECTION 529.00 $476.10 $211.60 $423.20 $296.24 $370.30 $338.56 $423.20 $412.62 $238.05 $216.89 $222.18 $211.60 $396.75 $343.85
WWH LAB/RAD FEE SCHEDULE - 4206 113716 44500 HCHG IR INTRO LONG GI TUBE 208.00 $187.20 $83.20 $166.40 $116.48 $145.60 $133.12 $166.40 $162.24 $93.60 $85.28 $87.36 $83.20 $156.00 $135.20
WWH LAB/RAD FEE SCHEDULE - 4206 113850 38792 HCHG NM INJECTION FOR SENTINEL NODE 589.00 $530.10 $235.60 $471.20 $329.84 $412.30 $376.96 $471.20 $459.42 $265.05 $241.49 $247.38 $235.60 $441.75 $382.85
WWH LAB/RAD FEE SCHEDULE - 4206 113852 10005 HCHG US FINE NEEDLE ASPIRATION BIOPSY W IMAGE GUIDE 1ST LESION 570.00 $513.00 $228.00 $456.00 $319.20 $399.00 $364.80 $456.00 $444.60 $256.50 $233.70 $239.40 $228.00 $427.50 $370.50
WWH LAB/RAD FEE SCHEDULE - 4206 113853 10060 HCHG US DRAIN SUBCUTANEOUS ABSCESS 412.00 $370.80 $164.80 $329.60 $230.72 $288.40 $263.68 $329.60 $321.36 $185.40 $168.92 $173.04 $164.80 $309.00 $267.80
WWH LAB/RAD FEE SCHEDULE - 4206 113855 10160 HCHG US ASPIRATION FLUID OR CYST 480.00 $432.00 $192.00 $384.00 $268.80 $336.00 $307.20 $384.00 $374.40 $216.00 $196.80 $201.60 $192.00 $360.00 $312.00
WWH LAB/RAD FEE SCHEDULE - 4206 113857 17999 HCHG US DRAIN SUBCUTANEOUS FLUID COLLECTION "1,535.00" " $1,381.50 " $614.00 " $1,228.00 " $859.60 " $1,074.50 " $982.40 " $1,228.00 " " $1,197.30 " $690.75 $629.35 $644.70 $614.00 " $1,151.25 " $997.75
WWH LAB/RAD FEE SCHEDULE - 4206 113858 19000 HCHG RAD PUNCTURE BREAST CYST ASPIRATION 470.00 $423.00 $188.00 $376.00 $263.20 $329.00 $300.80 $376.00 $366.60 $211.50 $192.70 $197.40 $188.00 $352.50 $305.50
WWH LAB/RAD FEE SCHEDULE - 4206 113859 19001 HCHG RAD PUNCTURE BREAST CYST ASPIRATION EACH ADDL 160.00 $144.00 $64.00 $128.00 $89.60 $112.00 $102.40 $128.00 $124.80 $72.00 $65.60 $67.20 $64.00 $120.00 $104.00
WWH LAB/RAD FEE SCHEDULE - 4206 113865 20206 HCHG US BIOPSY MUSCLE 788.00 $709.20 $315.20 $630.40 $441.28 $551.60 $504.32 $630.40 $614.64 $354.60 $323.08 $330.96 $315.20 $591.00 $512.20
WWH LAB/RAD FEE SCHEDULE - 4206 113866 20220 HCHG US BIOPSY BONE SUPERFICIAL 713.00 $641.70 $285.20 $570.40 $399.28 $499.10 $456.32 $570.40 $556.14 $320.85 $292.33 $299.46 $285.20 $534.75 $463.45
WWH LAB/RAD FEE SCHEDULE - 4206 113867 20604 HCHG RAD INJECT OR ASPIRATE SMALL JOINT OR BURSA W US GUIDE 490.00 $441.00 $196.00 $392.00 $274.40 $343.00 $313.60 $392.00 $382.20 $220.50 $200.90 $205.80 $196.00 $367.50 $318.50
WWH LAB/RAD FEE SCHEDULE - 4206 113868 20606 HCHG RAD INJECT OR ASPIRATE INTERMED JOINT OR BURSA W US GUIDE 625.00 $562.50 $250.00 $500.00 $350.00 $437.50 $400.00 $500.00 $487.50 $281.25 $256.25 $262.50 $250.00 $468.75 $406.25
WWH LAB/RAD FEE SCHEDULE - 4206 113869 20611 HCHG RAD INJECT OR ASPIRATE MAJOR JOINT OR BURSA W US GUIDE 653.00 $587.70 $261.20 $522.40 $365.68 $457.10 $417.92 $522.40 $509.34 $293.85 $267.73 $274.26 $261.20 $489.75 $424.45
WWH LAB/RAD FEE SCHEDULE - 4206 113870 20612 HCHG RAD ASPIRATION OR INJECTION GANGLION CYST ANY LOCATJ 353.00 $317.70 $141.20 $282.40 $197.68 $247.10 $225.92 $282.40 $275.34 $158.85 $144.73 $148.26 $141.20 $264.75 $229.45
WWH LAB/RAD FEE SCHEDULE - 4206 113873 21550 HCHG US BIOPSY SOFT TISSUE NECK OR CHEST 969.00 $872.10 $387.60 $775.20 $542.64 $678.30 $620.16 $775.20 $755.82 $436.05 $397.29 $406.98 $387.60 $726.75 $629.85
WWH LAB/RAD FEE SCHEDULE - 4206 113877 22999 HCHG RAD UNLISTED ABDOMEN PROCEDURE "2,802.00" " $2,521.80 " " $1,120.80 " " $2,241.60 " " $1,569.12 " " $1,961.40 " " $1,793.28 " " $2,241.60 " " $2,185.56 " " $1,260.90 " " $1,148.82 " " $1,176.84 " " $1,120.80 " " $2,101.50 " " $1,821.30 "
WWH LAB/RAD FEE SCHEDULE - 4206 113879 24066 HCHG US BIOPSY DEEP SOFT TISSUE AXILLA BREAST CENTER "2,891.00" " $2,601.90 " " $1,156.40 " " $2,312.80 " " $1,618.96 " " $2,023.70 " " $1,850.24 " " $2,312.80 " " $2,254.98 " " $1,300.95 " " $1,185.31 " " $1,214.22 " " $1,156.40 " " $2,168.25 " " $1,879.15 "
WWH LAB/RAD FEE SCHEDULE - 4206 113880 24999 HCHG RAD UNLISTED HUMERUS OR ELBOW PROCEDURE "1,172.00" " $1,054.80 " $468.80 $937.60 $656.32 $820.40 $750.08 $937.60 $914.16 $527.40 $480.52 $492.24 $468.80 $879.00 $761.80
WWH LAB/RAD FEE SCHEDULE - 4206 113881 27323 HCHG RAD BIOPSY SOFT TISSUE THIGH OR KNEE SUPERFICIAL 768.00 $691.20 $307.20 $614.40 $430.08 $537.60 $491.52 $614.40 $599.04 $345.60 $314.88 $322.56 $307.20 $576.00 $499.20
WWH LAB/RAD FEE SCHEDULE - 4206 113885 32555 HCHG US THORACENTESIS PLEURAL SPACE "2,134.00" " $1,920.60 " $853.60 " $1,707.20 " " $1,195.04 " " $1,493.80 " " $1,365.76 " " $1,707.20 " " $1,664.52 " $960.30 $874.94 $896.28 $853.60 " $1,600.50 " " $1,387.10 "
WWH LAB/RAD FEE SCHEDULE - 4206 113894 38505 HCHG US BIOPSY LYMPH NODE 794.00 $714.60 $317.60 $635.20 $444.64 $555.80 $508.16 $635.20 $619.32 $357.30 $325.54 $333.48 $317.60 $595.50 $516.10
WWH LAB/RAD FEE SCHEDULE - 4206 113898 47000 HCHG US BIOPSY LIVER 909.00 $818.10 $363.60 $727.20 $509.04 $636.30 $581.76 $727.20 $709.02 $409.05 $372.69 $381.78 $363.60 $681.75 $590.85
WWH LAB/RAD FEE SCHEDULE - 4206 113907 49083 HCHG US PARACENTESIS ABDOMEN WITH IMAGING "1,630.00" " $1,467.00 " $652.00 " $1,304.00 " $912.80 " $1,141.00 " " $1,043.20 " " $1,304.00 " " $1,271.40 " $733.50 $668.30 $684.60 $652.00 " $1,222.50 " " $1,059.50 "
WWH LAB/RAD FEE SCHEDULE - 4206 113909 49180 HCHG US BIOPSY ABDOMEN OR RETROPERITONEUM MASS 800.00 $720.00 $320.00 $640.00 $448.00 $560.00 $512.00 $640.00 $624.00 $360.00 $328.00 $336.00 $320.00 $600.00 $520.00
WWH LAB/RAD FEE SCHEDULE - 4206 113914 51798 HCHG RAD MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP 150.00 $135.00 $60.00 $120.00 $84.00 $105.00 $96.00 $120.00 $117.00 $67.50 $61.50 $63.00 $60.00 $112.50 $97.50
WWH LAB/RAD FEE SCHEDULE - 4206 113915 55700 HCHG US BIOPSY PROSTATE "1,010.00" $909.00 $404.00 $808.00 $565.60 $707.00 $646.40 $808.00 $787.80 $454.50 $414.10 $424.20 $404.00 $757.50 $656.50
WWH LAB/RAD FEE SCHEDULE - 4206 113916 58340 (IA) HCHG US INJ HYSTEROSALPINGOGRAM 672.00 $604.80 $268.80 $537.60 $376.32 $470.40 $430.08 $537.60 $524.16 $302.40 $275.52 $282.24 $268.80 $504.00 $436.80
WWH LAB/RAD FEE SCHEDULE - 4206 113921 59000 HCHG RAD AMNIOCENTESIS DIAGNOSTIC 780.00 $702.00 $312.00 $624.00 $436.80 $546.00 $499.20 $624.00 $608.40 $351.00 $319.80 $327.60 $312.00 $585.00 $507.00
WWH LAB/RAD FEE SCHEDULE - 4206 113931 60100 HCHG US BIOPSY THYROID CORE NEEDLE 523.00 $470.70 $209.20 $418.40 $292.88 $366.10 $334.72 $418.40 $407.94 $235.35 $214.43 $219.66 $209.20 $392.25 $339.95
WWH LAB/RAD FEE SCHEDULE - 4206 113932 60300 HCHG RAD ASPIRATION AND/OR INJECTION THYROID CYST 384.00 $345.60 $153.60 $307.20 $215.04 $268.80 $245.76 $307.20 $299.52 $172.80 $157.44 $161.28 $153.60 $288.00 $249.60
WWH LAB/RAD FEE SCHEDULE - 4206 113945 20501 HCHG XR INJ SINUS TRACT DIAGNOSTIC 333.00 $299.70 $133.20 $266.40 $186.48 $233.10 $213.12 $266.40 $259.74 $149.85 $136.53 $139.86 $133.20 $249.75 $216.45
WWH LAB/RAD FEE SCHEDULE - 4206 113947 20550 HCHG XR INJECTION SINGLE TENDON SHEATH LIGAMENT 247.00 $222.30 $98.80 $197.60 $138.32 $172.90 $158.08 $197.60 $192.66 $111.15 $101.27 $103.74 $98.80 $185.25 $160.55
WWH LAB/RAD FEE SCHEDULE - 4206 113948 20551 HCHG RAD INJECTION SINGLE TENDON ORIGIN/INSERTION 231.00 $207.90 $92.40 $184.80 $129.36 $161.70 $147.84 $184.80 $180.18 $103.95 $94.71 $97.02 $92.40 $173.25 $150.15
WWH LAB/RAD FEE SCHEDULE - 4206 113951 20600 HCHG RAD ARTHROCENTESIS ASPIRATION SMALL JOINT OR BURSA 311.00 $279.90 $124.40 $248.80 $174.16 $217.70 $199.04 $248.80 $242.58 $139.95 $127.51 $130.62 $124.40 $233.25 $202.15
WWH LAB/RAD FEE SCHEDULE - 4206 113952 20605 HCHG XR ARTHROCENTESIS INTERMEDIATE JOINT OR BURSA 431.00 $387.90 $172.40 $344.80 $241.36 $301.70 $275.84 $344.80 $336.18 $193.95 $176.71 $181.02 $172.40 $323.25 $280.15
WWH LAB/RAD FEE SCHEDULE - 4206 113953 20610 HCHG XR ARTHROCENTESIS MAJOR JOINT OR BURSA 516.00 $464.40 $206.40 $412.80 $288.96 $361.20 $330.24 $412.80 $402.48 $232.20 $211.56 $216.72 $206.40 $387.00 $335.40
WWH LAB/RAD FEE SCHEDULE - 4206 113956 23350 HCHG XR INJ FOR ARTHROGRAM SHOULDER 701.00 $630.90 $280.40 $560.80 $392.56 $490.70 $448.64 $560.80 $546.78 $315.45 $287.41 $294.42 $280.40 $525.75 $455.65
WWH LAB/RAD FEE SCHEDULE - 4206 113958 24220 HCHG RAD INJECTION FOR ARTHROGRAM ELBOW 769.00 $692.10 $307.60 $615.20 $430.64 $538.30 $492.16 $615.20 $599.82 $346.05 $315.29 $322.98 $307.60 $576.75 $499.85
WWH LAB/RAD FEE SCHEDULE - 4206 113959 25246 HCHG RAD INJECTION FOR ARTHROGRAM WRIST 877.00 $789.30 $350.80 $701.60 $491.12 $613.90 $561.28 $701.60 $684.06 $394.65 $359.57 $368.34 $350.80 $657.75 $570.05
WWH LAB/RAD FEE SCHEDULE - 4206 113961 27093 HCHG XR INJ ARTHROGRAM HIP WO ANESTHESIA 732.00 $658.80 $292.80 $585.60 $409.92 $512.40 $468.48 $585.60 $570.96 $329.40 $300.12 $307.44 $292.80 $549.00 $475.80
WWH LAB/RAD FEE SCHEDULE - 4206 113963 27369 HCHG RAD INJECTION KNEE ARTHROGRAM CNTRST ENHNCD CT OR MRI 486.00 $437.40 $194.40 $388.80 $272.16 $340.20 $311.04 $388.80 $379.08 $218.70 $199.26 $204.12 $194.40 $364.50 $315.90
WWH LAB/RAD FEE SCHEDULE - 4206 113967 28899 HCHG RAD UNLISTED FOOT OR TOE PROCEDURE 812.00 $730.80 $324.80 $649.60 $454.72 $568.40 $519.68 $649.60 $633.36 $365.40 $332.92 $341.04 $324.80 $609.00 $527.80
WWH LAB/RAD FEE SCHEDULE - 4206 113969 36005 HCHG XR VENOGRAM INJECTION 828.00 $745.20 $331.20 $662.40 $463.68 $579.60 $529.92 $662.40 $645.84 $372.60 $339.48 $347.76 $331.20 $621.00 $538.20
WWH LAB/RAD FEE SCHEDULE - 4206 113972 36598 HCHG XR INJECTION FOR CENTRAL VENOUS CATH EVAL 452.00 $406.80 $180.80 $361.60 $253.12 $316.40 $289.28 $361.60 $352.56 $203.40 $185.32 $189.84 $180.80 $339.00 $293.80
WWH LAB/RAD FEE SCHEDULE - 4206 113976 42550 (IA) HCHG XR INJ SIALOGRAM 529.00 $476.10 $211.60 $423.20 $296.24 $370.30 $338.56 $423.20 $412.62 $238.05 $216.89 $222.18 $211.60 $396.75 $343.85
WWH LAB/RAD FEE SCHEDULE - 4206 113979 43752 HCHG XR NG TUBE PLACEMENT 330.00 $297.00 $132.00 $264.00 $184.80 $231.00 $211.20 $264.00 $257.40 $148.50 $135.30 $138.60 $132.00 $247.50 $214.50
WWH LAB/RAD FEE SCHEDULE - 4206 113984 49450 HCHG XR REPLACEMENT GASTROSTOMY OR CECOSTOMY TUBE "1,246.00" " $1,121.40 " $498.40 $996.80 $697.76 $872.20 $797.44 $996.80 $971.88 $560.70 $510.86 $523.32 $498.40 $934.50 $809.90
WWH LAB/RAD FEE SCHEDULE - 4206 113985 49452 HCHG XR REPLACEMENT GASTRO JEJUNOSTOMY TUBE "1,655.00" " $1,489.50 " $662.00 " $1,324.00 " $926.80 " $1,158.50 " " $1,059.20 " " $1,324.00 " " $1,290.90 " $744.75 $678.55 $695.10 $662.00 " $1,241.25 " " $1,075.75 "
WWH LAB/RAD FEE SCHEDULE - 4206 113987 49465 HCHG XR INJ FOR GASTRO TUBE EVAL 311.00 $279.90 $124.40 $248.80 $174.16 $217.70 $199.04 $248.80 $242.58 $139.95 $127.51 $130.62 $124.40 $233.25 $202.15
WWH LAB/RAD FEE SCHEDULE - 4206 113990 51600 HCHG XR INJECTION FOR CYSTOGRAPHY 523.00 $470.70 $209.20 $418.40 $292.88 $366.10 $334.72 $418.40 $407.94 $235.35 $214.43 $219.66 $209.20 $392.25 $339.95
WWH LAB/RAD FEE SCHEDULE - 4206 113991 51610 HCHG XR INJ FOR RETROGRADE URETHROCYSTOGRAM 542.00 $487.80 $216.80 $433.60 $303.52 $379.40 $346.88 $433.60 $422.76 $243.90 $222.22 $227.64 $216.80 $406.50 $352.30
WWH LAB/RAD FEE SCHEDULE - 4206 113993 58340 HCHG XR INJ HYSTEROSALPINGOGRAM 687.00 $618.30 $274.80 $549.60 $384.72 $480.90 $439.68 $549.60 $535.86 $309.15 $281.67 $288.54 $274.80 $515.25 $446.55
WWH LAB/RAD FEE SCHEDULE - 4206 113998 62328 HCHG XR LUMBAR PUNCTURE DIAGNOSTIC 600.00 $540.00 $240.00 $480.00 $336.00 $420.00 $384.00 $480.00 $468.00 $270.00 $246.00 $252.00 $240.00 $450.00 $390.00
WWH LAB/RAD FEE SCHEDULE - 4206 114001 62284 HCHG XR INJECTION FOR MYELOGRAM OR SPINAL CT 719.00 $647.10 $287.60 $575.20 $402.64 $503.30 $460.16 $575.20 $560.82 $323.55 $294.79 $301.98 $287.60 $539.25 $467.35
WWH LAB/RAD FEE SCHEDULE - 4206 114009 64450 HCHG XR INJ NERVE BLOCK PERIPHERAL NERVE 558.00 $502.20 $223.20 $446.40 $312.48 $390.60 $357.12 $446.40 $435.24 $251.10 $228.78 $234.36 $223.20 $418.50 $362.70
WWH LAB/RAD FEE SCHEDULE - 4206 114011 64479 HCHG XR INJ TRANSFORAMINAL CERVICAL OR THORACIC SINGLE LEV "1,628.00" " $1,465.20 " $651.20 " $1,302.40 " $911.68 " $1,139.60 " " $1,041.92 " " $1,302.40 " " $1,269.84 " $732.60 $667.48 $683.76 $651.20 " $1,221.00 " " $1,058.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 114012 64480 HCHG XR INJ TRANSFORAMINAL CERVICAL OR THORACIC EA ADDL LEV 735.00 $661.50 $294.00 $588.00 $411.60 $514.50 $470.40 $588.00 $573.30 $330.75 $301.35 $308.70 $294.00 $551.25 $477.75
WWH LAB/RAD FEE SCHEDULE - 4206 114013 64483 HCHG XR INJ TRANSFORAMINAL LUMBAR OR SACRAL SINGLE LEV "1,450.00" " $1,305.00 " $580.00 " $1,160.00 " $812.00 " $1,015.00 " $928.00 " $1,160.00 " " $1,131.00 " $652.50 $594.50 $609.00 $580.00 " $1,087.50 " $942.50
WWH LAB/RAD FEE SCHEDULE - 4206 114014 64484 HCHG XR INJ TRANSFORAMINAL LUMBAR OR SACRAL EA ADDL LEV 812.00 $730.80 $324.80 $649.60 $454.72 $568.40 $519.68 $649.60 $633.36 $365.40 $332.92 $341.04 $324.80 $609.00 $527.80
WWH LAB/RAD FEE SCHEDULE - 4206 114015 64490 HCHG XR INJ FACET JOINT CERVICAL OR THORACIC SINGLE LEV 869.00 $782.10 $347.60 $695.20 $486.64 $608.30 $556.16 $695.20 $677.82 $391.05 $356.29 $364.98 $347.60 $651.75 $564.85
WWH LAB/RAD FEE SCHEDULE - 4206 114016 64491 HCHG XR INJ FACET JOINT CERVICAL OR THORACIC SECOND LEVEL 543.00 $488.70 $217.20 $434.40 $304.08 $380.10 $347.52 $434.40 $423.54 $244.35 $222.63 $228.06 $217.20 $407.25 $352.95
WWH LAB/RAD FEE SCHEDULE - 4206 114018 64493 HCHG XR INJ FACET LUMBAR OR SACRAL SINGLE LEV "1,332.00" " $1,198.80 " $532.80 " $1,065.60 " $745.92 $932.40 $852.48 " $1,065.60 " " $1,038.96 " $599.40 $546.12 $559.44 $532.80 $999.00 $865.80
WWH LAB/RAD FEE SCHEDULE - 4206 114019 64494 HCHG XR INJ FACET LUMBAR OR SACRAL SECOND LEVEL 414.00 $372.60 $165.60 $331.20 $231.84 $289.80 $264.96 $331.20 $322.92 $186.30 $169.74 $173.88 $165.60 $310.50 $269.10
WWH LAB/RAD FEE SCHEDULE - 4206 114020 64495 HCHG XR INJ FACET LUMBAR OR SACRAL THIRD LEVEL OR MORE 398.00 $358.20 $159.20 $318.40 $222.88 $278.60 $254.72 $318.40 $310.44 $179.10 $163.18 $167.16 $159.20 $298.50 $258.70
WWH LAB/RAD FEE SCHEDULE - 4206 114023 64633 HCHG RAD DSTR NROLYTC AGNT PARVERTEB FACET SNGL CRVCL/THORA "4,729.00" " $4,256.10 " " $1,891.60 " " $3,783.20 " " $2,648.24 " " $3,310.30 " " $3,026.56 " " $3,783.20 " " $3,688.62 " " $2,128.05 " " $1,938.89 " " $1,986.18 " " $1,891.60 " " $3,546.75 " " $3,073.85 "
WWH LAB/RAD FEE SCHEDULE - 4206 114025 64635 HCHG RAD DSTR NROLYTC AGNT PARVERTEB FACET SNGL LMBR/SACRAL "4,729.00" " $4,256.10 " " $1,891.60 " " $3,783.20 " " $2,648.24 " " $3,310.30 " " $3,026.56 " " $3,783.20 " " $3,688.62 " " $2,128.05 " " $1,938.89 " " $1,986.18 " " $1,891.60 " " $3,546.75 " " $3,073.85 "
WWH LAB/RAD FEE SCHEDULE - 4206 114029 G0260 HCHG XR INJ SACROILIAC JOINT "1,400.00" " $1,260.00 " $560.00 " $1,120.00 " $784.00 $980.00 $896.00 " $1,120.00 " " $1,092.00 " $630.00 $574.00 $588.00 $560.00 " $1,050.00 " $910.00
WWH LAB/RAD FEE SCHEDULE - 4206 114230 19083 HCHG RAD BIOPSY BREAST INC MARKER 1ST LESION W US GUIDE "1,822.00" " $1,639.80 " $728.80 " $1,457.60 " " $1,020.32 " " $1,275.40 " " $1,166.08 " " $1,457.60 " " $1,421.16 " $819.90 $747.02 $765.24 $728.80 " $1,366.50 " " $1,184.30 "
WWH LAB/RAD FEE SCHEDULE - 4206 114231 19084 HCHG US BX BREAST INC MARKER EA ADDL W GUIDE "1,144.00" " $1,029.60 " $457.60 $915.20 $640.64 $800.80 $732.16 $915.20 $892.32 $514.80 $469.04 $480.48 $457.60 $858.00 $743.60
WWH LAB/RAD FEE SCHEDULE - 4206 114232 19084 HCHG RAD BIOPSY BREAST INC MARKER EA ADDL LESION W US GUIDE "1,144.00" " $1,029.60 " $457.60 $915.20 $640.64 $800.80 $732.16 $915.20 $892.32 $514.80 $469.04 $480.48 $457.60 $858.00 $743.60
WWH LAB/RAD FEE SCHEDULE - 4206 114236 19281 HCHG XR MAMMO BREAST LOC PERC MARKER 1ST LESION W GUIDE "2,208.00" " $1,987.20 " $883.20 " $1,766.40 " " $1,236.48 " " $1,545.60 " " $1,413.12 " " $1,766.40 " " $1,722.24 " $993.60 $905.28 $927.36 $883.20 " $1,656.00 " " $1,435.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 114237 19282 HCHG XR MAMMO BREAST LOC PERC MARKER EA ADDL W GUIDE 471.00 $423.90 $188.40 $376.80 $263.76 $329.70 $301.44 $376.80 $367.38 $211.95 $193.11 $197.82 $188.40 $353.25 $306.15
WWH LAB/RAD FEE SCHEDULE - 4206 114238 19282 (IA) HCHG XR MAMMO BREAST LOC PERC MARKER EA ADDL W GUIDE RT 471.00 $423.90 $188.40 $376.80 $263.76 $329.70 $301.44 $376.80 $367.38 $211.95 $193.11 $197.82 $188.40 $353.25 $306.15
WWH LAB/RAD FEE SCHEDULE - 4206 114245 19285 HCHG RAD BREAST LOC PERC MARKER 1ST LESION W US GUIDE 745.00 $670.50 $298.00 $596.00 $417.20 $521.50 $476.80 $596.00 $581.10 $335.25 $305.45 $312.90 $298.00 $558.75 $484.25
WWH LAB/RAD FEE SCHEDULE - 4206 114246 19286 HCHG RAD BREAST LOC PERC MARK EACH ADDL W US GUIDE 597.00 $537.30 $238.80 $477.60 $334.32 $417.90 $382.08 $477.60 $465.66 $268.65 $244.77 $250.74 $238.80 $447.75 $388.05
WWH LAB/RAD FEE SCHEDULE - 4206 114247 19286 (IA) HCHG RAD BREAST LOC PERC MARKER EACH ADDL W US GUIDE 597.00 $537.30 $238.80 $477.60 $334.32 $417.90 $382.08 $477.60 $465.66 $268.65 $244.77 $250.74 $238.80 $447.75 $388.05
WWH LAB/RAD FEE SCHEDULE - 4206 114257 49406 HCHG CT DRAIN ABSCESS PERITONEAL PERC INC GUIDE "2,562.00" " $2,305.80 " " $1,024.80 " " $2,049.60 " " $1,434.72 " " $1,793.40 " " $1,639.68 " " $2,049.60 " " $1,998.36 " " $1,152.90 " " $1,050.42 " " $1,076.04 " " $1,024.80 " " $1,921.50 " " $1,665.30 "
WWH LAB/RAD FEE SCHEDULE - 4206 114262 49406 HCHG US DRAIN ABSCESS PERITONEAL PERC INC GUIDE "2,562.00" " $2,305.80 " " $1,024.80 " " $2,049.60 " " $1,434.72 " " $1,793.40 " " $1,639.68 " " $2,049.60 " " $1,998.36 " " $1,152.90 " " $1,050.42 " " $1,076.04 " " $1,024.80 " " $1,921.50 " " $1,665.30 "
WWH LAB/RAD FEE SCHEDULE - 4206 114273 10030 HCHG CT CATH FLUID COLLECTION DRAINAGE SOFT TISSUE INC GUIDE "1,311.00" " $1,179.90 " $524.40 " $1,048.80 " $734.16 $917.70 $839.04 " $1,048.80 " " $1,022.58 " $589.95 $537.51 $550.62 $524.40 $983.25 $852.15
WWH LAB/RAD FEE SCHEDULE - 4206 114275 10030 HCHG US CATH FLUID COLLECTION DRAINAGE SOFT TISSUE INC GUIDE "1,311.00" " $1,179.90 " $524.40 " $1,048.80 " $734.16 $917.70 $839.04 " $1,048.80 " " $1,022.58 " $589.95 $537.51 $550.62 $524.40 $983.25 $852.15
WWH LAB/RAD FEE SCHEDULE - 4206 114276 10030 (IA) HCHG XR CATH FLUID COLLECTION DRAINAGE SOFT TISSUE INC GUIDE "1,311.00" " $1,179.90 " $524.40 " $1,048.80 " $734.16 $917.70 $839.04 " $1,048.80 " " $1,022.58 " $589.95 $537.51 $550.62 $524.40 $983.25 $852.15
WWH LAB/RAD FEE SCHEDULE - 4206 115052 64425 HCHG CT ILIOINGUINAL NERVE INJ 553.00 $497.70 $221.20 $442.40 $309.68 $387.10 $353.92 $442.40 $431.34 $248.85 $226.73 $232.26 $221.20 $414.75 $359.45
WWH LAB/RAD FEE SCHEDULE - 4206 115071 36573 HCHG XR PICC => 5 YRS INSERTION W GUIDANCE S&I "1,163.00" " $1,046.70 " $465.20 $930.40 $651.28 $814.10 $744.32 $930.40 $907.14 $523.35 $476.83 $488.46 $465.20 $872.25 $755.95
WWH LAB/RAD FEE SCHEDULE - 4206 115103 62302 HCHG XR INJ FOR MYELOGRAM CERVICAL "1,520.00" " $1,368.00 " $608.00 " $1,216.00 " $851.20 " $1,064.00 " $972.80 " $1,216.00 " " $1,185.60 " $684.00 $623.20 $638.40 $608.00 " $1,140.00 " $988.00
WWH LAB/RAD FEE SCHEDULE - 4206 115105 62304 HCHG XR INJ FOR MYELOGRAM LUMBOSACRAL "1,520.00" " $1,368.00 " $608.00 " $1,216.00 " $851.20 " $1,064.00 " $972.80 " $1,216.00 " " $1,185.60 " $684.00 $623.20 $638.40 $608.00 " $1,140.00 " $988.00
WWH LAB/RAD FEE SCHEDULE - 4206 115470 93352 HCHG RAD ECHO ADMIN ECG STRESS ECHO CONTRAST AGENT 330.00 $297.00 $132.00 $264.00 $184.80 $231.00 $211.20 $264.00 $257.40 $148.50 $135.30 $138.60 $132.00 $247.50 $214.50
WWH LAB/RAD FEE SCHEDULE - 4206 115492 20552 HCHG US INJ(S) SGL/MUL TRIG PT(S) 1 OR 2 MUSC 437.00 $393.30 $174.80 $349.60 $244.72 $305.90 $279.68 $349.60 $340.86 $196.65 $179.17 $183.54 $174.80 $327.75 $284.05
WWH LAB/RAD FEE SCHEDULE - 4206 115493 20553 HCHG US INJ(S) SGL/MUL TRIG PT(S) 3 OR > MUSC 461.00 $414.90 $184.40 $368.80 $258.16 $322.70 $295.04 $368.80 $359.58 $207.45 $189.01 $193.62 $184.40 $345.75 $299.65
WWH LAB/RAD FEE SCHEDULE - 4206 115539 64625 HCHG RAD RADIOFREQUENCY ABLTJ NERVES NRVTG SI JT W/IMG GDN "4,729.00" " $4,256.10 " " $1,891.60 " " $3,783.20 " " $2,648.24 " " $3,310.30 " " $3,026.56 " " $3,783.20 " " $3,688.62 " " $2,128.05 " " $1,938.89 " " $1,986.18 " " $1,891.60 " " $3,546.75 " " $3,073.85 "
WWH LAB/RAD FEE SCHEDULE - 4206 115721 62323 HCHG XR INJ EPIDURAL LUMBAR OR SACRAL W GUIDE "1,445.00" " $1,300.50 " $578.00 " $1,156.00 " $809.20 " $1,011.50 " $924.80 " $1,156.00 " " $1,127.10 " $650.25 $592.45 $606.90 $578.00 " $1,083.75 " $939.25
WWH LAB/RAD FEE SCHEDULE - 4206 115776 62302 HCHG RAD INJ FOR MYELOGRAM CERVICAL "1,520.00" " $1,368.00 " $608.00 " $1,216.00 " $851.20 " $1,064.00 " $972.80 " $1,216.00 " " $1,185.60 " $684.00 $623.20 $638.40 $608.00 " $1,140.00 " $988.00
WWH LAB/RAD FEE SCHEDULE - 4206 115945 64640 HCHG XR RF ABLATION OTHER PERIPHERAL NERVE OR BRANCH "1,577.00" " $1,419.30 " $630.80 " $1,261.60 " $883.12 " $1,103.90 " " $1,009.28 " " $1,261.60 " " $1,230.06 " $709.65 $646.57 $662.34 $630.80 " $1,182.75 " " $1,025.05 "
WWH LAB/RAD FEE SCHEDULE - 4206 116061 64447 HCHG RAD INJ ANESTIC AGENT & STEROID FEMORAL NERVE W IMG GUIDE "1,628.00" " $1,465.20 " $651.20 " $1,302.40 " $911.68 " $1,139.60 " " $1,041.92 " " $1,302.40 " " $1,269.84 " $732.60 $667.48 $683.76 $651.20 " $1,221.00 " " $1,058.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 116123 64451 HCHG XR INJ ANES STEROID INNERVATING SACROILIAC INC GUIDE "2,754.00" " $2,478.60 " " $1,101.60 " " $2,203.20 " " $1,542.24 " " $1,927.80 " " $1,762.56 " " $2,203.20 " " $2,148.12 " " $1,239.30 " " $1,129.14 " " $1,156.68 " " $1,101.60 " " $2,065.50 " " $1,790.10 "
WWH LAB/RAD FEE SCHEDULE - 4206 116126 64454 HCHG RAD INJECTION ANES &/STRD GENICULAR NRV BRANCHES W/IMG "2,754.00" " $2,478.60 " " $1,101.60 " " $2,203.20 " " $1,542.24 " " $1,927.80 " " $1,762.56 " " $2,203.20 " " $2,148.12 " " $1,239.30 " " $1,129.14 " " $1,156.68 " " $1,101.60 " " $2,065.50 " " $1,790.10 "
WWH LAB/RAD FEE SCHEDULE - 4206 116129 64624 (IA) HCHG XR DESTRUCTION GENICULAR NERVE BRANCH W NEUROLYTIC AGENT "4,729.00" " $4,256.10 " " $1,891.60 " " $3,783.20 " " $2,648.24 " " $3,310.30 " " $3,026.56 " " $3,783.20 " " $3,688.62 " " $2,128.05 " " $1,938.89 " " $1,986.18 " " $1,891.60 " " $3,546.75 " " $3,073.85 "
WWH LAB/RAD FEE SCHEDULE - 4206 116133 64624 HCHG CT DESTRUCTION GENICULAR NERVE BRANCHES W NEUROLYTIC AGENT "4,729.00" " $4,256.10 " " $1,891.60 " " $3,783.20 " " $2,648.24 " " $3,310.30 " " $3,026.56 " " $3,783.20 " " $3,688.62 " " $2,128.05 " " $1,938.89 " " $1,986.18 " " $1,891.60 " " $3,546.75 " " $3,073.85 "
WWH LAB/RAD FEE SCHEDULE - 4206 116247 64640 HCHG XR DESTRUCTION PERIPHERAL NERVE BRANCH W NEUROLYTIC AGENT "1,577.00" " $1,419.30 " $630.80 " $1,261.60 " $883.12 " $1,103.90 " " $1,009.28 " " $1,261.60 " " $1,230.06 " $709.65 $646.57 $662.34 $630.80 " $1,182.75 " " $1,025.05 "
WWH LAB/RAD FEE SCHEDULE - 4206 116560 70030 HCHG RAD XRAY EYE DETECTION OF FOREIGN BODY 284.00 $255.60 $113.60 $227.20 $159.04 $198.80 $181.76 $227.20 $221.52 $127.80 $116.44 $119.28 $113.60 $213.00 $184.60
WWH LAB/RAD FEE SCHEDULE - 4206 116561 70100 HCHG RAD XRAY MANDIBLE THREE VIEWS OR LESS 121.00 $108.90 $48.40 $96.80 $67.76 $84.70 $77.44 $96.80 $94.38 $54.45 $49.61 $50.82 $48.40 $90.75 $78.65
WWH LAB/RAD FEE SCHEDULE - 4206 116562 70110 HCHG RAD XRAY MANDIBLE MINIMUM OF FOUR VIEWS 201.00 $180.90 $80.40 $160.80 $112.56 $140.70 $128.64 $160.80 $156.78 $90.45 $82.41 $84.42 $80.40 $150.75 $130.65
WWH LAB/RAD FEE SCHEDULE - 4206 116564 70130 HCHG RAD XRAY MASTOIDS MINIMUM OF THREE VIEWS 130.00 $117.00 $52.00 $104.00 $72.80 $91.00 $83.20 $104.00 $101.40 $58.50 $53.30 $54.60 $52.00 $97.50 $84.50
WWH LAB/RAD FEE SCHEDULE - 4206 116566 70140 HCHG RAD XRAY FACIAL BONES TWO VIEWS OR LESS 206.00 $185.40 $82.40 $164.80 $115.36 $144.20 $131.84 $164.80 $160.68 $92.70 $84.46 $86.52 $82.40 $154.50 $133.90
WWH LAB/RAD FEE SCHEDULE - 4206 116567 70150 HCHG RAD XRAY FACIAL BONES COMPLETE MINIMUM OF THREE VIEWS 308.00 $277.20 $123.20 $246.40 $172.48 $215.60 $197.12 $246.40 $240.24 $138.60 $126.28 $129.36 $123.20 $231.00 $200.20
WWH LAB/RAD FEE SCHEDULE - 4206 116568 70160 HCHG RAD XRAY NASAL BONES COMPLETE MINIMUM OF THREE VIEWS 174.00 $156.60 $69.60 $139.20 $97.44 $121.80 $111.36 $139.20 $135.72 $78.30 $71.34 $73.08 $69.60 $130.50 $113.10
WWH LAB/RAD FEE SCHEDULE - 4206 116571 70200 HCHG RAD XRAY ORBITS MINIMUM OF FOUR VIEWS 186.00 $167.40 $74.40 $148.80 $104.16 $130.20 $119.04 $148.80 $145.08 $83.70 $76.26 $78.12 $74.40 $139.50 $120.90
WWH LAB/RAD FEE SCHEDULE - 4206 116572 70200 HCHG RAD XRAY ORBITS MINIMUM OF FOUR VIEWS LIMITED 340.00 $306.00 $136.00 $272.00 $190.40 $238.00 $217.60 $272.00 $265.20 $153.00 $139.40 $142.80 $136.00 $255.00 $221.00
WWH LAB/RAD FEE SCHEDULE - 4206 116573 70210 HCHG RAD XRAY SINUSES TWO VIEWS OR LESS 125.00 $112.50 $50.00 $100.00 $70.00 $87.50 $80.00 $100.00 $97.50 $56.25 $51.25 $52.50 $50.00 $93.75 $81.25
WWH LAB/RAD FEE SCHEDULE - 4206 116574 70220 HCHG RAD XRAY SINUSES COMPLETE MINIMUM OF THREE VIEWS 211.00 $189.90 $84.40 $168.80 $118.16 $147.70 $135.04 $168.80 $164.58 $94.95 $86.51 $88.62 $84.40 $158.25 $137.15
WWH LAB/RAD FEE SCHEDULE - 4206 116576 70250 HCHG RAD XRAY SKULL THREE VIEWS OR LESS 276.00 $248.40 $110.40 $220.80 $154.56 $193.20 $176.64 $220.80 $215.28 $124.20 $113.16 $115.92 $110.40 $207.00 $179.40
WWH LAB/RAD FEE SCHEDULE - 4206 116577 70250 HCHG RAD XRAY SKULL THREE VIEWS OR LESS PORTABLE 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH LAB/RAD FEE SCHEDULE - 4206 116578 70260 HCHG RAD XRAY SKULL COMPLETE MINIMUM OF FOUR VIEWS 382.00 $343.80 $152.80 $305.60 $213.92 $267.40 $244.48 $305.60 $297.96 $171.90 $156.62 $160.44 $152.80 $286.50 $248.30
WWH LAB/RAD FEE SCHEDULE - 4206 116582 70328 HCHG RAD XRAY TEMPROMANDIBULAR JOINTS UNILATERAL 105.00 $94.50 $42.00 $84.00 $58.80 $73.50 $67.20 $84.00 $81.90 $47.25 $43.05 $44.10 $42.00 $78.75 $68.25
WWH LAB/RAD FEE SCHEDULE - 4206 116583 70330 HCHG RAD XRAY TEMPROMANDIBULAR JOINTS BILATERAL 219.00 $197.10 $87.60 $175.20 $122.64 $153.30 $140.16 $175.20 $170.82 $98.55 $89.79 $91.98 $87.60 $164.25 $142.35
WWH LAB/RAD FEE SCHEDULE - 4206 116584 70336 HCHG RAD MRI TEMPOROMANDIBULAR JOINT "3,345.00" " $3,010.50 " " $1,338.00 " " $2,676.00 " " $1,873.20 " " $2,341.50 " " $2,140.80 " " $2,676.00 " " $2,609.10 " " $1,505.25 " " $1,371.45 " " $1,404.90 " " $1,338.00 " " $2,508.75 " " $2,174.25 "
WWH LAB/RAD FEE SCHEDULE - 4206 116586 70360 HCHG RAD XRAY NECK SOFT TISSUE 164.00 $147.60 $65.60 $131.20 $91.84 $114.80 $104.96 $131.20 $127.92 $73.80 $67.24 $68.88 $65.60 $123.00 $106.60
WWH LAB/RAD FEE SCHEDULE - 4206 116587 70360 HCHG RAD XRAY NECK SOFT TISSUE PORTABLE 182.00 $163.80 $72.80 $145.60 $101.92 $127.40 $116.48 $145.60 $141.96 $81.90 $74.62 $76.44 $72.80 $136.50 $118.30
WWH LAB/RAD FEE SCHEDULE - 4206 116589 70390 HCHG RAD SIALOGRAM 468.00 $421.20 $187.20 $374.40 $262.08 $327.60 $299.52 $374.40 $365.04 $210.60 $191.88 $196.56 $187.20 $351.00 $304.20
WWH LAB/RAD FEE SCHEDULE - 4206 116590 70450 HCHG RAD CT HEAD BRAIN WO "1,991.00" " $1,791.90 " $796.40 " $1,592.80 " " $1,114.96 " " $1,393.70 " " $1,274.24 " " $1,592.80 " " $1,552.98 " $895.95 $816.31 $836.22 $796.40 " $1,493.25 " " $1,294.15 "
WWH LAB/RAD FEE SCHEDULE - 4206 116591 70460 HCHG RAD CT HEAD BRAIN W "1,254.00" " $1,128.60 " $501.60 " $1,003.20 " $702.24 $877.80 $802.56 " $1,003.20 " $978.12 $564.30 $514.14 $526.68 $501.60 $940.50 $815.10
WWH LAB/RAD FEE SCHEDULE - 4206 116592 70470 HCHG RAD CT HEAD BRAIN WWO "1,627.00" " $1,464.30 " $650.80 " $1,301.60 " $911.12 " $1,138.90 " " $1,041.28 " " $1,301.60 " " $1,269.06 " $732.15 $667.07 $683.34 $650.80 " $1,220.25 " " $1,057.55 "
WWH LAB/RAD FEE SCHEDULE - 4206 116593 70480 HCHG RAD CT ORBITS OR TEMPORAL BONES WO "1,383.00" " $1,244.70 " $553.20 " $1,106.40 " $774.48 $968.10 $885.12 " $1,106.40 " " $1,078.74 " $622.35 $567.03 $580.86 $553.20 " $1,037.25 " $898.95
WWH LAB/RAD FEE SCHEDULE - 4206 116595 70481 HCHG RAD CT ORBITS OR TEMPORAL BONES W "1,627.00" " $1,464.30 " $650.80 " $1,301.60 " $911.12 " $1,138.90 " " $1,041.28 " " $1,301.60 " " $1,269.06 " $732.15 $667.07 $683.34 $650.80 " $1,220.25 " " $1,057.55 "
WWH LAB/RAD FEE SCHEDULE - 4206 116596 70482 HCHG RAD CT ORBITS OR TEMPORAL BONES WWO "1,489.00" " $1,340.10 " $595.60 " $1,191.20 " $833.84 " $1,042.30 " $952.96 " $1,191.20 " " $1,161.42 " $670.05 $610.49 $625.38 $595.60 " $1,116.75 " $967.85
WWH LAB/RAD FEE SCHEDULE - 4206 116597 70486 HCHG RAD CT FACIAL BONES AND SINUS WO 974.00 $876.60 $389.60 $779.20 $545.44 $681.80 $623.36 $779.20 $759.72 $438.30 $399.34 $409.08 $389.60 $730.50 $633.10
WWH LAB/RAD FEE SCHEDULE - 4206 116599 70487 HCHG RAD CT FACIAL BONES AND SINUS W "1,627.00" " $1,464.30 " $650.80 " $1,301.60 " $911.12 " $1,138.90 " " $1,041.28 " " $1,301.60 " " $1,269.06 " $732.15 $667.07 $683.34 $650.80 " $1,220.25 " " $1,057.55 "
WWH LAB/RAD FEE SCHEDULE - 4206 116600 70488 HCHG RAD CT FACIAL BONES AND SINUS WWO "1,371.00" " $1,233.90 " $548.40 " $1,096.80 " $767.76 $959.70 $877.44 " $1,096.80 " " $1,069.38 " $616.95 $562.11 $575.82 $548.40 " $1,028.25 " $891.15
WWH LAB/RAD FEE SCHEDULE - 4206 116601 70490 HCHG RAD CT NECK SOFT TISSUE WO "1,771.00" " $1,593.90 " $708.40 " $1,416.80 " $991.76 " $1,239.70 " " $1,133.44 " " $1,416.80 " " $1,381.38 " $796.95 $726.11 $743.82 $708.40 " $1,328.25 " " $1,151.15 "
WWH LAB/RAD FEE SCHEDULE - 4206 116602 70491 HCHG RAD CT NECK SOFT TISSUE W "2,730.00" " $2,457.00 " " $1,092.00 " " $2,184.00 " " $1,528.80 " " $1,911.00 " " $1,747.20 " " $2,184.00 " " $2,129.40 " " $1,228.50 " " $1,119.30 " " $1,146.60 " " $1,092.00 " " $2,047.50 " " $1,774.50 "
WWH LAB/RAD FEE SCHEDULE - 4206 116603 70492 HCHG RAD CT NECK SOFT TISSUE WWO "1,452.00" " $1,306.80 " $580.80 " $1,161.60 " $813.12 " $1,016.40 " $929.28 " $1,161.60 " " $1,132.56 " $653.40 $595.32 $609.84 $580.80 " $1,089.00 " $943.80
WWH LAB/RAD FEE SCHEDULE - 4206 116604 70496 HCHG RAD CT ANGIO HEAD W CONTRAST "3,408.00" " $3,067.20 " " $1,363.20 " " $2,726.40 " " $1,908.48 " " $2,385.60 " " $2,181.12 " " $2,726.40 " " $2,658.24 " " $1,533.60 " " $1,397.28 " " $1,431.36 " " $1,363.20 " " $2,556.00 " " $2,215.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 116605 70498 HCHG RAD CT ANGIO NECK W CONTRAST "3,516.00" " $3,164.40 " " $1,406.40 " " $2,812.80 " " $1,968.96 " " $2,461.20 " " $2,250.24 " " $2,812.80 " " $2,742.48 " " $1,582.20 " " $1,441.56 " " $1,476.72 " " $1,406.40 " " $2,637.00 " " $2,285.40 "
WWH LAB/RAD FEE SCHEDULE - 4206 116606 70540 HCHG RAD MRI NECK SOFT TISSUE ORBIT FACE WO "2,759.00" " $2,483.10 " " $1,103.60 " " $2,207.20 " " $1,545.04 " " $1,931.30 " " $1,765.76 " " $2,207.20 " " $2,152.02 " " $1,241.55 " " $1,131.19 " " $1,158.78 " " $1,103.60 " " $2,069.25 " " $1,793.35 "
WWH LAB/RAD FEE SCHEDULE - 4206 116607 70542 HCHG RAD MRI NECK SOFT TISSUE ORBIT FACE W "4,043.00" " $3,638.70 " " $1,617.20 " " $3,234.40 " " $2,264.08 " " $2,830.10 " " $2,587.52 " " $3,234.40 " " $3,153.54 " " $1,819.35 " " $1,657.63 " " $1,698.06 " " $1,617.20 " " $3,032.25 " " $2,627.95 "
WWH LAB/RAD FEE SCHEDULE - 4206 116608 70543 HCHG RAD MRI NECK SOFT TISSUE ORBIT FACE WWO "5,088.00" " $4,579.20 " " $2,035.20 " " $4,070.40 " " $2,849.28 " " $3,561.60 " " $3,256.32 " " $4,070.40 " " $3,968.64 " " $2,289.60 " " $2,086.08 " " $2,136.96 " " $2,035.20 " " $3,816.00 " " $3,307.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 116609 70544 HCHG RAD MRI ANGIO HEAD WO "3,688.00" " $3,319.20 " " $1,475.20 " " $2,950.40 " " $2,065.28 " " $2,581.60 " " $2,360.32 " " $2,950.40 " " $2,876.64 " " $1,659.60 " " $1,512.08 " " $1,548.96 " " $1,475.20 " " $2,766.00 " " $2,397.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 116610 70545 HCHG RAD MRI ANGIO HEAD W "2,188.00" " $1,969.20 " $875.20 " $1,750.40 " " $1,225.28 " " $1,531.60 " " $1,400.32 " " $1,750.40 " " $1,706.64 " $984.60 $897.08 $918.96 $875.20 " $1,641.00 " " $1,422.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 116611 70546 HCHG RAD MRI ANGIO HEAD BRAIN WWO "6,160.00" " $5,544.00 " " $2,464.00 " " $4,928.00 " " $3,449.60 " " $4,312.00 " " $3,942.40 " " $4,928.00 " " $4,804.80 " " $2,772.00 " " $2,525.60 " " $2,587.20 " " $2,464.00 " " $4,620.00 " " $4,004.00 "
WWH LAB/RAD FEE SCHEDULE - 4206 116612 70547 HCHG RAD MRI ANGIO NECK WO "3,309.00" " $2,978.10 " " $1,323.60 " " $2,647.20 " " $1,853.04 " " $2,316.30 " " $2,117.76 " " $2,647.20 " " $2,581.02 " " $1,489.05 " " $1,356.69 " " $1,389.78 " " $1,323.60 " " $2,481.75 " " $2,150.85 "
WWH LAB/RAD FEE SCHEDULE - 4206 116613 70548 HCHG RAD MRI ANGIO NECK W "2,061.00" " $1,854.90 " $824.40 " $1,648.80 " " $1,154.16 " " $1,442.70 " " $1,319.04 " " $1,648.80 " " $1,607.58 " $927.45 $845.01 $865.62 $824.40 " $1,545.75 " " $1,339.65 "
WWH LAB/RAD FEE SCHEDULE - 4206 116614 70549 HCHG RAD MRI ANGIO NECK WWO "5,832.00" " $5,248.80 " " $2,332.80 " " $4,665.60 " " $3,265.92 " " $4,082.40 " " $3,732.48 " " $4,665.60 " " $4,548.96 " " $2,624.40 " " $2,391.12 " " $2,449.44 " " $2,332.80 " " $4,374.00 " " $3,790.80 "
WWH LAB/RAD FEE SCHEDULE - 4206 116615 70551 HCHG RAD MRI HEAD BRAIN WO "2,922.00" " $2,629.80 " " $1,168.80 " " $2,337.60 " " $1,636.32 " " $2,045.40 " " $1,870.08 " " $2,337.60 " " $2,279.16 " " $1,314.90 " " $1,198.02 " " $1,227.24 " " $1,168.80 " " $2,191.50 " " $1,899.30 "
WWH LAB/RAD FEE SCHEDULE - 4206 116616 70551 HCHG RAD MRI HEAD BRAIN WO LIMITED "1,849.00" " $1,664.10 " $739.60 " $1,479.20 " " $1,035.44 " " $1,294.30 " " $1,183.36 " " $1,479.20 " " $1,442.22 " $832.05 $758.09 $776.58 $739.60 " $1,386.75 " " $1,201.85 "
WWH LAB/RAD FEE SCHEDULE - 4206 116617 70552 HCHG RAD MRI HEAD BRAIN W "4,237.00" " $3,813.30 " " $1,694.80 " " $3,389.60 " " $2,372.72 " " $2,965.90 " " $2,711.68 " " $3,389.60 " " $3,304.86 " " $1,906.65 " " $1,737.17 " " $1,779.54 " " $1,694.80 " " $3,177.75 " " $2,754.05 "
WWH LAB/RAD FEE SCHEDULE - 4206 116618 70552 HCHG RAD MRI HEAD BRAIN W LIMITED "4,237.00" " $3,813.30 " " $1,694.80 " " $3,389.60 " " $2,372.72 " " $2,965.90 " " $2,711.68 " " $3,389.60 " " $3,304.86 " " $1,906.65 " " $1,737.17 " " $1,779.54 " " $1,694.80 " " $3,177.75 " " $2,754.05 "
WWH LAB/RAD FEE SCHEDULE - 4206 116619 70553 HCHG RAD MRI HEAD BRAIN WWO "4,860.00" " $4,374.00 " " $1,944.00 " " $3,888.00 " " $2,721.60 " " $3,402.00 " " $3,110.40 " " $3,888.00 " " $3,790.80 " " $2,187.00 " " $1,992.60 " " $2,041.20 " " $1,944.00 " " $3,645.00 " " $3,159.00 "
WWH LAB/RAD FEE SCHEDULE - 4206 116625 71045 HCHG RAD XRAY CHEST FRONTAL 1 VIEW 200.00 $180.00 $80.00 $160.00 $112.00 $140.00 $128.00 $160.00 $156.00 $90.00 $82.00 $84.00 $80.00 $150.00 $130.00
WWH LAB/RAD FEE SCHEDULE - 4206 116626 71045 HCHG RAD XRAY CHEST FRONTAL 1 VIEW PORTABLE 200.00 $180.00 $80.00 $160.00 $112.00 $140.00 $128.00 $160.00 $156.00 $90.00 $82.00 $84.00 $80.00 $150.00 $130.00
WWH LAB/RAD FEE SCHEDULE - 4206 116627 71046 HCHG RAD XRAY CHEST 2 VIEWS PA AND LATERAL 286.00 $257.40 $114.40 $228.80 $160.16 $200.20 $183.04 $228.80 $223.08 $128.70 $117.26 $120.12 $114.40 $214.50 $185.90
WWH LAB/RAD FEE SCHEDULE - 4206 116628 71046 HCHG RAD XRAY CHEST 2 VIEWS PA AND LAT PORTABLE 264.00 $237.60 $105.60 $211.20 $147.84 $184.80 $168.96 $211.20 $205.92 $118.80 $108.24 $110.88 $105.60 $198.00 $171.60
WWH LAB/RAD FEE SCHEDULE - 4206 116629 71047 HCHG RAD XRAY CHEST 2 VIEWS APICAL LORDOTIC 298.00 $268.20 $119.20 $238.40 $166.88 $208.60 $190.72 $238.40 $232.44 $134.10 $122.18 $125.16 $119.20 $223.50 $193.70
WWH LAB/RAD FEE SCHEDULE - 4206 116630 71048 HCHG RAD XRAY CHEST 4 VIEWS OR MORE 308.00 $277.20 $123.20 $246.40 $172.48 $215.60 $197.12 $246.40 $240.24 $138.60 $126.28 $129.36 $123.20 $231.00 $200.20
WWH LAB/RAD FEE SCHEDULE - 4206 116631 71100 HCHG RAD XRAY RIBS 2 VIEWS UNILATERAL 273.00 $245.70 $109.20 $218.40 $152.88 $191.10 $174.72 $218.40 $212.94 $122.85 $111.93 $114.66 $109.20 $204.75 $177.45
WWH LAB/RAD FEE SCHEDULE - 4206 116632 71101 HCHG RAD XRAY RIBS UNI INCLUDING PA CHEST MINIMUM OF 3 VIEWS 319.00 $287.10 $127.60 $255.20 $178.64 $223.30 $204.16 $255.20 $248.82 $143.55 $130.79 $133.98 $127.60 $239.25 $207.35
WWH LAB/RAD FEE SCHEDULE - 4206 116633 71110 HCHG RAD XRAY RIBS 3 VIEWS BILATERAL 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 116634 71111 HCHG RAD XRAY RIBS BILATERAL AND CHEST MINIMUM 4 VIEWS 386.00 $347.40 $154.40 $308.80 $216.16 $270.20 $247.04 $308.80 $301.08 $173.70 $158.26 $162.12 $154.40 $289.50 $250.90
WWH LAB/RAD FEE SCHEDULE - 4206 116635 71120 HCHG RAD XRAY STERNUM MINIMUM 2 VIEWS 174.00 $156.60 $69.60 $139.20 $97.44 $121.80 $111.36 $139.20 $135.72 $78.30 $71.34 $73.08 $69.60 $130.50 $113.10
WWH LAB/RAD FEE SCHEDULE - 4206 116636 71130 HCHG RAD XRAY STERNOCLAVICULAR JOINT(S) MIN 3 VIEWS 224.00 $201.60 $89.60 $179.20 $125.44 $156.80 $143.36 $179.20 $174.72 $100.80 $91.84 $94.08 $89.60 $168.00 $145.60
WWH LAB/RAD FEE SCHEDULE - 4206 116637 71250 HCHG RAD CT CHEST WO CONTRAST DIAGNOSTIC "2,828.00" " $2,545.20 " " $1,131.20 " " $2,262.40 " " $1,583.68 " " $1,979.60 " " $1,809.92 " " $2,262.40 " " $2,205.84 " " $1,272.60 " " $1,159.48 " " $1,187.76 " " $1,131.20 " " $2,121.00 " " $1,838.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 116638 71250 HCHG RAD CT CHEST WO CONTRAST DIAGNOSTIC ADD-ON "2,828.00" " $2,545.20 " " $1,131.20 " " $2,262.40 " " $1,583.68 " " $1,979.60 " " $1,809.92 " " $2,262.40 " " $2,205.84 " " $1,272.60 " " $1,159.48 " " $1,187.76 " " $1,131.20 " " $2,121.00 " " $1,838.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 116639 71250 HCHG RAD CT CHEST WO CONTRAST DIAGNOSTIC LOW DOSE "2,828.00" " $2,545.20 " " $1,131.20 " " $2,262.40 " " $1,583.68 " " $1,979.60 " " $1,809.92 " " $2,262.40 " " $2,205.84 " " $1,272.60 " " $1,159.48 " " $1,187.76 " " $1,131.20 " " $2,121.00 " " $1,838.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 116641 71260 HCHG RAD CT CHEST W CONTRAST DIAGNOSTIC "2,951.00" " $2,655.90 " " $1,180.40 " " $2,360.80 " " $1,652.56 " " $2,065.70 " " $1,888.64 " " $2,360.80 " " $2,301.78 " " $1,327.95 " " $1,209.91 " " $1,239.42 " " $1,180.40 " " $2,213.25 " " $1,918.15 "
WWH LAB/RAD FEE SCHEDULE - 4206 116642 71260 HCHG RAD CT CHEST W CONTRAST DIAGNOSTIC ADD-ON "2,951.00" " $2,655.90 " " $1,180.40 " " $2,360.80 " " $1,652.56 " " $2,065.70 " " $1,888.64 " " $2,360.80 " " $2,301.78 " " $1,327.95 " " $1,209.91 " " $1,239.42 " " $1,180.40 " " $2,213.25 " " $1,918.15 "
WWH LAB/RAD FEE SCHEDULE - 4206 116643 71270 HCHG RAD CT CHEST WWO CONTRAST DIAGNOSTIC "1,947.00" " $1,752.30 " $778.80 " $1,557.60 " " $1,090.32 " " $1,362.90 " " $1,246.08 " " $1,557.60 " " $1,518.66 " $876.15 $798.27 $817.74 $778.80 " $1,460.25 " " $1,265.55 "
WWH LAB/RAD FEE SCHEDULE - 4206 116644 71270 HCHG RAD CT CHEST WWO CONTRAST DIAGNOSTIC ADD-ON "2,791.00" " $2,511.90 " " $1,116.40 " " $2,232.80 " " $1,562.96 " " $1,953.70 " " $1,786.24 " " $2,232.80 " " $2,176.98 " " $1,255.95 " " $1,144.31 " " $1,172.22 " " $1,116.40 " " $2,093.25 " " $1,814.15 "
WWH LAB/RAD FEE SCHEDULE - 4206 116645 71271 HCHG RAD CT THORAX LOW DOSE LUNG CANCER SCREEN WO 241.00 $216.90 $96.40 $192.80 $134.96 $168.70 $154.24 $192.80 $187.98 $108.45 $98.81 $101.22 $96.40 $180.75 $156.65
WWH LAB/RAD FEE SCHEDULE - 4206 116646 71275 HCHG RAD CT ANGIO CHEST "3,299.00" " $2,969.10 " " $1,319.60 " " $2,639.20 " " $1,847.44 " " $2,309.30 " " $2,111.36 " " $2,639.20 " " $2,573.22 " " $1,484.55 " " $1,352.59 " " $1,385.58 " " $1,319.60 " " $2,474.25 " " $2,144.35 "
WWH LAB/RAD FEE SCHEDULE - 4206 116647 71550 HCHG RAD MRI CHEST WO "2,048.00" " $1,843.20 " $819.20 " $1,638.40 " " $1,146.88 " " $1,433.60 " " $1,310.72 " " $1,638.40 " " $1,597.44 " $921.60 $839.68 $860.16 $819.20 " $1,536.00 " " $1,331.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 116648 71551 HCHG RAD MRI CHEST W "1,997.00" " $1,797.30 " $798.80 " $1,597.60 " " $1,118.32 " " $1,397.90 " " $1,278.08 " " $1,597.60 " " $1,557.66 " $898.65 $818.77 $838.74 $798.80 " $1,497.75 " " $1,298.05 "
WWH LAB/RAD FEE SCHEDULE - 4206 116649 71552 HCHG RAD MRI CHEST WWO "5,954.00" " $5,358.60 " " $2,381.60 " " $4,763.20 " " $3,334.24 " " $4,167.80 " " $3,810.56 " " $4,763.20 " " $4,644.12 " " $2,679.30 " " $2,441.14 " " $2,500.68 " " $2,381.60 " " $4,465.50 " " $3,870.10 "
WWH LAB/RAD FEE SCHEDULE - 4206 116651 72020 HCHG RAD XRAY SPINE 1 VIEW 83.00 $74.70 $33.20 $66.40 $46.48 $58.10 $53.12 $66.40 $64.74 $37.35 $34.03 $34.86 $33.20 $62.25 $53.95
WWH LAB/RAD FEE SCHEDULE - 4206 116652 72020 HCHG RAD XRAY SPINE 1 VIEW PORTABLE 61.00 $54.90 $24.40 $48.80 $34.16 $42.70 $39.04 $48.80 $47.58 $27.45 $25.01 $25.62 $24.40 $45.75 $39.65
WWH LAB/RAD FEE SCHEDULE - 4206 116653 72040 HCHG RAD XRAY SPINE CERVICAL 2 OR 3 VIEWS 184.00 $165.60 $73.60 $147.20 $103.04 $128.80 $117.76 $147.20 $143.52 $82.80 $75.44 $77.28 $73.60 $138.00 $119.60
WWH LAB/RAD FEE SCHEDULE - 4206 116654 72040 HCHG RAD XRAY SPINE CERVICAL 2 OR 3 VIEWS PORTABLE 138.00 $124.20 $55.20 $110.40 $77.28 $96.60 $88.32 $110.40 $107.64 $62.10 $56.58 $57.96 $55.20 $103.50 $89.70
WWH LAB/RAD FEE SCHEDULE - 4206 116655 72050 HCHG RAD XRAY SPINE CERVICAL FOUR OR FIVE VIEWS 261.00 $234.90 $104.40 $208.80 $146.16 $182.70 $167.04 $208.80 $203.58 $117.45 $107.01 $109.62 $104.40 $195.75 $169.65
WWH LAB/RAD FEE SCHEDULE - 4206 116656 72052 HCHG RAD XRAY CERVICAL SPINE SIX OR MORE VIEWS 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH LAB/RAD FEE SCHEDULE - 4206 116657 72070 HCHG RAD XRAY SPINE THORACIC 2 VIEWS 141.00 $126.90 $56.40 $112.80 $78.96 $98.70 $90.24 $112.80 $109.98 $63.45 $57.81 $59.22 $56.40 $105.75 $91.65
WWH LAB/RAD FEE SCHEDULE - 4206 116658 72070 HCHG RAD XRAY SPINE THORACIC 2 VIEWS PORTABLE 138.00 $124.20 $55.20 $110.40 $77.28 $96.60 $88.32 $110.40 $107.64 $62.10 $56.58 $57.96 $55.20 $103.50 $89.70
WWH LAB/RAD FEE SCHEDULE - 4206 116659 72072 HCHG RAD XRAY SPINE THORACIC 3 VIEWS 314.00 $282.60 $125.60 $251.20 $175.84 $219.80 $200.96 $251.20 $244.92 $141.30 $128.74 $131.88 $125.60 $235.50 $204.10
WWH LAB/RAD FEE SCHEDULE - 4206 116660 72074 HCHG RAD XRAY SPINE THORACIC MINIMUM 4 VIEWS 197.00 $177.30 $78.80 $157.60 $110.32 $137.90 $126.08 $157.60 $153.66 $88.65 $80.77 $82.74 $78.80 $147.75 $128.05
WWH LAB/RAD FEE SCHEDULE - 4206 116661 72080 HCHG RAD XRAY SPINE THORACOLUMBAR JUNCTION MINIMUM OF 2 VIEWS 308.00 $277.20 $123.20 $246.40 $172.48 $215.60 $197.12 $246.40 $240.24 $138.60 $126.28 $129.36 $123.20 $231.00 $200.20
WWH LAB/RAD FEE SCHEDULE - 4206 116662 72080 HCHG RAD XRAY SPINE THORACOLUMBAR JUNCT MINIMUM 2 VIEW PORTABLE 209.00 $188.10 $83.60 $167.20 $117.04 $146.30 $133.76 $167.20 $163.02 $94.05 $85.69 $87.78 $83.60 $156.75 $135.85
WWH LAB/RAD FEE SCHEDULE - 4206 116664 72081 HCHG RAD XRAY SPINE THORACOLUMBAR STANDING SCOLIOSIS 1 VIEW 211.00 $189.90 $84.40 $168.80 $118.16 $147.70 $135.04 $168.80 $164.58 $94.95 $86.51 $88.62 $84.40 $158.25 $137.15
WWH LAB/RAD FEE SCHEDULE - 4206 116665 72082 HCHG RAD XRAY SPINE ENTIRE 2 TO 3 VIEWS 237.00 $213.30 $94.80 $189.60 $132.72 $165.90 $151.68 $189.60 $184.86 $106.65 $97.17 $99.54 $94.80 $177.75 $154.05
WWH LAB/RAD FEE SCHEDULE - 4206 116666 72082 HCHG RAD XRAY SPINE THORACOLUMBAR STANDING SCOLIOSIS 2 TO 3VIEW 209.00 $188.10 $83.60 $167.20 $117.04 $146.30 $133.76 $167.20 $163.02 $94.05 $85.69 $87.78 $83.60 $156.75 $135.85
WWH LAB/RAD FEE SCHEDULE - 4206 116667 72082 HCHG RAD XRAY SPINE ENTIRE 2 TO 3 VIEWS PORTABLE 165.00 $148.50 $66.00 $132.00 $92.40 $115.50 $105.60 $132.00 $128.70 $74.25 $67.65 $69.30 $66.00 $123.75 $107.25
WWH LAB/RAD FEE SCHEDULE - 4206 116668 72083 HCHG RAD XRAY SPINE ENTIRE 4 TO 5 VIEWS 298.00 $268.20 $119.20 $238.40 $166.88 $208.60 $190.72 $238.40 $232.44 $134.10 $122.18 $125.16 $119.20 $223.50 $193.70
WWH LAB/RAD FEE SCHEDULE - 4206 116669 72084 HCHG RAD XRAY SPINE ENTIRE MINIMUM OF 6 VIEWS 277.00 $249.30 $110.80 $221.60 $155.12 $193.90 $177.28 $221.60 $216.06 $124.65 $113.57 $116.34 $110.80 $207.75 $180.05
WWH LAB/RAD FEE SCHEDULE - 4206 116670 72100 HCHG RAD XRAY LUMBOSACRAL SPINE 2 OR 3 VIEWS 193.00 $173.70 $77.20 $154.40 $108.08 $135.10 $123.52 $154.40 $150.54 $86.85 $79.13 $81.06 $77.20 $144.75 $125.45
WWH LAB/RAD FEE SCHEDULE - 4206 116671 72100 HCHG RAD XRAY LUMBOSACRAL SPINE 2 OR 3 VIEWS PORTABLE 153.00 $137.70 $61.20 $122.40 $85.68 $107.10 $97.92 $122.40 $119.34 $68.85 $62.73 $64.26 $61.20 $114.75 $99.45
WWH LAB/RAD FEE SCHEDULE - 4206 116672 72110 HCHG RAD XRAY LUMBOSACRAL MINIMUM OF 4 VIEWS 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH LAB/RAD FEE SCHEDULE - 4206 116673 72114 HCHG RAD XRAY SPINE LUMBAR INC BENDING MINIMUM 6 VIEWS 380.00 $342.00 $152.00 $304.00 $212.80 $266.00 $243.20 $304.00 $296.40 $171.00 $155.80 $159.60 $152.00 $285.00 $247.00
WWH LAB/RAD FEE SCHEDULE - 4206 116674 72120 HCHG RAD XRAY BENDING LUMBOSACRAL SPINE 2 OR 3 VIEWS 255.00 $229.50 $102.00 $204.00 $142.80 $178.50 $163.20 $204.00 $198.90 $114.75 $104.55 $107.10 $102.00 $191.25 $165.75
WWH LAB/RAD FEE SCHEDULE - 4206 116675 72125 HCHG RAD CT SPINE CERVICAL WO "1,868.00" " $1,681.20 " $747.20 " $1,494.40 " " $1,046.08 " " $1,307.60 " " $1,195.52 " " $1,494.40 " " $1,457.04 " $840.60 $765.88 $784.56 $747.20 " $1,401.00 " " $1,214.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 116676 72126 HCHG RAD CT SPINE CERVICAL W "1,893.00" " $1,703.70 " $757.20 " $1,514.40 " " $1,060.08 " " $1,325.10 " " $1,211.52 " " $1,514.40 " " $1,476.54 " $851.85 $776.13 $795.06 $757.20 " $1,419.75 " " $1,230.45 "
WWH LAB/RAD FEE SCHEDULE - 4206 116678 72128 HCHG RAD CT SPINE THORACIC WO "1,866.00" " $1,679.40 " $746.40 " $1,492.80 " " $1,044.96 " " $1,306.20 " " $1,194.24 " " $1,492.80 " " $1,455.48 " $839.70 $765.06 $783.72 $746.40 " $1,399.50 " " $1,212.90 "
WWH LAB/RAD FEE SCHEDULE - 4206 116679 72129 HCHG RAD CT SPINE THORACIC W "2,130.00" " $1,917.00 " $852.00 " $1,704.00 " " $1,192.80 " " $1,491.00 " " $1,363.20 " " $1,704.00 " " $1,661.40 " $958.50 $873.30 $894.60 $852.00 " $1,597.50 " " $1,384.50 "
WWH LAB/RAD FEE SCHEDULE - 4206 116681 72131 HCHG RAD CT SPINE LUMBAR OR SACRUM WO "1,866.00" " $1,679.40 " $746.40 " $1,492.80 " " $1,044.96 " " $1,306.20 " " $1,194.24 " " $1,492.80 " " $1,455.48 " $839.70 $765.06 $783.72 $746.40 " $1,399.50 " " $1,212.90 "
WWH LAB/RAD FEE SCHEDULE - 4206 116682 72132 HCHG RAD CT SPINE LUMBAR OR SACRUM W "2,247.00" " $2,022.30 " $898.80 " $1,797.60 " " $1,258.32 " " $1,572.90 " " $1,438.08 " " $1,797.60 " " $1,752.66 " " $1,011.15 " $921.27 $943.74 $898.80 " $1,685.25 " " $1,460.55 "
WWH LAB/RAD FEE SCHEDULE - 4206 116683 72133 HCHG RAD CT SPINE LUMBAR WWO "1,474.00" " $1,326.60 " $589.60 " $1,179.20 " $825.44 " $1,031.80 " $943.36 " $1,179.20 " " $1,149.72 " $663.30 $604.34 $619.08 $589.60 " $1,105.50 " $958.10
WWH LAB/RAD FEE SCHEDULE - 4206 116684 72141 HCHG RAD MRI SPINE CERVICAL WO "2,770.00" " $2,493.00 " " $1,108.00 " " $2,216.00 " " $1,551.20 " " $1,939.00 " " $1,772.80 " " $2,216.00 " " $2,160.60 " " $1,246.50 " " $1,135.70 " " $1,163.40 " " $1,108.00 " " $2,077.50 " " $1,800.50 "
WWH LAB/RAD FEE SCHEDULE - 4206 116685 72141 HCHG RAD MRI SPINE CERVICAL WO LIMITED "2,012.00" " $1,810.80 " $804.80 " $1,609.60 " " $1,126.72 " " $1,408.40 " " $1,287.68 " " $1,609.60 " " $1,569.36 " $905.40 $824.92 $845.04 $804.80 " $1,509.00 " " $1,307.80 "
WWH LAB/RAD FEE SCHEDULE - 4206 116686 72142 HCHG RAD MRI SPINE CERVICAL W "3,021.00" " $2,718.90 " " $1,208.40 " " $2,416.80 " " $1,691.76 " " $2,114.70 " " $1,933.44 " " $2,416.80 " " $2,356.38 " " $1,359.45 " " $1,238.61 " " $1,268.82 " " $1,208.40 " " $2,265.75 " " $1,963.65 "
WWH LAB/RAD FEE SCHEDULE - 4206 116687 72142 HCHG RAD MRI SPINE CERVICAL W LIMITED "4,277.00" " $3,849.30 " " $1,710.80 " " $3,421.60 " " $2,395.12 " " $2,993.90 " " $2,737.28 " " $3,421.60 " " $3,336.06 " " $1,924.65 " " $1,753.57 " " $1,796.34 " " $1,710.80 " " $3,207.75 " " $2,780.05 "
WWH LAB/RAD FEE SCHEDULE - 4206 116688 72146 HCHG RAD MRI SPINE THORACIC WO "3,201.00" " $2,880.90 " " $1,280.40 " " $2,560.80 " " $1,792.56 " " $2,240.70 " " $2,048.64 " " $2,560.80 " " $2,496.78 " " $1,440.45 " " $1,312.41 " " $1,344.42 " " $1,280.40 " " $2,400.75 " " $2,080.65 "
WWH LAB/RAD FEE SCHEDULE - 4206 116689 72146 HCHG RAD MRI SPINE THORACIC WO LIMITED "3,448.00" " $3,103.20 " " $1,379.20 " " $2,758.40 " " $1,930.88 " " $2,413.60 " " $2,206.72 " " $2,758.40 " " $2,689.44 " " $1,551.60 " " $1,413.68 " " $1,448.16 " " $1,379.20 " " $2,586.00 " " $2,241.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 116690 72147 HCHG RAD MRI SPINE THORACIC W "3,799.00" " $3,419.10 " " $1,519.60 " " $3,039.20 " " $2,127.44 " " $2,659.30 " " $2,431.36 " " $3,039.20 " " $2,963.22 " " $1,709.55 " " $1,557.59 " " $1,595.58 " " $1,519.60 " " $2,849.25 " " $2,469.35 "
WWH LAB/RAD FEE SCHEDULE - 4206 116691 72147 HCHG RAD MRI SPINE THORACIC W LIMITED "3,799.00" " $3,419.10 " " $1,519.60 " " $3,039.20 " " $2,127.44 " " $2,659.30 " " $2,431.36 " " $3,039.20 " " $2,963.22 " " $1,709.55 " " $1,557.59 " " $1,595.58 " " $1,519.60 " " $2,849.25 " " $2,469.35 "
WWH LAB/RAD FEE SCHEDULE - 4206 116692 72148 HCHG RAD MRI SPINE LUMBAR WO "2,870.00" " $2,583.00 " " $1,148.00 " " $2,296.00 " " $1,607.20 " " $2,009.00 " " $1,836.80 " " $2,296.00 " " $2,238.60 " " $1,291.50 " " $1,176.70 " " $1,205.40 " " $1,148.00 " " $2,152.50 " " $1,865.50 "
WWH LAB/RAD FEE SCHEDULE - 4206 116693 72148 HCHG RAD MRI SPINE LUMBAR WO LIMITED "2,004.00" " $1,803.60 " $801.60 " $1,603.20 " " $1,122.24 " " $1,402.80 " " $1,282.56 " " $1,603.20 " " $1,563.12 " $901.80 $821.64 $841.68 $801.60 " $1,503.00 " " $1,302.60 "
WWH LAB/RAD FEE SCHEDULE - 4206 116694 72149 HCHG RAD MRI SPINE LUMBAR W "4,223.00" " $3,800.70 " " $1,689.20 " " $3,378.40 " " $2,364.88 " " $2,956.10 " " $2,702.72 " " $3,378.40 " " $3,293.94 " " $1,900.35 " " $1,731.43 " " $1,773.66 " " $1,689.20 " " $3,167.25 " " $2,744.95 "
WWH LAB/RAD FEE SCHEDULE - 4206 116695 72149 HCHG RAD MRI SPINE LUMBAR W LIMITED "4,223.00" " $3,800.70 " " $1,689.20 " " $3,378.40 " " $2,364.88 " " $2,956.10 " " $2,702.72 " " $3,378.40 " " $3,293.94 " " $1,900.35 " " $1,731.43 " " $1,773.66 " " $1,689.20 " " $3,167.25 " " $2,744.95 "
WWH LAB/RAD FEE SCHEDULE - 4206 116696 72156 HCHG RAD MRI SPINE CERVICAL WWO "4,209.00" " $3,788.10 " " $1,683.60 " " $3,367.20 " " $2,357.04 " " $2,946.30 " " $2,693.76 " " $3,367.20 " " $3,283.02 " " $1,894.05 " " $1,725.69 " " $1,767.78 " " $1,683.60 " " $3,156.75 " " $2,735.85 "
WWH LAB/RAD FEE SCHEDULE - 4206 116697 72156 HCHG RAD MRI SPINE CERVICAL WWO LIMITED "5,079.00" " $4,571.10 " " $2,031.60 " " $4,063.20 " " $2,844.24 " " $3,555.30 " " $3,250.56 " " $4,063.20 " " $3,961.62 " " $2,285.55 " " $2,082.39 " " $2,133.18 " " $2,031.60 " " $3,809.25 " " $3,301.35 "
WWH LAB/RAD FEE SCHEDULE - 4206 116698 72157 HCHG RAD MRI SPINE THORACIC WWO "4,209.00" " $3,788.10 " " $1,683.60 " " $3,367.20 " " $2,357.04 " " $2,946.30 " " $2,693.76 " " $3,367.20 " " $3,283.02 " " $1,894.05 " " $1,725.69 " " $1,767.78 " " $1,683.60 " " $3,156.75 " " $2,735.85 "
WWH LAB/RAD FEE SCHEDULE - 4206 116699 72157 HCHG RAD MRI SPINE THORACIC WWO LIMITED "4,714.00" " $4,242.60 " " $1,885.60 " " $3,771.20 " " $2,639.84 " " $3,299.80 " " $3,016.96 " " $3,771.20 " " $3,676.92 " " $2,121.30 " " $1,932.74 " " $1,979.88 " " $1,885.60 " " $3,535.50 " " $3,064.10 "
WWH LAB/RAD FEE SCHEDULE - 4206 116700 72158 HCHG RAD MRI SPINE LUMBAR WWO "5,424.00" " $4,881.60 " " $2,169.60 " " $4,339.20 " " $3,037.44 " " $3,796.80 " " $3,471.36 " " $4,339.20 " " $4,230.72 " " $2,440.80 " " $2,223.84 " " $2,278.08 " " $2,169.60 " " $4,068.00 " " $3,525.60 "
WWH LAB/RAD FEE SCHEDULE - 4206 116701 72158 HCHG RAD MRI SPINE LUMBAR WWO LIMITED "5,006.00" " $4,505.40 " " $2,002.40 " " $4,004.80 " " $2,803.36 " " $3,504.20 " " $3,203.84 " " $4,004.80 " " $3,904.68 " " $2,252.70 " " $2,052.46 " " $2,102.52 " " $2,002.40 " " $3,754.50 " " $3,253.90 "
WWH LAB/RAD FEE SCHEDULE - 4206 116702 72170 HCHG RAD XRAY PELVIS 1 OR 2 VIEWS 145.00 $130.50 $58.00 $116.00 $81.20 $101.50 $92.80 $116.00 $113.10 $65.25 $59.45 $60.90 $58.00 $108.75 $94.25
WWH LAB/RAD FEE SCHEDULE - 4206 116703 72170 HCHG RAD XRAY PELVIS 1 OR 2 VIEWS PORTABLE 145.00 $130.50 $58.00 $116.00 $81.20 $101.50 $92.80 $116.00 $113.10 $65.25 $59.45 $60.90 $58.00 $108.75 $94.25
WWH LAB/RAD FEE SCHEDULE - 4206 116704 72190 HCHG RAD XRAY PELVIS THREE VIEWS OR MORE 308.00 $277.20 $123.20 $246.40 $172.48 $215.60 $197.12 $246.40 $240.24 $138.60 $126.28 $129.36 $123.20 $231.00 $200.20
WWH LAB/RAD FEE SCHEDULE - 4206 116706 72192 HCHG RAD CT PELVIS WO "1,335.00" " $1,201.50 " $534.00 " $1,068.00 " $747.60 $934.50 $854.40 " $1,068.00 " " $1,041.30 " $600.75 $547.35 $560.70 $534.00 " $1,001.25 " $867.75
WWH LAB/RAD FEE SCHEDULE - 4206 116708 72193 HCHG RAD CT PELVIS W "1,519.00" " $1,367.10 " $607.60 " $1,215.20 " $850.64 " $1,063.30 " $972.16 " $1,215.20 " " $1,184.82 " $683.55 $622.79 $637.98 $607.60 " $1,139.25 " $987.35
WWH LAB/RAD FEE SCHEDULE - 4206 116709 72194 HCHG RAD CT PELVIS WWO "2,766.00" " $2,489.40 " " $1,106.40 " " $2,212.80 " " $1,548.96 " " $1,936.20 " " $1,770.24 " " $2,212.80 " " $2,157.48 " " $1,244.70 " " $1,134.06 " " $1,161.72 " " $1,106.40 " " $2,074.50 " " $1,797.90 "
WWH LAB/RAD FEE SCHEDULE - 4206 116710 72195 HCHG RAD MRI PELVIS WO "2,560.00" " $2,304.00 " " $1,024.00 " " $2,048.00 " " $1,433.60 " " $1,792.00 " " $1,638.40 " " $2,048.00 " " $1,996.80 " " $1,152.00 " " $1,049.60 " " $1,075.20 " " $1,024.00 " " $1,920.00 " " $1,664.00 "
WWH LAB/RAD FEE SCHEDULE - 4206 116711 72196 HCHG RAD MRI PELVIS W "4,141.00" " $3,726.90 " " $1,656.40 " " $3,312.80 " " $2,318.96 " " $2,898.70 " " $2,650.24 " " $3,312.80 " " $3,229.98 " " $1,863.45 " " $1,697.81 " " $1,739.22 " " $1,656.40 " " $3,105.75 " " $2,691.65 "
WWH LAB/RAD FEE SCHEDULE - 4206 116712 72197 HCHG RAD MRI PELVIS WWO "4,328.00" " $3,895.20 " " $1,731.20 " " $3,462.40 " " $2,423.68 " " $3,029.60 " " $2,769.92 " " $3,462.40 " " $3,375.84 " " $1,947.60 " " $1,774.48 " " $1,817.76 " " $1,731.20 " " $3,246.00 " " $2,813.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 116713 72200 HCHG RAD XRAY SACROILIAC JOINTS TWO VIEWS OR LESS 170.00 $153.00 $68.00 $136.00 $95.20 $119.00 $108.80 $136.00 $132.60 $76.50 $69.70 $71.40 $68.00 $127.50 $110.50
WWH LAB/RAD FEE SCHEDULE - 4206 116714 72202 HCHG RAD XRAY SACROILIAC JOINTS THREE VIEWS OR MORE 203.00 $182.70 $81.20 $162.40 $113.68 $142.10 $129.92 $162.40 $158.34 $91.35 $83.23 $85.26 $81.20 $152.25 $131.95
WWH LAB/RAD FEE SCHEDULE - 4206 116715 72220 HCHG RAD XRAY SACRUM AND COCCYX TWO VIEWS OR MORE 306.00 $275.40 $122.40 $244.80 $171.36 $214.20 $195.84 $244.80 $238.68 $137.70 $125.46 $128.52 $122.40 $229.50 $198.90
WWH LAB/RAD FEE SCHEDULE - 4206 116722 73000 HCHG RAD XRAY CLAVICLE COMPLETE 229.00 $206.10 $91.60 $183.20 $128.24 $160.30 $146.56 $183.20 $178.62 $103.05 $93.89 $96.18 $91.60 $171.75 $148.85
WWH LAB/RAD FEE SCHEDULE - 4206 116723 73000 HCHG RAD XRAY CLAVICLE COMPLETE PORTABLE 229.00 $206.10 $91.60 $183.20 $128.24 $160.30 $146.56 $183.20 $178.62 $103.05 $93.89 $96.18 $91.60 $171.75 $148.85
WWH LAB/RAD FEE SCHEDULE - 4206 116725 73010 HCHG RAD XRAY SCAPULA COMPLETE 176.00 $158.40 $70.40 $140.80 $98.56 $123.20 $112.64 $140.80 $137.28 $79.20 $72.16 $73.92 $70.40 $132.00 $114.40
WWH LAB/RAD FEE SCHEDULE - 4206 116726 73020 HCHG RAD XRAY SHOULDER 1 VIEW 141.00 $126.90 $56.40 $112.80 $78.96 $98.70 $90.24 $112.80 $109.98 $63.45 $57.81 $59.22 $56.40 $105.75 $91.65
WWH LAB/RAD FEE SCHEDULE - 4206 116727 73020 HCHG RAD XRAY SHOULDER 1 VIEW PORTABLE 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 116728 73030 HCHG RAD XRAY SHOULDER COMPLETE 2 VIEWS OR MORE 272.00 $244.80 $108.80 $217.60 $152.32 $190.40 $174.08 $217.60 $212.16 $122.40 $111.52 $114.24 $108.80 $204.00 $176.80
WWH LAB/RAD FEE SCHEDULE - 4206 116729 73030 HCHG RAD XRAY SHOULDER COMPLETE 2 VIEWS OR MORE PORTABLE 282.00 $253.80 $112.80 $225.60 $157.92 $197.40 $180.48 $225.60 $219.96 $126.90 $115.62 $118.44 $112.80 $211.50 $183.30
WWH LAB/RAD FEE SCHEDULE - 4206 116731 73040 HCHG RAD XRAY ARTHROGRAM SHOULDER 468.00 $421.20 $187.20 $374.40 $262.08 $327.60 $299.52 $374.40 $365.04 $210.60 $191.88 $196.56 $187.20 $351.00 $304.20
WWH LAB/RAD FEE SCHEDULE - 4206 116732 73050 HCHG RAD XRAY ACROMIOCLAVICULAR JOINTS BILATERAL WWO WEIGHTS 196.00 $176.40 $78.40 $156.80 $109.76 $137.20 $125.44 $156.80 $152.88 $88.20 $80.36 $82.32 $78.40 $147.00 $127.40
WWH LAB/RAD FEE SCHEDULE - 4206 116733 73060 HCHG RAD XRAY HUMERUS TWO VIEWS OR MORE 273.00 $245.70 $109.20 $218.40 $152.88 $191.10 $174.72 $218.40 $212.94 $122.85 $111.93 $114.66 $109.20 $204.75 $177.45
WWH LAB/RAD FEE SCHEDULE - 4206 116734 73060 HCHG RAD XRAY HUMERUS TWO VIEWS OR MORE PORTABLE 240.00 $216.00 $96.00 $192.00 $134.40 $168.00 $153.60 $192.00 $187.20 $108.00 $98.40 $100.80 $96.00 $180.00 $156.00
WWH LAB/RAD FEE SCHEDULE - 4206 116735 73060 HCHG RAD XRAY HUMERUS TWO VIEWS OR MORE LIMITED 240.00 $216.00 $96.00 $192.00 $134.40 $168.00 $153.60 $192.00 $187.20 $108.00 $98.40 $100.80 $96.00 $180.00 $156.00
WWH LAB/RAD FEE SCHEDULE - 4206 116736 73070 HCHG RAD XRAY ELBOW 2 VIEWS 133.00 $119.70 $53.20 $106.40 $74.48 $93.10 $85.12 $106.40 $103.74 $59.85 $54.53 $55.86 $53.20 $99.75 $86.45
WWH LAB/RAD FEE SCHEDULE - 4206 116737 73070 HCHG RAD XRAY ELBOW 2 VIEWS PORTABLE 112.00 $100.80 $44.80 $89.60 $62.72 $78.40 $71.68 $89.60 $87.36 $50.40 $45.92 $47.04 $44.80 $84.00 $72.80
WWH LAB/RAD FEE SCHEDULE - 4206 116738 73070 HCHG RAD XRAY ELBOW 2 VIEWS LIMITED 133.00 $119.70 $53.20 $106.40 $74.48 $93.10 $85.12 $106.40 $103.74 $59.85 $54.53 $55.86 $53.20 $99.75 $86.45
WWH LAB/RAD FEE SCHEDULE - 4206 116739 73080 HCHG RAD XRAY ELBOW COMPLETE THREE VIEWS OR MORE 244.00 $219.60 $97.60 $195.20 $136.64 $170.80 $156.16 $195.20 $190.32 $109.80 $100.04 $102.48 $97.60 $183.00 $158.60
WWH LAB/RAD FEE SCHEDULE - 4206 116741 73090 HCHG RAD XRAY FOREARM 2 VIEWS 231.00 $207.90 $92.40 $184.80 $129.36 $161.70 $147.84 $184.80 $180.18 $103.95 $94.71 $97.02 $92.40 $173.25 $150.15
WWH LAB/RAD FEE SCHEDULE - 4206 116742 73090 HCHG RAD XRAY FOREARM 2 VIEWS PORTABLE 158.00 $142.20 $63.20 $126.40 $88.48 $110.60 $101.12 $126.40 $123.24 $71.10 $64.78 $66.36 $63.20 $118.50 $102.70
WWH LAB/RAD FEE SCHEDULE - 4206 116743 73090 HCHG RAD XRAY FOREARM 2 VIEWS LIMITED 158.00 $142.20 $63.20 $126.40 $88.48 $110.60 $101.12 $126.40 $123.24 $71.10 $64.78 $66.36 $63.20 $118.50 $102.70
WWH LAB/RAD FEE SCHEDULE - 4206 116744 73092 HCHG RAD XRAY UPPER EXTREMITY INFANT TWO VIEWS OR MORE 151.00 $135.90 $60.40 $120.80 $84.56 $105.70 $96.64 $120.80 $117.78 $67.95 $61.91 $63.42 $60.40 $113.25 $98.15
WWH LAB/RAD FEE SCHEDULE - 4206 116745 73100 HCHG RAD XRAY WRIST 2 VIEWS 176.00 $158.40 $70.40 $140.80 $98.56 $123.20 $112.64 $140.80 $137.28 $79.20 $72.16 $73.92 $70.40 $132.00 $114.40
WWH LAB/RAD FEE SCHEDULE - 4206 116746 73100 HCHG RAD XRAY WRIST 2 VIEWS PORTABLE 176.00 $158.40 $70.40 $140.80 $98.56 $123.20 $112.64 $140.80 $137.28 $79.20 $72.16 $73.92 $70.40 $132.00 $114.40
WWH LAB/RAD FEE SCHEDULE - 4206 116747 73110 HCHG RAD XRAY WRIST THREE VIEWS OR MORE 250.00 $225.00 $100.00 $200.00 $140.00 $175.00 $160.00 $200.00 $195.00 $112.50 $102.50 $105.00 $100.00 $187.50 $162.50
WWH LAB/RAD FEE SCHEDULE - 4206 116748 73110 HCHG RAD XRAY WRIST THREE VIEWS OR MORE PORTABLE 250.00 $225.00 $100.00 $200.00 $140.00 $175.00 $160.00 $200.00 $195.00 $112.50 $102.50 $105.00 $100.00 $187.50 $162.50
WWH LAB/RAD FEE SCHEDULE - 4206 116749 73115 HCHG RAD XRAY ARTHROGRAM WRIST 409.00 $368.10 $163.60 $327.20 $229.04 $286.30 $261.76 $327.20 $319.02 $184.05 $167.69 $171.78 $163.60 $306.75 $265.85
WWH LAB/RAD FEE SCHEDULE - 4206 116750 73120 HCHG RAD XRAY HAND 2 VIEWS 136.00 $122.40 $54.40 $108.80 $76.16 $95.20 $87.04 $108.80 $106.08 $61.20 $55.76 $57.12 $54.40 $102.00 $88.40
WWH LAB/RAD FEE SCHEDULE - 4206 116751 73120 HCHG RAD XRAY HAND 2 VIEWS PORTABLE 172.00 $154.80 $68.80 $137.60 $96.32 $120.40 $110.08 $137.60 $134.16 $77.40 $70.52 $72.24 $68.80 $129.00 $111.80
WWH LAB/RAD FEE SCHEDULE - 4206 116752 73120 HCHG RAD XRAY HAND 2 VIEWS LIMITED 136.00 $122.40 $54.40 $108.80 $76.16 $95.20 $87.04 $108.80 $106.08 $61.20 $55.76 $57.12 $54.40 $102.00 $88.40
WWH LAB/RAD FEE SCHEDULE - 4206 116753 73130 HCHG RAD XRAY HAND 3 VIEWS OR MORE 258.00 $232.20 $103.20 $206.40 $144.48 $180.60 $165.12 $206.40 $201.24 $116.10 $105.78 $108.36 $103.20 $193.50 $167.70
WWH LAB/RAD FEE SCHEDULE - 4206 116754 73140 HCHG RAD XRAY FINGER TWO VIEWS OR MORE 202.00 $181.80 $80.80 $161.60 $113.12 $141.40 $129.28 $161.60 $157.56 $90.90 $82.82 $84.84 $80.80 $151.50 $131.30
WWH LAB/RAD FEE SCHEDULE - 4206 116755 73140 HCHG RAD XRAY FINGER TWO VIEWS OR MORE PORTABLE 198.00 $178.20 $79.20 $158.40 $110.88 $138.60 $126.72 $158.40 $154.44 $89.10 $81.18 $83.16 $79.20 $148.50 $128.70
WWH LAB/RAD FEE SCHEDULE - 4206 116756 73200 HCHG RAD CT UPPER EXTREMITY WO "1,355.00" " $1,219.50 " $542.00 " $1,084.00 " $758.80 $948.50 $867.20 " $1,084.00 " " $1,056.90 " $609.75 $555.55 $569.10 $542.00 " $1,016.25 " $880.75
WWH LAB/RAD FEE SCHEDULE - 4206 116757 73201 HCHG RAD CT UPPER EXTREMITY W "2,137.00" " $1,923.30 " $854.80 " $1,709.60 " " $1,196.72 " " $1,495.90 " " $1,367.68 " " $1,709.60 " " $1,666.86 " $961.65 $876.17 $897.54 $854.80 " $1,602.75 " " $1,389.05 "
WWH LAB/RAD FEE SCHEDULE - 4206 116758 73202 HCHG RAD CT UPPER EXTREMITY WWO "1,364.00" " $1,227.60 " $545.60 " $1,091.20 " $763.84 $954.80 $872.96 " $1,091.20 " " $1,063.92 " $613.80 $559.24 $572.88 $545.60 " $1,023.00 " $886.60
WWH LAB/RAD FEE SCHEDULE - 4206 116759 73206 HCHG RAD CT ANGIO UPPER EXTREMITY "2,864.00" " $2,577.60 " " $1,145.60 " " $2,291.20 " " $1,603.84 " " $2,004.80 " " $1,832.96 " " $2,291.20 " " $2,233.92 " " $1,288.80 " " $1,174.24 " " $1,202.88 " " $1,145.60 " " $2,148.00 " " $1,861.60 "
WWH LAB/RAD FEE SCHEDULE - 4206 116760 73218 HCHG RAD MRI NON JOINT UPPER EXTREMITY WO "2,478.00" " $2,230.20 " $991.20 " $1,982.40 " " $1,387.68 " " $1,734.60 " " $1,585.92 " " $1,982.40 " " $1,932.84 " " $1,115.10 " " $1,015.98 " " $1,040.76 " $991.20 " $1,858.50 " " $1,610.70 "
WWH LAB/RAD FEE SCHEDULE - 4206 116761 73220 HCHG RAD MRI NON JOINT UPPER EXTREMITY WWO "5,152.00" " $4,636.80 " " $2,060.80 " " $4,121.60 " " $2,885.12 " " $3,606.40 " " $3,297.28 " " $4,121.60 " " $4,018.56 " " $2,318.40 " " $2,112.32 " " $2,163.84 " " $2,060.80 " " $3,864.00 " " $3,348.80 "
WWH LAB/RAD FEE SCHEDULE - 4206 116762 73221 HCHG RAD MRI JOINT OF UPPER EXTREMITY WO "2,895.00" " $2,605.50 " " $1,158.00 " " $2,316.00 " " $1,621.20 " " $2,026.50 " " $1,852.80 " " $2,316.00 " " $2,258.10 " " $1,302.75 " " $1,186.95 " " $1,215.90 " " $1,158.00 " " $2,171.25 " " $1,881.75 "
WWH LAB/RAD FEE SCHEDULE - 4206 116763 73222 HCHG RAD MRI JOINT OF UPPER EXTREMITY W "3,840.00" " $3,456.00 " " $1,536.00 " " $3,072.00 " " $2,150.40 " " $2,688.00 " " $2,457.60 " " $3,072.00 " " $2,995.20 " " $1,728.00 " " $1,574.40 " " $1,612.80 " " $1,536.00 " " $2,880.00 " " $2,496.00 "
WWH LAB/RAD FEE SCHEDULE - 4206 116764 73223 HCHG RAD MRI JOINT OF UPPER EXTREMITY WWO "4,831.00" " $4,347.90 " " $1,932.40 " " $3,864.80 " " $2,705.36 " " $3,381.70 " " $3,091.84 " " $3,864.80 " " $3,768.18 " " $2,173.95 " " $1,980.71 " " $2,029.02 " " $1,932.40 " " $3,623.25 " " $3,140.15 "
WWH LAB/RAD FEE SCHEDULE - 4206 116765 73501 HCHG RAD XRAY HIP UNILATERAL WWO PELVIS 1 VIEW 193.00 $173.70 $77.20 $154.40 $108.08 $135.10 $123.52 $154.40 $150.54 $86.85 $79.13 $81.06 $77.20 $144.75 $125.45
WWH LAB/RAD FEE SCHEDULE - 4206 116766 73501 HCHG RAD XRAY HIP UNILATERAL WWO PELVIS1 VIEW PORTABLE 209.00 $188.10 $83.60 $167.20 $117.04 $146.30 $133.76 $167.20 $163.02 $94.05 $85.69 $87.78 $83.60 $156.75 $135.85
WWH LAB/RAD FEE SCHEDULE - 4206 116767 73502 HCHG RAD XRAY HIP WWO PELVIS UNILATERAL 2 OR 3 VIEWS 221.00 $198.90 $88.40 $176.80 $123.76 $154.70 $141.44 $176.80 $172.38 $99.45 $90.61 $92.82 $88.40 $165.75 $143.65
WWH LAB/RAD FEE SCHEDULE - 4206 116768 73502 HCHG RAD XRAY HIP WWO PELVIS UNILATERAL 2 OR 3 VIEWS ADD-ON 164.00 $147.60 $65.60 $131.20 $91.84 $114.80 $104.96 $131.20 $127.92 $73.80 $67.24 $68.88 $65.60 $123.00 $106.60
WWH LAB/RAD FEE SCHEDULE - 4206 116769 73502 HCHG RAD XRAY HIP WWO PELVIS UNILATERAL 2 OR 3 VIEWS PORTABLE 199.00 $179.10 $79.60 $159.20 $111.44 $139.30 $127.36 $159.20 $155.22 $89.55 $81.59 $83.58 $79.60 $149.25 $129.35
WWH LAB/RAD FEE SCHEDULE - 4206 116770 73503 HCHG RAD XRAY HIP WWO PELVIS UNILATERAL MINIMUM 4 VIEWS 186.00 $167.40 $74.40 $148.80 $104.16 $130.20 $119.04 $148.80 $145.08 $83.70 $76.26 $78.12 $74.40 $139.50 $120.90
WWH LAB/RAD FEE SCHEDULE - 4206 116773 73521 HCHG RAD XRAY HIPS BILATERAL 2V WWO PELVIS 379.00 $341.10 $151.60 $303.20 $212.24 $265.30 $242.56 $303.20 $295.62 $170.55 $155.39 $159.18 $151.60 $284.25 $246.35
WWH LAB/RAD FEE SCHEDULE - 4206 116774 73521 HCHG RAD XRAY PELVIS AND HIPS BILAT INFANT/CHILD 2VIEWS 221.00 $198.90 $88.40 $176.80 $123.76 $154.70 $141.44 $176.80 $172.38 $99.45 $90.61 $92.82 $88.40 $165.75 $143.65
WWH LAB/RAD FEE SCHEDULE - 4206 116775 73521 HCHG RAD XRAY HIPS BILATERAL 2V WWO PELVIS PORTABLE 338.00 $304.20 $135.20 $270.40 $189.28 $236.60 $216.32 $270.40 $263.64 $152.10 $138.58 $141.96 $135.20 $253.50 $219.70
WWH LAB/RAD FEE SCHEDULE - 4206 116779 73525 HCHG RAD ARTHROGRAM HIP 455.00 $409.50 $182.00 $364.00 $254.80 $318.50 $291.20 $364.00 $354.90 $204.75 $186.55 $191.10 $182.00 $341.25 $295.75
WWH LAB/RAD FEE SCHEDULE - 4206 116780 73551 HCHG RAD XRAY FEMUR 1 VIEW UNILATERAL 209.00 $188.10 $83.60 $167.20 $117.04 $146.30 $133.76 $167.20 $163.02 $94.05 $85.69 $87.78 $83.60 $156.75 $135.85
WWH LAB/RAD FEE SCHEDULE - 4206 116781 73551 HCHG RAD XRAY FEMUR 1 VIEW UNILATERAL PORTABLE 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 116782 73552 HCHG RAD XRAY FEMUR 2 VIEWS 252.00 $226.80 $100.80 $201.60 $141.12 $176.40 $161.28 $201.60 $196.56 $113.40 $103.32 $105.84 $100.80 $189.00 $163.80
WWH LAB/RAD FEE SCHEDULE - 4206 116783 73552 HCHG RAD XRAY FEMUR 2 VIEWS PORTABLE 182.00 $163.80 $72.80 $145.60 $101.92 $127.40 $116.48 $145.60 $141.96 $81.90 $74.62 $76.44 $72.80 $136.50 $118.30
WWH LAB/RAD FEE SCHEDULE - 4206 116784 73552 HCHG RAD XRAY FEMUR 2 VIEWS LIMITED 252.00 $226.80 $100.80 $201.60 $141.12 $176.40 $161.28 $201.60 $196.56 $113.40 $103.32 $105.84 $100.80 $189.00 $163.80
WWH LAB/RAD FEE SCHEDULE - 4206 116785 73560 HCHG RAD XRAY KNEE 1 OR 2 VIEWS 141.00 $126.90 $56.40 $112.80 $78.96 $98.70 $90.24 $112.80 $109.98 $63.45 $57.81 $59.22 $56.40 $105.75 $91.65
WWH LAB/RAD FEE SCHEDULE - 4206 116786 73560 HCHG RAD XRAY KNEE 1 OR 2 VIEWS PORTABLE 119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
WWH LAB/RAD FEE SCHEDULE - 4206 116787 73562 HCHG RAD XRAY KNEE 3 VIEWS 258.00 $232.20 $103.20 $206.40 $144.48 $180.60 $165.12 $206.40 $201.24 $116.10 $105.78 $108.36 $103.20 $193.50 $167.70
WWH LAB/RAD FEE SCHEDULE - 4206 116789 73564 HCHG RAD XRAY KNEE COMPLETE 4 VIEWS OR MORE 203.00 $182.70 $81.20 $162.40 $113.68 $142.10 $129.92 $162.40 $158.34 $91.35 $83.23 $85.26 $81.20 $152.25 $131.95
WWH LAB/RAD FEE SCHEDULE - 4206 116791 73580 HCHG RAD XRAY ARTHROGRAM KNEE 443.00 $398.70 $177.20 $354.40 $248.08 $310.10 $283.52 $354.40 $345.54 $199.35 $181.63 $186.06 $177.20 $332.25 $287.95
WWH LAB/RAD FEE SCHEDULE - 4206 116792 73590 HCHG RAD XRAY TIBIA AND FIBULA 2 VIEWS 227.00 $204.30 $90.80 $181.60 $127.12 $158.90 $145.28 $181.60 $177.06 $102.15 $93.07 $95.34 $90.80 $170.25 $147.55
WWH LAB/RAD FEE SCHEDULE - 4206 116793 73590 HCHG RAD XRAY TIBIA AND FIBULA 2 VIEWS PORTABLE 160.00 $144.00 $64.00 $128.00 $89.60 $112.00 $102.40 $128.00 $124.80 $72.00 $65.60 $67.20 $64.00 $120.00 $104.00
WWH LAB/RAD FEE SCHEDULE - 4206 116794 73590 HCHG RAD XRAY TIBIA AND FIBULA 2 VIEWS LIMITED 227.00 $204.30 $90.80 $181.60 $127.12 $158.90 $145.28 $181.60 $177.06 $102.15 $93.07 $95.34 $90.80 $170.25 $147.55
WWH LAB/RAD FEE SCHEDULE - 4206 116795 73592 HCHG RAD XRAY LOWER EXTREMITY INFANT 2 VIEWS OR MORE 151.00 $135.90 $60.40 $120.80 $84.56 $105.70 $96.64 $120.80 $117.78 $67.95 $61.91 $63.42 $60.40 $113.25 $98.15
WWH LAB/RAD FEE SCHEDULE - 4206 116796 73600 HCHG RAD XRAY ANKLE 2 VIEWS 133.00 $119.70 $53.20 $106.40 $74.48 $93.10 $85.12 $106.40 $103.74 $59.85 $54.53 $55.86 $53.20 $99.75 $86.45
WWH LAB/RAD FEE SCHEDULE - 4206 116797 73600 HCHG RAD XRAY ANKLE 2 VIEWS PORTABLE 109.00 $98.10 $43.60 $87.20 $61.04 $76.30 $69.76 $87.20 $85.02 $49.05 $44.69 $45.78 $43.60 $81.75 $70.85
WWH LAB/RAD FEE SCHEDULE - 4206 116798 73610 HCHG RAD XRAY ANKLE COMPLETE 3 VIEWS OR MORE 258.00 $232.20 $103.20 $206.40 $144.48 $180.60 $165.12 $206.40 $201.24 $116.10 $105.78 $108.36 $103.20 $193.50 $167.70
WWH LAB/RAD FEE SCHEDULE - 4206 116799 73610 HCHG RAD XRAY ANKLE COMPLETE 3 VIEWS OR MORE PORTABLE 239.00 $215.10 $95.60 $191.20 $133.84 $167.30 $152.96 $191.20 $186.42 $107.55 $97.99 $100.38 $95.60 $179.25 $155.35
WWH LAB/RAD FEE SCHEDULE - 4206 116801 73620 HCHG RAD XRAY FOOT 2 VIEWS 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH LAB/RAD FEE SCHEDULE - 4206 116802 73620 HCHG RAD XRAY FOOT 2 VIEWS PORTABLE 100.00 $90.00 $40.00 $80.00 $56.00 $70.00 $64.00 $80.00 $78.00 $45.00 $41.00 $42.00 $40.00 $75.00 $65.00
WWH LAB/RAD FEE SCHEDULE - 4206 116803 73620 HCHG RAD XRAY FOOT 2 VIEWS PORTABLE LIMITED 100.00 $90.00 $40.00 $80.00 $56.00 $70.00 $64.00 $80.00 $78.00 $45.00 $41.00 $42.00 $40.00 $75.00 $65.00
WWH LAB/RAD FEE SCHEDULE - 4206 116804 73620 HCHG RAD XRAY FOOT 2 VIEWS LIMITED 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH LAB/RAD FEE SCHEDULE - 4206 116805 73630 HCHG RAD XRAY FOOT COMPLETE MINIMUM OF 3 VIEWS 235.00 $211.50 $94.00 $188.00 $131.60 $164.50 $150.40 $188.00 $183.30 $105.75 $96.35 $98.70 $94.00 $176.25 $152.75
WWH LAB/RAD FEE SCHEDULE - 4206 116806 73630 HCHG RAD XRAY FOOT COMPLETE MINIMUM OF 3 VIEWS PORTABLE 156.00 $140.40 $62.40 $124.80 $87.36 $109.20 $99.84 $124.80 $121.68 $70.20 $63.96 $65.52 $62.40 $117.00 $101.40
WWH LAB/RAD FEE SCHEDULE - 4206 116807 73650 HCHG RAD XRAY CALCANEUS 2 VIEWS 132.00 $118.80 $52.80 $105.60 $73.92 $92.40 $84.48 $105.60 $102.96 $59.40 $54.12 $55.44 $52.80 $99.00 $85.80
WWH LAB/RAD FEE SCHEDULE - 4206 116808 73650 HCHG RAD XRAY CALCANEUS 2 VIEWS LTD 111.00 $99.90 $44.40 $88.80 $62.16 $77.70 $71.04 $88.80 $86.58 $49.95 $45.51 $46.62 $44.40 $83.25 $72.15
WWH LAB/RAD FEE SCHEDULE - 4206 116809 73660 HCHG RAD XRAY TOE(S) MINIMUM OF 2 VIEWS 193.00 $173.70 $77.20 $154.40 $108.08 $135.10 $123.52 $154.40 $150.54 $86.85 $79.13 $81.06 $77.20 $144.75 $125.45
WWH LAB/RAD FEE SCHEDULE - 4206 116810 73660 HCHG RAD XRAY TOE(S) MINIMUM OF 2 VIEWS PORTABLE 144.00 $129.60 $57.60 $115.20 $80.64 $100.80 $92.16 $115.20 $112.32 $64.80 $59.04 $60.48 $57.60 $108.00 $93.60
WWH LAB/RAD FEE SCHEDULE - 4206 116811 73700 HCHG RAD CT LOWER EXTREMITY WO "1,824.00" " $1,641.60 " $729.60 " $1,459.20 " " $1,021.44 " " $1,276.80 " " $1,167.36 " " $1,459.20 " " $1,422.72 " $820.80 $747.84 $766.08 $729.60 " $1,368.00 " " $1,185.60 "
WWH LAB/RAD FEE SCHEDULE - 4206 116812 73701 HCHG RAD CT LOWER EXTREMITY W "1,879.00" " $1,691.10 " $751.60 " $1,503.20 " " $1,052.24 " " $1,315.30 " " $1,202.56 " " $1,503.20 " " $1,465.62 " $845.55 $770.39 $789.18 $751.60 " $1,409.25 " " $1,221.35 "
WWH LAB/RAD FEE SCHEDULE - 4206 116813 73702 HCHG RAD CT LOWER EXTREMITY WWO "2,864.00" " $2,577.60 " " $1,145.60 " " $2,291.20 " " $1,603.84 " " $2,004.80 " " $1,832.96 " " $2,291.20 " " $2,233.92 " " $1,288.80 " " $1,174.24 " " $1,202.88 " " $1,145.60 " " $2,148.00 " " $1,861.60 "
WWH LAB/RAD FEE SCHEDULE - 4206 116814 73706 HCHG RAD CT ANGIO LOWER EXTREMITY "1,626.00" " $1,463.40 " $650.40 " $1,300.80 " $910.56 " $1,138.20 " " $1,040.64 " " $1,300.80 " " $1,268.28 " $731.70 $666.66 $682.92 $650.40 " $1,219.50 " " $1,056.90 "
WWH LAB/RAD FEE SCHEDULE - 4206 116815 73718 HCHG RAD MRI LOWER EXTREMITY NON JOINT WO "3,650.00" " $3,285.00 " " $1,460.00 " " $2,920.00 " " $2,044.00 " " $2,555.00 " " $2,336.00 " " $2,920.00 " " $2,847.00 " " $1,642.50 " " $1,496.50 " " $1,533.00 " " $1,460.00 " " $2,737.50 " " $2,372.50 "
WWH LAB/RAD FEE SCHEDULE - 4206 116816 73719 HCHG RAD MRI LOWER EXT NON JOINT W CONTRAST "4,046.00" " $3,641.40 " " $1,618.40 " " $3,236.80 " " $2,265.76 " " $2,832.20 " " $2,589.44 " " $3,236.80 " " $3,155.88 " " $1,820.70 " " $1,658.86 " " $1,699.32 " " $1,618.40 " " $3,034.50 " " $2,629.90 "
WWH LAB/RAD FEE SCHEDULE - 4206 116817 73720 HCHG RAD MRI NON JOINT LOWER EXTREMITY WWO "4,036.00" " $3,632.40 " " $1,614.40 " " $3,228.80 " " $2,260.16 " " $2,825.20 " " $2,583.04 " " $3,228.80 " " $3,148.08 " " $1,816.20 " " $1,654.76 " " $1,695.12 " " $1,614.40 " " $3,027.00 " " $2,623.40 "
WWH LAB/RAD FEE SCHEDULE - 4206 116818 73721 HCHG RAD MRI JOINT LOWER EXTREMITY WO "2,651.00" " $2,385.90 " " $1,060.40 " " $2,120.80 " " $1,484.56 " " $1,855.70 " " $1,696.64 " " $2,120.80 " " $2,067.78 " " $1,192.95 " " $1,086.91 " " $1,113.42 " " $1,060.40 " " $1,988.25 " " $1,723.15 "
WWH LAB/RAD FEE SCHEDULE - 4206 116819 73721 HCHG RAD MRI JOINT LOWER EXTREMITY WO LIMITED "1,992.00" " $1,792.80 " $796.80 " $1,593.60 " " $1,115.52 " " $1,394.40 " " $1,274.88 " " $1,593.60 " " $1,553.76 " $896.40 $816.72 $836.64 $796.80 " $1,494.00 " " $1,294.80 "
WWH LAB/RAD FEE SCHEDULE - 4206 116820 73722 HCHG RAD MRI JOINT OF LOWER EXTREMITY W "3,879.00" " $3,491.10 " " $1,551.60 " " $3,103.20 " " $2,172.24 " " $2,715.30 " " $2,482.56 " " $3,103.20 " " $3,025.62 " " $1,745.55 " " $1,590.39 " " $1,629.18 " " $1,551.60 " " $2,909.25 " " $2,521.35 "
WWH LAB/RAD FEE SCHEDULE - 4206 116821 73723 HCHG RAD MRI JOINT OF LOWER EXTREMITY WWO "4,814.00" " $4,332.60 " " $1,925.60 " " $3,851.20 " " $2,695.84 " " $3,369.80 " " $3,080.96 " " $3,851.20 " " $3,754.92 " " $2,166.30 " " $1,973.74 " " $2,021.88 " " $1,925.60 " " $3,610.50 " " $3,129.10 "
WWH LAB/RAD FEE SCHEDULE - 4206 116822 74018 HCHG RAD XRAY ABDOMEN SINGLE AP VIEW 207.00 $186.30 $82.80 $165.60 $115.92 $144.90 $132.48 $165.60 $161.46 $93.15 $84.87 $86.94 $82.80 $155.25 $134.55
WWH LAB/RAD FEE SCHEDULE - 4206 116823 74018 HCHG RAD XRAY ABDOMEN SINGLE AP VIEW PORTABLE 207.00 $186.30 $82.80 $165.60 $115.92 $144.90 $132.48 $165.60 $161.46 $93.15 $84.87 $86.94 $82.80 $155.25 $134.55
WWH LAB/RAD FEE SCHEDULE - 4206 116825 74019 HCHG RAD XRAY ABDOMEN COMPLETE 244.00 $219.60 $97.60 $195.20 $136.64 $170.80 $156.16 $195.20 $190.32 $109.80 $100.04 $102.48 $97.60 $183.00 $158.60
WWH LAB/RAD FEE SCHEDULE - 4206 116829 74150 HCHG RAD CT ABDOMEN WO "1,288.00" " $1,159.20 " $515.20 " $1,030.40 " $721.28 $901.60 $824.32 " $1,030.40 " " $1,004.64 " $579.60 $528.08 $540.96 $515.20 $966.00 $837.20
WWH LAB/RAD FEE SCHEDULE - 4206 116831 74160 HCHG RAD CT ABDOMEN W "1,627.00" " $1,464.30 " $650.80 " $1,301.60 " $911.12 " $1,138.90 " " $1,041.28 " " $1,301.60 " " $1,269.06 " $732.15 $667.07 $683.34 $650.80 " $1,220.25 " " $1,057.55 "
WWH LAB/RAD FEE SCHEDULE - 4206 116832 74170 HCHG RAD CT ABDOMEN WWO "2,766.00" " $2,489.40 " " $1,106.40 " " $2,212.80 " " $1,548.96 " " $1,936.20 " " $1,770.24 " " $2,212.80 " " $2,157.48 " " $1,244.70 " " $1,134.06 " " $1,161.72 " " $1,106.40 " " $2,074.50 " " $1,797.90 "
WWH LAB/RAD FEE SCHEDULE - 4206 116833 74174 HCHG RAD CT ANGIO ABDOMEN PELVIS "3,421.00" " $3,078.90 " " $1,368.40 " " $2,736.80 " " $1,915.76 " " $2,394.70 " " $2,189.44 " " $2,736.80 " " $2,668.38 " " $1,539.45 " " $1,402.61 " " $1,436.82 " " $1,368.40 " " $2,565.75 " " $2,223.65 "
WWH LAB/RAD FEE SCHEDULE - 4206 116835 74175 HCHG RAD CT ANGIO ABDOMEN "3,215.00" " $2,893.50 " " $1,286.00 " " $2,572.00 " " $1,800.40 " " $2,250.50 " " $2,057.60 " " $2,572.00 " " $2,507.70 " " $1,446.75 " " $1,318.15 " " $1,350.30 " " $1,286.00 " " $2,411.25 " " $2,089.75 "
WWH LAB/RAD FEE SCHEDULE - 4206 116836 74176 HCHG RAD CT ABDOMEN PELVIS WO "2,922.00" " $2,629.80 " " $1,168.80 " " $2,337.60 " " $1,636.32 " " $2,045.40 " " $1,870.08 " " $2,337.60 " " $2,279.16 " " $1,314.90 " " $1,198.02 " " $1,227.24 " " $1,168.80 " " $2,191.50 " " $1,899.30 "
WWH LAB/RAD FEE SCHEDULE - 4206 116837 74177 HCHG RAD CT ABDOMEN PELVIS W "3,526.00" " $3,173.40 " " $1,410.40 " " $2,820.80 " " $1,974.56 " " $2,468.20 " " $2,256.64 " " $2,820.80 " " $2,750.28 " " $1,586.70 " " $1,445.66 " " $1,480.92 " " $1,410.40 " " $2,644.50 " " $2,291.90 "
WWH LAB/RAD FEE SCHEDULE - 4206 116838 74178 HCHG RAD CT ABDOMEN PELVIS WWO "4,069.00" " $3,662.10 " " $1,627.60 " " $3,255.20 " " $2,278.64 " " $2,848.30 " " $2,604.16 " " $3,255.20 " " $3,173.82 " " $1,831.05 " " $1,668.29 " " $1,708.98 " " $1,627.60 " " $3,051.75 " " $2,644.85 "
WWH LAB/RAD FEE SCHEDULE - 4206 116839 74181 HCHG RAD MRI ABDOMEN WO "3,363.00" " $3,026.70 " " $1,345.20 " " $2,690.40 " " $1,883.28 " " $2,354.10 " " $2,152.32 " " $2,690.40 " " $2,623.14 " " $1,513.35 " " $1,378.83 " " $1,412.46 " " $1,345.20 " " $2,522.25 " " $2,185.95 "
WWH LAB/RAD FEE SCHEDULE - 4206 116840 74182 HCHG RAD MRI ABDOMEN W "2,250.00" " $2,025.00 " $900.00 " $1,800.00 " " $1,260.00 " " $1,575.00 " " $1,440.00 " " $1,800.00 " " $1,755.00 " " $1,012.50 " $922.50 $945.00 $900.00 " $1,687.50 " " $1,462.50 "
WWH LAB/RAD FEE SCHEDULE - 4206 116841 74183 HCHG RAD MRI ABDOMEN WWO "5,187.00" " $4,668.30 " " $2,074.80 " " $4,149.60 " " $2,904.72 " " $3,630.90 " " $3,319.68 " " $4,149.60 " " $4,045.86 " " $2,334.15 " " $2,126.67 " " $2,178.54 " " $2,074.80 " " $3,890.25 " " $3,371.55 "
WWH LAB/RAD FEE SCHEDULE - 4206 116844 74210 HCHG RAD XRAY PHARYNX AND/OR CERVICAL ESOPHAGUS 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH LAB/RAD FEE SCHEDULE - 4206 116845 74220 HCHG RAD XRAY ESOPHAGUS 562.00 $505.80 $224.80 $449.60 $314.72 $393.40 $359.68 $449.60 $438.36 $252.90 $230.42 $236.04 $224.80 $421.50 $365.30
WWH LAB/RAD FEE SCHEDULE - 4206 116847 74230 HCHG RAD XRAY VIDEO SWALLOW STUDY 613.00 $551.70 $245.20 $490.40 $343.28 $429.10 $392.32 $490.40 $478.14 $275.85 $251.33 $257.46 $245.20 $459.75 $398.45
WWH LAB/RAD FEE SCHEDULE - 4206 116848 74240 HCHG RAD XRAY UPPER GI 709.00 $638.10 $283.60 $567.20 $397.04 $496.30 $453.76 $567.20 $553.02 $319.05 $290.69 $297.78 $283.60 $531.75 $460.85
WWH LAB/RAD FEE SCHEDULE - 4206 116849 74246 HCHG RAD XRAY UPPER GI AIR CONTRAST 927.00 $834.30 $370.80 $741.60 $519.12 $648.90 $593.28 $741.60 $723.06 $417.15 $380.07 $389.34 $370.80 $695.25 $602.55
WWH LAB/RAD FEE SCHEDULE - 4206 116850 74248 HCHG RAD XRAY SMALL BOWEL FOLLOW THROUGH 341.00 $306.90 $136.40 $272.80 $190.96 $238.70 $218.24 $272.80 $265.98 $153.45 $139.81 $143.22 $136.40 $255.75 $221.65
WWH LAB/RAD FEE SCHEDULE - 4206 116851 74250 HCHG RAD XRAY SMALL INTESTINE 613.00 $551.70 $245.20 $490.40 $343.28 $429.10 $392.32 $490.40 $478.14 $275.85 $251.33 $257.46 $245.20 $459.75 $398.45
WWH LAB/RAD FEE SCHEDULE - 4206 116853 74261 HCHG RAD CT ABDOMEN PELVIS COLONOGRAPHY DIAGNOSTIC WO "1,923.00" " $1,730.70 " $769.20 " $1,538.40 " " $1,076.88 " " $1,346.10 " " $1,230.72 " " $1,538.40 " " $1,499.94 " $865.35 $788.43 $807.66 $769.20 " $1,442.25 " " $1,249.95 "
WWH LAB/RAD FEE SCHEDULE - 4206 116854 74262 HCHG RAD CT ABDOMEN PELVIS COLONOGRAPHY DIAGNOSTIC W "2,636.00" " $2,372.40 " " $1,054.40 " " $2,108.80 " " $1,476.16 " " $1,845.20 " " $1,687.04 " " $2,108.80 " " $2,056.08 " " $1,186.20 " " $1,080.76 " " $1,107.12 " " $1,054.40 " " $1,977.00 " " $1,713.40 "
WWH LAB/RAD FEE SCHEDULE - 4206 116855 74263 HCHG RAD CT ABDOMEN PELVIS COLONOGRAPHY SCREENING WO "4,328.00" " $3,895.20 " " $1,731.20 " " $3,462.40 " " $2,423.68 " " $3,029.60 " " $2,769.92 " " $3,462.40 " " $3,375.84 " " $1,947.60 " " $1,774.48 " " $1,817.76 " " $1,731.20 " " $3,246.00 " " $2,813.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 116856 74270 HCHG RAD COLON W CONTRAST 632.00 $568.80 $252.80 $505.60 $353.92 $442.40 $404.48 $505.60 $492.96 $284.40 $259.12 $265.44 $252.80 $474.00 $410.80
WWH LAB/RAD FEE SCHEDULE - 4206 116857 74280 HCHG RAD XRAY COLON AIR CONTRAST 762.00 $685.80 $304.80 $609.60 $426.72 $533.40 $487.68 $609.60 $594.36 $342.90 $312.42 $320.04 $304.80 $571.50 $495.30
WWH LAB/RAD FEE SCHEDULE - 4206 116860 74300 HCHG RAD XRAY CHOLANGIOGRAM OPERATIVE 339.00 $305.10 $135.60 $271.20 $189.84 $237.30 $216.96 $271.20 $264.42 $152.55 $138.99 $142.38 $135.60 $254.25 $220.35
WWH LAB/RAD FEE SCHEDULE - 4206 116865 74340 HCHG RAD GI TUBE LONG W FLUORO AND IMAGES 565.00 $508.50 $226.00 $452.00 $316.40 $395.50 $361.60 $452.00 $440.70 $254.25 $231.65 $237.30 $226.00 $423.75 $367.25
WWH LAB/RAD FEE SCHEDULE - 4206 116867 74360 HCHG RAD ESOPHAGEAL DILITATION 330.00 $297.00 $132.00 $264.00 $184.80 $231.00 $211.20 $264.00 $257.40 $148.50 $135.30 $138.60 $132.00 $247.50 $214.50
WWH LAB/RAD FEE SCHEDULE - 4206 116870 74410 HCHG RAD IVP 344.00 $309.60 $137.60 $275.20 $192.64 $240.80 $220.16 $275.20 $268.32 $154.80 $141.04 $144.48 $137.60 $258.00 $223.60
WWH LAB/RAD FEE SCHEDULE - 4206 116872 74420 HCHG RAD XRAY RETROGRADE PYELOGRAM WWO KUB 450.00 $405.00 $180.00 $360.00 $252.00 $315.00 $288.00 $360.00 $351.00 $202.50 $184.50 $189.00 $180.00 $337.50 $292.50
WWH LAB/RAD FEE SCHEDULE - 4206 116873 74425 HCHG RAD UROGRAPHY ANTEGRADE 174.00 $156.60 $69.60 $139.20 $97.44 $121.80 $111.36 $139.20 $135.72 $78.30 $71.34 $73.08 $69.60 $130.50 $113.10
WWH LAB/RAD FEE SCHEDULE - 4206 116874 74430 HCHG RAD CYSTOGRAM 487.00 $438.30 $194.80 $389.60 $272.72 $340.90 $311.68 $389.60 $379.86 $219.15 $199.67 $204.54 $194.80 $365.25 $316.55
WWH LAB/RAD FEE SCHEDULE - 4206 116875 74450 HCHG RAD URETHROCYSTOGRAM RETROGRADE 487.00 $438.30 $194.80 $389.60 $272.72 $340.90 $311.68 $389.60 $379.86 $219.15 $199.67 $204.54 $194.80 $365.25 $316.55
WWH LAB/RAD FEE SCHEDULE - 4206 116876 74455 HCHG RAD VOIDING CYSTOURETHROGRAM 423.00 $380.70 $169.20 $338.40 $236.88 $296.10 $270.72 $338.40 $329.94 $190.35 $173.43 $177.66 $169.20 $317.25 $274.95
WWH LAB/RAD FEE SCHEDULE - 4206 116882 74740 HCHG RAD HYSTEROSALPINGOGRAM 595.00 $535.50 $238.00 $476.00 $333.20 $416.50 $380.80 $476.00 $464.10 $267.75 $243.95 $249.90 $238.00 $446.25 $386.75
WWH LAB/RAD FEE SCHEDULE - 4206 116890 75571 HCHG RAD CT CARDIAC CALCIUM SCORING WO 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH LAB/RAD FEE SCHEDULE - 4206 116893 75574 HCHG RAD CT ANGIO HEART CORONARY ARTERIES "3,408.00" " $3,067.20 " " $1,363.20 " " $2,726.40 " " $1,908.48 " " $2,385.60 " " $2,181.12 " " $2,726.40 " " $2,658.24 " " $1,533.60 " " $1,397.28 " " $1,431.36 " " $1,363.20 " " $2,556.00 " " $2,215.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 116898 75635 HCHG RAD CT ANGIO ABDOMEN PELVIS LOWER EXTREMITY RUNOFF "3,686.00" " $3,317.40 " " $1,474.40 " " $2,948.80 " " $2,064.16 " " $2,580.20 " " $2,359.04 " " $2,948.80 " " $2,875.08 " " $1,658.70 " " $1,511.26 " " $1,548.12 " " $1,474.40 " " $2,764.50 " " $2,395.90 "
WWH LAB/RAD FEE SCHEDULE - 4206 116917 75820 HCHG RAD VENOGRAM EXTREMITY UNILATERAL 401.00 $360.90 $160.40 $320.80 $224.56 $280.70 $256.64 $320.80 $312.78 $180.45 $164.41 $168.42 $160.40 $300.75 $260.65
WWH LAB/RAD FEE SCHEDULE - 4206 116942 75984 HCHG RAD CATHETER CHANGE NON GASTRO TUBE 402.00 $361.80 $160.80 $321.60 $225.12 $281.40 $257.28 $321.60 $313.56 $180.90 $164.82 $168.84 $160.80 $301.50 $261.30
WWH LAB/RAD FEE SCHEDULE - 4206 116943 75989 HCHG RAD GUIDE PERCUTANEOUS DRAIN CATHETER 868.00 $781.20 $347.20 $694.40 $486.08 $607.60 $555.52 $694.40 $677.04 $390.60 $355.88 $364.56 $347.20 $651.00 $564.20
WWH LAB/RAD FEE SCHEDULE - 4206 116945 76000 HCHG RAD XRAY C-ARM EQUAL OR LESS THAN 1 HR 574.00 $516.60 $229.60 $459.20 $321.44 $401.80 $367.36 $459.20 $447.72 $258.30 $235.34 $241.08 $229.60 $430.50 $373.10
WWH LAB/RAD FEE SCHEDULE - 4206 116954 76010 HCHG RAD XRAY NOSE TO RECTUM OF CHILD FOR FOREIGN BODY 216.00 $194.40 $86.40 $172.80 $120.96 $151.20 $138.24 $172.80 $168.48 $97.20 $88.56 $90.72 $86.40 $162.00 $140.40
WWH LAB/RAD FEE SCHEDULE - 4206 116955 76080 HCHG RAD ABSCESS/FISTULA/SINUS TRACT 280.00 $252.00 $112.00 $224.00 $156.80 $196.00 $179.20 $224.00 $218.40 $126.00 $114.80 $117.60 $112.00 $210.00 $182.00
WWH LAB/RAD FEE SCHEDULE - 4206 116956 76098 HCHG RAD XRAY SURGICAL SPECIMEN 307.00 $276.30 $122.80 $245.60 $171.92 $214.90 $196.48 $245.60 $239.46 $138.15 $125.87 $128.94 $122.80 $230.25 $199.55
WWH LAB/RAD FEE SCHEDULE - 4206 116958 76376 HCHG RAD 3D RECON ACQUISITION WKST 401.00 $360.90 $160.40 $320.80 $224.56 $280.70 $256.64 $320.80 $312.78 $180.45 $164.41 $168.42 $160.40 $300.75 $260.65
WWH LAB/RAD FEE SCHEDULE - 4206 116974 76536 HCHG RAD US NECK OR HEAD SOFT TISSUE 752.00 $676.80 $300.80 $601.60 $421.12 $526.40 $481.28 $601.60 $586.56 $338.40 $308.32 $315.84 $300.80 $564.00 $488.80
WWH LAB/RAD FEE SCHEDULE - 4206 116975 76604 HCHG RAD US CHEST 461.00 $414.90 $184.40 $368.80 $258.16 $322.70 $295.04 $368.80 $359.58 $207.45 $189.01 $193.62 $184.40 $345.75 $299.65
WWH LAB/RAD FEE SCHEDULE - 4206 116977 76641 HCHG RAD US BREAST COMPLETE 473.00 $425.70 $189.20 $378.40 $264.88 $331.10 $302.72 $378.40 $368.94 $212.85 $193.93 $198.66 $189.20 $354.75 $307.45
WWH LAB/RAD FEE SCHEDULE - 4206 116978 76642 HCHG RAD US BREAST LIMITED 552.00 $496.80 $220.80 $441.60 $309.12 $386.40 $353.28 $441.60 $430.56 $248.40 $226.32 $231.84 $220.80 $414.00 $358.80
WWH LAB/RAD FEE SCHEDULE - 4206 116979 76700 HCHG RAD US ABDOMEN COMPLETE "1,027.00" $924.30 $410.80 $821.60 $575.12 $718.90 $657.28 $821.60 $801.06 $462.15 $421.07 $431.34 $410.80 $770.25 $667.55
WWH LAB/RAD FEE SCHEDULE - 4206 116981 76705 HCHG RAD US ABDOMEN LIMITED 563.00 $506.70 $225.20 $450.40 $315.28 $394.10 $360.32 $450.40 $439.14 $253.35 $230.83 $236.46 $225.20 $422.25 $365.95
WWH LAB/RAD FEE SCHEDULE - 4206 116983 76706 HCHG RAD US ABD AORTA SCREENING 492.00 $442.80 $196.80 $393.60 $275.52 $344.40 $314.88 $393.60 $383.76 $221.40 $201.72 $206.64 $196.80 $369.00 $319.80
WWH LAB/RAD FEE SCHEDULE - 4206 116984 76770 HCHG RAD US RETROPERITONEAL COMPLETE "1,016.00" $914.40 $406.40 $812.80 $568.96 $711.20 $650.24 $812.80 $792.48 $457.20 $416.56 $426.72 $406.40 $762.00 $660.40
WWH LAB/RAD FEE SCHEDULE - 4206 116986 76775 HCHG RAD US RETROPERITONEAL LIMITED STUDY 764.00 $687.60 $305.60 $611.20 $427.84 $534.80 $488.96 $611.20 $595.92 $343.80 $313.24 $320.88 $305.60 $573.00 $496.60
WWH LAB/RAD FEE SCHEDULE - 4206 116988 76775 HCHG RAD US RENAL TRANSPLANT 480.00 $432.00 $192.00 $384.00 $268.80 $336.00 $307.20 $384.00 $374.40 $216.00 $196.80 $201.60 $192.00 $360.00 $312.00
WWH LAB/RAD FEE SCHEDULE - 4206 116989 76776 HCHG RAD US RENAL TRANSPLANT WITH DUPLEX DOPPLER 579.00 $521.10 $231.60 $463.20 $324.24 $405.30 $370.56 $463.20 $451.62 $260.55 $237.39 $243.18 $231.60 $434.25 $376.35
WWH LAB/RAD FEE SCHEDULE - 4206 116991 76800 HCHG RAD US SPINAL CANAL AND CONTENTS 620.00 $558.00 $248.00 $496.00 $347.20 $434.00 $396.80 $496.00 $483.60 $279.00 $254.20 $260.40 $248.00 $465.00 $403.00
WWH LAB/RAD FEE SCHEDULE - 4206 116992 76801 HCHG RAD US OB 1ST TRI SINGLE TRANSABD 839.00 $755.10 $335.60 $671.20 $469.84 $587.30 $536.96 $671.20 $654.42 $377.55 $343.99 $352.38 $335.60 $629.25 $545.35
WWH LAB/RAD FEE SCHEDULE - 4206 116994 76802 HCHG RAD US OB 1ST TRI EACH ADDL GESTATION TRANSABD 625.00 $562.50 $250.00 $500.00 $350.00 $437.50 $400.00 $500.00 $487.50 $281.25 $256.25 $262.50 $250.00 $468.75 $406.25
WWH LAB/RAD FEE SCHEDULE - 4206 116996 76805 HCHG RAD US OB EQUAL OR GREATER THAN 14 WKS SINGLE GEST 881.00 $792.90 $352.40 $704.80 $493.36 $616.70 $563.84 $704.80 $687.18 $396.45 $361.21 $370.02 $352.40 $660.75 $572.65
WWH LAB/RAD FEE SCHEDULE - 4206 116998 76810 HCHG RAD US OB EQUAL OR GREATER THAN 14 WKS EA ADDL GEST 826.00 $743.40 $330.40 $660.80 $462.56 $578.20 $528.64 $660.80 $644.28 $371.70 $338.66 $346.92 $330.40 $619.50 $536.90
WWH LAB/RAD FEE SCHEDULE - 4206 117000 76811 HCHG RAD US OB FETAL ANATOMY SINGLE GESTATION "1,027.00" $924.30 $410.80 $821.60 $575.12 $718.90 $657.28 $821.60 $801.06 $462.15 $421.07 $431.34 $410.80 $770.25 $667.55
WWH LAB/RAD FEE SCHEDULE - 4206 117002 76812 HCHG RAD US OB DETAIL FETAL ANATOMY EACH ADDL GESTATION 826.00 $743.40 $330.40 $660.80 $462.56 $578.20 $528.64 $660.80 $644.28 $371.70 $338.66 $346.92 $330.40 $619.50 $536.90
WWH LAB/RAD FEE SCHEDULE - 4206 117004 76813 HCHG RAD US OB NUCHAL TRANSLUCENCY SINGLE GEST 602.00 $541.80 $240.80 $481.60 $337.12 $421.40 $385.28 $481.60 $469.56 $270.90 $246.82 $252.84 $240.80 $451.50 $391.30
WWH LAB/RAD FEE SCHEDULE - 4206 117006 76814 HCHG RAD US OB NUCHAL TRANSLUCENCY EACH ADDL GESTATION 399.00 $359.10 $159.60 $319.20 $223.44 $279.30 $255.36 $319.20 $311.22 $179.55 $163.59 $167.58 $159.60 $299.25 $259.35
WWH LAB/RAD FEE SCHEDULE - 4206 117008 76815 HCHG RAD US OB LIMITED ANY TRI 1 OR MORE FETUSES 622.00 $559.80 $248.80 $497.60 $348.32 $435.40 $398.08 $497.60 $485.16 $279.90 $255.02 $261.24 $248.80 $466.50 $404.30
WWH LAB/RAD FEE SCHEDULE - 4206 117010 76816 HCHG RAD US OB FOLLOW UP ANY TRI SINGLE TRANSABD 553.00 $497.70 $221.20 $442.40 $309.68 $387.10 $353.92 $442.40 $431.34 $248.85 $226.73 $232.26 $221.20 $414.75 $359.45
WWH LAB/RAD FEE SCHEDULE - 4206 117012 76817 HCHG RAD US OB TRANSVAGINAL 826.00 $743.40 $330.40 $660.80 $462.56 $578.20 $528.64 $660.80 $644.28 $371.70 $338.66 $346.92 $330.40 $619.50 $536.90
WWH LAB/RAD FEE SCHEDULE - 4206 117014 76817 HCHG RAD US OB TRANSVAGINAL LTD 826.00 $743.40 $330.40 $660.80 $462.56 $578.20 $528.64 $660.80 $644.28 $371.70 $338.66 $346.92 $330.40 $619.50 $536.90
WWH LAB/RAD FEE SCHEDULE - 4206 117015 76818 HCHG RAD US OB BIOPHYSICAL PROFILE W NONSTRESS TESTING 806.00 $725.40 $322.40 $644.80 $451.36 $564.20 $515.84 $644.80 $628.68 $362.70 $330.46 $338.52 $322.40 $604.50 $523.90
WWH LAB/RAD FEE SCHEDULE - 4206 117017 76819 HCHG RAD US OB BIOPHYSICAL PROFILE WO NONSTRESS TESTING 817.00 $735.30 $326.80 $653.60 $457.52 $571.90 $522.88 $653.60 $637.26 $367.65 $334.97 $343.14 $326.80 $612.75 $531.05
WWH LAB/RAD FEE SCHEDULE - 4206 117019 76820 HCHG RAD US FETAL DOPPLER VELOCIMETRY UMBILICAL ARTERY 327.00 $294.30 $130.80 $261.60 $183.12 $228.90 $209.28 $261.60 $255.06 $147.15 $134.07 $137.34 $130.80 $245.25 $212.55
WWH LAB/RAD FEE SCHEDULE - 4206 117030 76830 HCHG RAD US TRANSVAGINAL 699.00 $629.10 $279.60 $559.20 $391.44 $489.30 $447.36 $559.20 $545.22 $314.55 $286.59 $293.58 $279.60 $524.25 $454.35
WWH LAB/RAD FEE SCHEDULE - 4206 117031 76830 HCHG RAD US PELVIS COMPLETE TV ADD ON "1,030.00" $927.00 $412.00 $824.00 $576.80 $721.00 $659.20 $824.00 $803.40 $463.50 $422.30 $432.60 $412.00 $772.50 $669.50
WWH LAB/RAD FEE SCHEDULE - 4206 117032 76830 HCHG RAD US TRANSVAGINAL FOLLICLE STUDY "1,030.00" $927.00 $412.00 $824.00 $576.80 $721.00 $659.20 $824.00 $803.40 $463.50 $422.30 $432.60 $412.00 $772.50 $669.50
WWH LAB/RAD FEE SCHEDULE - 4206 117034 76831 HCHG RAD US HYSTEROSONOGRAM 762.00 $685.80 $304.80 $609.60 $426.72 $533.40 $487.68 $609.60 $594.36 $342.90 $312.42 $320.04 $304.80 $571.50 $495.30
WWH LAB/RAD FEE SCHEDULE - 4206 117035 76856 HCHG RAD US PELVIS COMPLETE NONOBSTETRIC 983.00 $884.70 $393.20 $786.40 $550.48 $688.10 $629.12 $786.40 $766.74 $442.35 $403.03 $412.86 $393.20 $737.25 $638.95
WWH LAB/RAD FEE SCHEDULE - 4206 117037 76857 HCHG RAD US PELVIS LIMITED STUDY 272.00 $244.80 $108.80 $217.60 $152.32 $190.40 $174.08 $217.60 $212.16 $122.40 $111.52 $114.24 $108.80 $204.00 $176.80
WWH LAB/RAD FEE SCHEDULE - 4206 117039 76870 HCHG RAD US SCROTUM 889.00 $800.10 $355.60 $711.20 $497.84 $622.30 $568.96 $711.20 $693.42 $400.05 $364.49 $373.38 $355.60 $666.75 $577.85
WWH LAB/RAD FEE SCHEDULE - 4206 117041 76872 HCHG RAD US TRANSRECTAL 684.00 $615.60 $273.60 $547.20 $383.04 $478.80 $437.76 $547.20 $533.52 $307.80 $280.44 $287.28 $273.60 $513.00 $444.60
WWH LAB/RAD FEE SCHEDULE - 4206 117042 76873 HCHG RAD US PROSTATE VOLUME STUDY PRE IMPLANT 664.00 $597.60 $265.60 $531.20 $371.84 $464.80 $424.96 $531.20 $517.92 $298.80 $272.24 $278.88 $265.60 $498.00 $431.60
WWH LAB/RAD FEE SCHEDULE - 4206 117044 76882 HCHG RAD US EXTREMITY FOCAL EVAL NONVASCULAR LTD STUDY 322.00 $289.80 $128.80 $257.60 $180.32 $225.40 $206.08 $257.60 $251.16 $144.90 $132.02 $135.24 $128.80 $241.50 $209.30
WWH LAB/RAD FEE SCHEDULE - 4206 117049 76937 HCHG RAD US GUIDED VASCULAR ACCESS 156.00 $140.40 $62.40 $124.80 $87.36 $109.20 $99.84 $124.80 $121.68 $70.20 $63.96 $65.52 $62.40 $117.00 $101.40
WWH LAB/RAD FEE SCHEDULE - 4206 117053 76942 HCHG RAD US GUIDED NEEDLE PLACEMENT 618.00 $556.20 $247.20 $494.40 $346.08 $432.60 $395.52 $494.40 $482.04 $278.10 $253.38 $259.56 $247.20 $463.50 $401.70
WWH LAB/RAD FEE SCHEDULE - 4206 117056 76946 HCHG RAD US GUIDANCE AMNIOCENTESIS 375.00 $337.50 $150.00 $300.00 $210.00 $262.50 $240.00 $300.00 $292.50 $168.75 $153.75 $157.50 $150.00 $281.25 $243.75
WWH LAB/RAD FEE SCHEDULE - 4206 117060 76981 HCHG RAD US ELASTOGRAPHY PARENCHYMA 304.00 $273.60 $121.60 $243.20 $170.24 $212.80 $194.56 $243.20 $237.12 $136.80 $124.64 $127.68 $121.60 $228.00 $197.60
WWH LAB/RAD FEE SCHEDULE - 4206 117066 77001 HCHG RAD FLUROSCOPY FOR CENTRAL VENOUS ACCESS DEVICE PLACEMENT 639.00 $575.10 $255.60 $511.20 $357.84 $447.30 $408.96 $511.20 $498.42 $287.55 $261.99 $268.38 $255.60 $479.25 $415.35
WWH LAB/RAD FEE SCHEDULE - 4206 117067 77002 HCHG RAD FLUORO GUIDANCE FOR NEEDLE PLACEMENT 570.00 $513.00 $228.00 $456.00 $319.20 $399.00 $364.80 $456.00 $444.60 $256.50 $233.70 $239.40 $228.00 $427.50 $370.50
WWH LAB/RAD FEE SCHEDULE - 4206 117068 77003 HCHG RAD FLUORO GUIDED SPINAL INJECTION 541.00 $486.90 $216.40 $432.80 $302.96 $378.70 $346.24 $432.80 $421.98 $243.45 $221.81 $227.22 $216.40 $405.75 $351.65
WWH LAB/RAD FEE SCHEDULE - 4206 117070 77012 HCHG RAD CT GUIDED NEEDLE PLACEMENT "1,019.00" $917.10 $407.60 $815.20 $570.64 $713.30 $652.16 $815.20 $794.82 $458.55 $417.79 $427.98 $407.60 $764.25 $662.35
WWH LAB/RAD FEE SCHEDULE - 4206 117082 77063 HCHG RAD SCREENING MAMMO TOMOSYNTHESIS BILAT 81.00 $72.90 $32.40 $64.80 $45.36 $56.70 $51.84 $64.80 $63.18 $36.45 $33.21 $34.02 $32.40 $60.75 $52.65
WWH LAB/RAD FEE SCHEDULE - 4206 117083 77063 HCHG RAD SCREENING MAMMO TOMOSYNTHESIS UNILAT 173.00 $155.70 $69.20 $138.40 $96.88 $121.10 $110.72 $138.40 $134.94 $77.85 $70.93 $72.66 $69.20 $129.75 $112.45
WWH LAB/RAD FEE SCHEDULE - 4206 117084 77065 HCHG RAD MAMMO UNI DIAGNOSTIC WWO CAD 490.00 $441.00 $196.00 $392.00 $274.40 $343.00 $313.60 $392.00 $382.20 $220.50 $200.90 $205.80 $196.00 $367.50 $318.50
WWH LAB/RAD FEE SCHEDULE - 4206 117085 77065 HCHG RAD MAMMO UNI DIAGNOSTIC 3D WWO CAD 490.00 $441.00 $196.00 $392.00 $274.40 $343.00 $313.60 $392.00 $382.20 $220.50 $200.90 $205.80 $196.00 $367.50 $318.50
WWH LAB/RAD FEE SCHEDULE - 4206 117087 77065 HCHG RAD MAMMO UNI DIAGNOSTIC W IMPLANT WWO CAD 490.00 $441.00 $196.00 $392.00 $274.40 $343.00 $313.60 $392.00 $382.20 $220.50 $200.90 $205.80 $196.00 $367.50 $318.50
WWH LAB/RAD FEE SCHEDULE - 4206 117089 77066 HCHG RAD MAMMO BILAT DIAGNOSTIC WWO CAD 554.00 $498.60 $221.60 $443.20 $310.24 $387.80 $354.56 $443.20 $432.12 $249.30 $227.14 $232.68 $221.60 $415.50 $360.10
WWH LAB/RAD FEE SCHEDULE - 4206 117090 77066 HCHG RAD MAMMO BILAT DIAGNOSTIC 3D WWO CAD 554.00 $498.60 $221.60 $443.20 $310.24 $387.80 $354.56 $443.20 $432.12 $249.30 $227.14 $232.68 $221.60 $415.50 $360.10
WWH LAB/RAD FEE SCHEDULE - 4206 117094 77067 HCHG RAD MAMMO BILAT SCREENING WWO CAD 509.00 $458.10 $203.60 $407.20 $285.04 $356.30 $325.76 $407.20 $397.02 $229.05 $208.69 $213.78 $203.60 $381.75 $330.85
WWH LAB/RAD FEE SCHEDULE - 4206 117095 77067 HCHG RAD MAMMO UNI SCREENING 3D WWO CAD 481.00 $432.90 $192.40 $384.80 $269.36 $336.70 $307.84 $384.80 $375.18 $216.45 $197.21 $202.02 $192.40 $360.75 $312.65
WWH LAB/RAD FEE SCHEDULE - 4206 117096 77067 HCHG RAD MAMMO BILAT SCREENING 3D WWO CAD 509.00 $458.10 $203.60 $407.20 $285.04 $356.30 $325.76 $407.20 $397.02 $229.05 $208.69 $213.78 $203.60 $381.75 $330.85
WWH LAB/RAD FEE SCHEDULE - 4206 117097 77067 HCHG RAD MAMMO BILAT SCREENING LTD WWO CAD 481.00 $432.90 $192.40 $384.80 $269.36 $336.70 $307.84 $384.80 $375.18 $216.45 $197.21 $202.02 $192.40 $360.75 $312.65
WWH LAB/RAD FEE SCHEDULE - 4206 117098 77067 HCHG RAD MAMMO BILAT SCREENING W IMPLANT WWO CAD 481.00 $432.90 $192.40 $384.80 $269.36 $336.70 $307.84 $384.80 $375.18 $216.45 $197.21 $202.02 $192.40 $360.75 $312.65
WWH LAB/RAD FEE SCHEDULE - 4206 117101 77072 HCHG RAD XRAY BONE AGE STUDIES 174.00 $156.60 $69.60 $139.20 $97.44 $121.80 $111.36 $139.20 $135.72 $78.30 $71.34 $73.08 $69.60 $130.50 $113.10
WWH LAB/RAD FEE SCHEDULE - 4206 117104 77074 HCHG RAD XRAY BONE SURVEY LIMITED STUDY 364.00 $327.60 $145.60 $291.20 $203.84 $254.80 $232.96 $291.20 $283.92 $163.80 $149.24 $152.88 $145.60 $273.00 $236.60
WWH LAB/RAD FEE SCHEDULE - 4206 117105 77075 HCHG RAD XRAY BONE SURVEY COMPLETE 491.00 $441.90 $196.40 $392.80 $274.96 $343.70 $314.24 $392.80 $382.98 $220.95 $201.31 $206.22 $196.40 $368.25 $319.15
WWH LAB/RAD FEE SCHEDULE - 4206 117106 77076 HCHG RAD XRAY BONE SURVEY INFANT/CHILD 503.00 $452.70 $201.20 $402.40 $281.68 $352.10 $321.92 $402.40 $392.34 $226.35 $206.23 $211.26 $201.20 $377.25 $326.95
WWH LAB/RAD FEE SCHEDULE - 4206 117108 77080 HCHG RAD DEXA BONE DENSITY 1/> SITE AXIAL SKELETON 387.00 $348.30 $154.80 $309.60 $216.72 $270.90 $247.68 $309.60 $301.86 $174.15 $158.67 $162.54 $154.80 $290.25 $251.55
WWH LAB/RAD FEE SCHEDULE - 4206 117109 77081 HCHG RAD DEXA BONE DENSITY 1/> PERIPHERAL SKELETON 156.00 $140.40 $62.40 $124.80 $87.36 $109.20 $99.84 $124.80 $121.68 $70.20 $63.96 $65.52 $62.40 $117.00 $101.40
WWH LAB/RAD FEE SCHEDULE - 4206 117118 78013 HCHG RAD NM THYROID IMAGING WITH VASCULAR FLOW 882.00 $793.80 $352.80 $705.60 $493.92 $617.40 $564.48 $705.60 $687.96 $396.90 $361.62 $370.44 $352.80 $661.50 $573.30
WWH LAB/RAD FEE SCHEDULE - 4206 117119 78014 HCHG RAD NM THYROID UPTAKE W FLOW QUANTITATIVE MEASURE "1,058.00" $952.20 $423.20 $846.40 $592.48 $740.60 $677.12 $846.40 $825.24 $476.10 $433.78 $444.36 $423.20 $793.50 $687.70
WWH LAB/RAD FEE SCHEDULE - 4206 117123 78070 HCHG RAD NM PARATHYROID SCAN 662.00 $595.80 $264.80 $529.60 $370.72 $463.40 $423.68 $529.60 $516.36 $297.90 $271.42 $278.04 $264.80 $496.50 $430.30
WWH LAB/RAD FEE SCHEDULE - 4206 117135 78195 HCHG RAD NM LYMPHATICS AND LYMPH NODE IMAGING "3,499.00" " $3,149.10 " " $1,399.60 " " $2,799.20 " " $1,959.44 " " $2,449.30 " " $2,239.36 " " $2,799.20 " " $2,729.22 " " $1,574.55 " " $1,434.59 " " $1,469.58 " " $1,399.60 " " $2,624.25 " " $2,274.35 "
WWH LAB/RAD FEE SCHEDULE - 4206 117138 78215 HCHG RAD NM LIVER SPLEEN STATIC ONLY 643.00 $578.70 $257.20 $514.40 $360.08 $450.10 $411.52 $514.40 $501.54 $289.35 $263.63 $270.06 $257.20 $482.25 $417.95
WWH LAB/RAD FEE SCHEDULE - 4206 117139 78216 HCHG RAD NM LIVER SPLEEN W VASCULAR FLOW 569.00 $512.10 $227.60 $455.20 $318.64 $398.30 $364.16 $455.20 $443.82 $256.05 $233.29 $238.98 $227.60 $426.75 $369.85
WWH LAB/RAD FEE SCHEDULE - 4206 117140 78226 HCHG RAD NM HEPATOBILIARY "1,988.00" " $1,789.20 " $795.20 " $1,590.40 " " $1,113.28 " " $1,391.60 " " $1,272.32 " " $1,590.40 " " $1,550.64 " $894.60 $815.08 $834.96 $795.20 " $1,491.00 " " $1,292.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 117141 78227 HCHG RAD NM HEPATOBILIARY W PHARM INTERVENTION "2,435.00" " $2,191.50 " $974.00 " $1,948.00 " " $1,363.60 " " $1,704.50 " " $1,558.40 " " $1,948.00 " " $1,899.30 " " $1,095.75 " $998.35 " $1,022.70 " $974.00 " $1,826.25 " " $1,582.75 "
WWH LAB/RAD FEE SCHEDULE - 4206 117144 78261 HCHG RAD NM GASTRIC MUCOSA IMAGING "1,120.00" " $1,008.00 " $448.00 $896.00 $627.20 $784.00 $716.80 $896.00 $873.60 $504.00 $459.20 $470.40 $448.00 $840.00 $728.00
WWH LAB/RAD FEE SCHEDULE - 4206 117146 78264 HCHG RAD NM GASTRIC EMPTYING "1,652.00" " $1,486.80 " $660.80 " $1,321.60 " $925.12 " $1,156.40 " " $1,057.28 " " $1,321.60 " " $1,288.56 " $743.40 $677.32 $693.84 $660.80 " $1,239.00 " " $1,073.80 "
WWH LAB/RAD FEE SCHEDULE - 4206 117147 78265 HCHG RAD NM GASTRIC EMPTYING W SMALL BOWEL "2,680.00" " $2,412.00 " " $1,072.00 " " $2,144.00 " " $1,500.80 " " $1,876.00 " " $1,715.20 " " $2,144.00 " " $2,090.40 " " $1,206.00 " " $1,098.80 " " $1,125.60 " " $1,072.00 " " $2,010.00 " " $1,742.00 "
WWH LAB/RAD FEE SCHEDULE - 4206 117149 78278 HCHG RAD NM GI BLOOD LOSS "2,512.00" " $2,260.80 " " $1,004.80 " " $2,009.60 " " $1,406.72 " " $1,758.40 " " $1,607.68 " " $2,009.60 " " $1,959.36 " " $1,130.40 " " $1,029.92 " " $1,055.04 " " $1,004.80 " " $1,884.00 " " $1,632.80 "
WWH LAB/RAD FEE SCHEDULE - 4206 117151 78290 HCHG RAD NM MECKELS "1,705.00" " $1,534.50 " $682.00 " $1,364.00 " $954.80 " $1,193.50 " " $1,091.20 " " $1,364.00 " " $1,329.90 " $767.25 $699.05 $716.10 $682.00 " $1,278.75 " " $1,108.25 "
WWH LAB/RAD FEE SCHEDULE - 4206 117154 78300 HCHG RAD NM BONE SCAN LIMITED AREA "1,082.00" $973.80 $432.80 $865.60 $605.92 $757.40 $692.48 $865.60 $843.96 $486.90 $443.62 $454.44 $432.80 $811.50 $703.30
WWH LAB/RAD FEE SCHEDULE - 4206 117155 78305 HCHG RAD NM BONE SCAN MULTIPLE AREAS "1,066.00" $959.40 $426.40 $852.80 $596.96 $746.20 $682.24 $852.80 $831.48 $479.70 $437.06 $447.72 $426.40 $799.50 $692.90
WWH LAB/RAD FEE SCHEDULE - 4206 117156 78306 HCHG RAD NM BONE SCAN WHOLE BODY "1,640.00" " $1,476.00 " $656.00 " $1,312.00 " $918.40 " $1,148.00 " " $1,049.60 " " $1,312.00 " " $1,279.20 " $738.00 $672.40 $688.80 $656.00 " $1,230.00 " " $1,066.00 "
WWH LAB/RAD FEE SCHEDULE - 4206 117157 78315 HCHG RAD NM BONE SCAN 3 PHASE "1,932.00" " $1,738.80 " $772.80 " $1,545.60 " " $1,081.92 " " $1,352.40 " " $1,236.48 " " $1,545.60 " " $1,506.96 " $869.40 $792.12 $811.44 $772.80 " $1,449.00 " " $1,255.80 "
WWH LAB/RAD FEE SCHEDULE - 4206 117166 78451 HCHG RAD NM MYOCARD SPECT SINGLE STUDY REST OR STRESS "2,285.00" " $2,056.50 " $914.00 " $1,828.00 " " $1,279.60 " " $1,599.50 " " $1,462.40 " " $1,828.00 " " $1,782.30 " " $1,028.25 " $936.85 $959.70 $914.00 " $1,713.75 " " $1,485.25 "
WWH LAB/RAD FEE SCHEDULE - 4206 117167 78452 HCHG RAD NM CARDIAC MYOCARD MULT SPECT WWO EF AND WM "4,882.00" " $4,393.80 " " $1,952.80 " " $3,905.60 " " $2,733.92 " " $3,417.40 " " $3,124.48 " " $3,905.60 " " $3,807.96 " " $2,196.90 " " $2,001.62 " " $2,050.44 " " $1,952.80 " " $3,661.50 " " $3,173.30 "
WWH LAB/RAD FEE SCHEDULE - 4206 117177 78472 HCHG RAD NM CARDIAC MUGA LEFT VENTRICLE 992.00 $892.80 $396.80 $793.60 $555.52 $694.40 $634.88 $793.60 $773.76 $446.40 $406.72 $416.64 $396.80 $744.00 $644.80
WWH LAB/RAD FEE SCHEDULE - 4206 117186 78579 HCHG RAD NM LUNG VENTILATION SCAN 839.00 $755.10 $335.60 $671.20 $469.84 $587.30 $536.96 $671.20 $654.42 $377.55 $343.99 $352.38 $335.60 $629.25 $545.35
WWH LAB/RAD FEE SCHEDULE - 4206 117187 78580 HCHG RAD NM LUNG PERFUSION SCAN "2,084.00" " $1,875.60 " $833.60 " $1,667.20 " " $1,167.04 " " $1,458.80 " " $1,333.76 " " $1,667.20 " " $1,625.52 " $937.80 $854.44 $875.28 $833.60 " $1,563.00 " " $1,354.60 "
WWH LAB/RAD FEE SCHEDULE - 4206 117188 78582 HCHG RAD NM LUNG VENTILATION AND PERFUSION SCAN "2,706.00" " $2,435.40 " " $1,082.40 " " $2,164.80 " " $1,515.36 " " $1,894.20 " " $1,731.84 " " $2,164.80 " " $2,110.68 " " $1,217.70 " " $1,109.46 " " $1,136.52 " " $1,082.40 " " $2,029.50 " " $1,758.90 "
WWH LAB/RAD FEE SCHEDULE - 4206 117206 78707 HCHG RAD NM RENAL SCAN 824.00 $741.60 $329.60 $659.20 $461.44 $576.80 $527.36 $659.20 $642.72 $370.80 $337.84 $346.08 $329.60 $618.00 $535.60
WWH LAB/RAD FEE SCHEDULE - 4206 117207 78708 HCHG RAD NM RENAL SINGLE W PHARM "1,698.00" " $1,528.20 " $679.20 " $1,358.40 " $950.88 " $1,188.60 " " $1,086.72 " " $1,358.40 " " $1,324.44 " $764.10 $696.18 $713.16 $679.20 " $1,273.50 " " $1,103.70 "
WWH LAB/RAD FEE SCHEDULE - 4206 117209 78740 HCHG RAD NM VOIDING CYSTOGRAM "1,123.00" " $1,010.70 " $449.20 $898.40 $628.88 $786.10 $718.72 $898.40 $875.94 $505.35 $460.43 $471.66 $449.20 $842.25 $729.95
WWH LAB/RAD FEE SCHEDULE - 4206 117220 78814 HCHG RAD PET CT LIMITED INITIAL TREATMENT "6,377.00" " $5,739.30 " " $2,550.80 " " $5,101.60 " " $3,571.12 " " $4,463.90 " " $4,081.28 " " $5,101.60 " " $4,974.06 " " $2,869.65 " " $2,614.57 " " $2,678.34 " " $2,550.80 " " $4,782.75 " " $4,145.05 "
WWH LAB/RAD FEE SCHEDULE - 4206 117221 78814 HCHG RAD PET CT LIMITED SUBSEQUENT TREATMENT "6,377.00" " $5,739.30 " " $2,550.80 " " $5,101.60 " " $3,571.12 " " $4,463.90 " " $4,081.28 " " $5,101.60 " " $4,974.06 " " $2,869.65 " " $2,614.57 " " $2,678.34 " " $2,550.80 " " $4,782.75 " " $4,145.05 "
WWH LAB/RAD FEE SCHEDULE - 4206 117223 78815 HCHG RAD PET CT SKULL BASE TO MID THIGH INITIAL TREAT "6,400.00" " $5,760.00 " " $2,560.00 " " $5,120.00 " " $3,584.00 " " $4,480.00 " " $4,096.00 " " $5,120.00 " " $4,992.00 " " $2,880.00 " " $2,624.00 " " $2,688.00 " " $2,560.00 " " $4,800.00 " " $4,160.00 "
WWH LAB/RAD FEE SCHEDULE - 4206 117224 78815 HCHG RAD PET CT SKULL BASE TO MID THIGH SUBSEQUENT TREAT "6,400.00" " $5,760.00 " " $2,560.00 " " $5,120.00 " " $3,584.00 " " $4,480.00 " " $4,096.00 " " $5,120.00 " " $4,992.00 " " $2,880.00 " " $2,624.00 " " $2,688.00 " " $2,560.00 " " $4,800.00 " " $4,160.00 "
WWH LAB/RAD FEE SCHEDULE - 4206 117226 78816 HCHG RAD PET CT WHOLE BODY INITIAL TREAT "6,400.00" " $5,760.00 " " $2,560.00 " " $5,120.00 " " $3,584.00 " " $4,480.00 " " $4,096.00 " " $5,120.00 " " $4,992.00 " " $2,880.00 " " $2,624.00 " " $2,688.00 " " $2,560.00 " " $4,800.00 " " $4,160.00 "
WWH LAB/RAD FEE SCHEDULE - 4206 117227 78816 HCHG RAD PET CT WHOLE BODY SUBSEQUENT TREAT "6,400.00" " $5,760.00 " " $2,560.00 " " $5,120.00 " " $3,584.00 " " $4,480.00 " " $4,096.00 " " $5,120.00 " " $4,992.00 " " $2,880.00 " " $2,624.00 " " $2,688.00 " " $2,560.00 " " $4,800.00 " " $4,160.00 "
WWH LAB/RAD FEE SCHEDULE - 4206 117241 93356 HCHG RAD ECHO MYOCARDIAL STRAIN IMAGING 456.00 $410.40 $182.40 $364.80 $255.36 $319.20 $291.84 $364.80 $355.68 $205.20 $186.96 $191.52 $182.40 $342.00 $296.40
WWH LAB/RAD FEE SCHEDULE - 4206 117243 93880 HCHG RAD US CAROTID DUPLEX BILATERAL "1,551.00" " $1,395.90 " $620.40 " $1,240.80 " $868.56 " $1,085.70 " $992.64 " $1,240.80 " " $1,209.78 " $697.95 $635.91 $651.42 $620.40 " $1,163.25 " " $1,008.15 "
WWH LAB/RAD FEE SCHEDULE - 4206 117245 93882 HCHG RAD US CAROTID DUPLEX LIMITED STUDY 349.00 $314.10 $139.60 $279.20 $195.44 $244.30 $223.36 $279.20 $272.22 $157.05 $143.09 $146.58 $139.60 $261.75 $226.85
WWH LAB/RAD FEE SCHEDULE - 4206 117249 93922 HCHG RAD US UPPER OR LOWER BRACHIAL INDEX LTD STUDY BILAT 692.00 $622.80 $276.80 $553.60 $387.52 $484.40 $442.88 $553.60 $539.76 $311.40 $283.72 $290.64 $276.80 $519.00 $449.80
WWH LAB/RAD FEE SCHEDULE - 4206 117251 93922 HCHG RAD US TOE PRESSURE ONLY BILAT 692.00 $622.80 $276.80 $553.60 $387.52 $484.40 $442.88 $553.60 $539.76 $311.40 $283.72 $290.64 $276.80 $519.00 $449.80
WWH LAB/RAD FEE SCHEDULE - 4206 117253 93923 HCHG RAD US UPPER OR LOWER BRACHIAL INDEX BILATERAL COMPLETE 920.00 $828.00 $368.00 $736.00 $515.20 $644.00 $588.80 $736.00 $717.60 $414.00 $377.20 $386.40 $368.00 $690.00 $598.00
WWH LAB/RAD FEE SCHEDULE - 4206 117254 93923 HCHG RAD US ARTERIAL SEG PRESSURES BILAT EXTREM W DIGIT 920.00 $828.00 $368.00 $736.00 $515.20 $644.00 $588.80 $736.00 $717.60 $414.00 $377.20 $386.40 $368.00 $690.00 $598.00
WWH LAB/RAD FEE SCHEDULE - 4206 117255 93923 HCHG RAD US ARTERIAL SEG W TOE PRESSURES 920.00 $828.00 $368.00 $736.00 $515.20 $644.00 $588.80 $736.00 $717.60 $414.00 $377.20 $386.40 $368.00 $690.00 $598.00
WWH LAB/RAD FEE SCHEDULE - 4206 117256 93924 HCHG RAD US ANKLE BRACHIAL BILAT POST STRESS TEST COMPLETE 672.00 $604.80 $268.80 $537.60 $376.32 $470.40 $430.08 $537.60 $524.16 $302.40 $275.52 $282.24 $268.80 $504.00 $436.80
WWH LAB/RAD FEE SCHEDULE - 4206 117257 93924 HCHG RAD US ARTERIAL SEG PRESSURES W EXERCISE 672.00 $604.80 $268.80 $537.60 $376.32 $470.40 $430.08 $537.60 $524.16 $302.40 $275.52 $282.24 $268.80 $504.00 $436.80
WWH LAB/RAD FEE SCHEDULE - 4206 117258 93925 HCHG RAD US LOWER EXTREMITY BILATERAL COMPLETE 899.00 $809.10 $359.60 $719.20 $503.44 $629.30 $575.36 $719.20 $701.22 $404.55 $368.59 $377.58 $359.60 $674.25 $584.35
WWH LAB/RAD FEE SCHEDULE - 4206 117260 93926 HCHG RAD US ARTERIAL LOWER EXTREMITY LIMITED STUDY 668.00 $601.20 $267.20 $534.40 $374.08 $467.60 $427.52 $534.40 $521.04 $300.60 $273.88 $280.56 $267.20 $501.00 $434.20
WWH LAB/RAD FEE SCHEDULE - 4206 117262 93930 HCHG RAD US ARTERIAL UPPER EXTREMITY BILATERAL COMPLETE 571.00 $513.90 $228.40 $456.80 $319.76 $399.70 $365.44 $456.80 $445.38 $256.95 $234.11 $239.82 $228.40 $428.25 $371.15
WWH LAB/RAD FEE SCHEDULE - 4206 117264 93931 HCHG RAD US ARTERIAL UPPER EXTREMITY UNLATERAL OR LTD STUDY 552.00 $496.80 $220.80 $441.60 $309.12 $386.40 $353.28 $441.60 $430.56 $248.40 $226.32 $231.84 $220.80 $414.00 $358.80
WWH LAB/RAD FEE SCHEDULE - 4206 117266 93970 HCHG RAD US DUPLEX SCAN EXTREMITY BILATERAL COMPLETE "1,394.00" " $1,254.60 " $557.60 " $1,115.20 " $780.64 $975.80 $892.16 " $1,115.20 " " $1,087.32 " $627.30 $571.54 $585.48 $557.60 " $1,045.50 " $906.10
WWH LAB/RAD FEE SCHEDULE - 4206 117268 93970 HCHG RAD US VEIN MAPPING EXTREMITY BILATERAL "1,394.00" " $1,254.60 " $557.60 " $1,115.20 " $780.64 $975.80 $892.16 " $1,115.20 " " $1,087.32 " $627.30 $571.54 $585.48 $557.60 " $1,045.50 " $906.10
WWH LAB/RAD FEE SCHEDULE - 4206 117269 93970 HCHG RAD US VENOUS INSUFFICIENCY LOWER EXTREMITY BILATERAL "1,394.00" " $1,254.60 " $557.60 " $1,115.20 " $780.64 $975.80 $892.16 " $1,115.20 " " $1,087.32 " $627.30 $571.54 $585.48 $557.60 " $1,045.50 " $906.10
WWH LAB/RAD FEE SCHEDULE - 4206 117270 93971 HCHG RAD US DUPLEX SCAN EXTREMITY UNI OR LTD STUDY 891.00 $801.90 $356.40 $712.80 $498.96 $623.70 $570.24 $712.80 $694.98 $400.95 $365.31 $374.22 $356.40 $668.25 $579.15
WWH LAB/RAD FEE SCHEDULE - 4206 117272 93971 HCHG RAD US VENOUS INSUFF OR VEIN MAPPING EXTREMITY UNILATERAL 891.00 $801.90 $356.40 $712.80 $498.96 $623.70 $570.24 $712.80 $694.98 $400.95 $365.31 $374.22 $356.40 $668.25 $579.15
WWH LAB/RAD FEE SCHEDULE - 4206 117273 93975 HCHG RAD DUPLEX SCAN ABDOMEN COMPLETE "1,014.00" $912.60 $405.60 $811.20 $567.84 $709.80 $648.96 $811.20 $790.92 $456.30 $415.74 $425.88 $405.60 $760.50 $659.10
WWH LAB/RAD FEE SCHEDULE - 4206 117275 93976 HCHG RAD DUPLEX SCAN ABDOMEN LIMITED 561.00 $504.90 $224.40 $448.80 $314.16 $392.70 $359.04 $448.80 $437.58 $252.45 $230.01 $235.62 $224.40 $420.75 $364.65
WWH LAB/RAD FEE SCHEDULE - 4206 117277 93976 HCHG RAD DUPLEX OVARY/SCROTUM LIMITED 561.00 $504.90 $224.40 $448.80 $314.16 $392.70 $359.04 $448.80 $437.58 $252.45 $230.01 $235.62 $224.40 $420.75 $364.65
WWH LAB/RAD FEE SCHEDULE - 4206 117278 93978 HCHG RAD DUPLEX AORTA ILIACS INF VENA CAVA COMPLETE 535.00 $481.50 $214.00 $428.00 $299.60 $374.50 $342.40 $428.00 $417.30 $240.75 $219.35 $224.70 $214.00 $401.25 $347.75
WWH LAB/RAD FEE SCHEDULE - 4206 117280 93979 HCHG RAD DUPLEX AORTA ILIACS INF VENA CAVA LIMITED STUDY 509.00 $458.10 $203.60 $407.20 $285.04 $356.30 $325.76 $407.20 $397.02 $229.05 $208.69 $213.78 $203.60 $381.75 $330.85
WWH LAB/RAD FEE SCHEDULE - 4206 117292 C8900 HCHG RAD MR ANGIO ABDOMEN W "4,093.00" " $3,683.70 " " $1,637.20 " " $3,274.40 " " $2,292.08 " " $2,865.10 " " $2,619.52 " " $3,274.40 " " $3,192.54 " " $1,841.85 " " $1,678.13 " " $1,719.06 " " $1,637.20 " " $3,069.75 " " $2,660.45 "
WWH LAB/RAD FEE SCHEDULE - 4206 117293 C8901 HCHG RAD MR ANGIO ABDOMEN WO "4,093.00" " $3,683.70 " " $1,637.20 " " $3,274.40 " " $2,292.08 " " $2,865.10 " " $2,619.52 " " $3,274.40 " " $3,192.54 " " $1,841.85 " " $1,678.13 " " $1,719.06 " " $1,637.20 " " $3,069.75 " " $2,660.45 "
WWH LAB/RAD FEE SCHEDULE - 4206 117294 C8902 HCHG RAD MR ANGIO ABDOMEN WWO "4,093.00" " $3,683.70 " " $1,637.20 " " $3,274.40 " " $2,292.08 " " $2,865.10 " " $2,619.52 " " $3,274.40 " " $3,192.54 " " $1,841.85 " " $1,678.13 " " $1,719.06 " " $1,637.20 " " $3,069.75 " " $2,660.45 "
WWH LAB/RAD FEE SCHEDULE - 4206 117298 C8908 HCHG RAD MRI BREAST BILATERAL WWO "2,318.00" " $2,086.20 " $927.20 " $1,854.40 " " $1,298.08 " " $1,622.60 " " $1,483.52 " " $1,854.40 " " $1,808.04 " " $1,043.10 " $950.38 $973.56 $927.20 " $1,738.50 " " $1,506.70 "
WWH LAB/RAD FEE SCHEDULE - 4206 117299 C8909 HCHG RAD MR ANGIO CHEST W "4,141.00" " $3,726.90 " " $1,656.40 " " $3,312.80 " " $2,318.96 " " $2,898.70 " " $2,650.24 " " $3,312.80 " " $3,229.98 " " $1,863.45 " " $1,697.81 " " $1,739.22 " " $1,656.40 " " $3,105.75 " " $2,691.65 "
WWH LAB/RAD FEE SCHEDULE - 4206 117300 C8910 HCHG RAD MR ANGIO CHEST WO "4,141.00" " $3,726.90 " " $1,656.40 " " $3,312.80 " " $2,318.96 " " $2,898.70 " " $2,650.24 " " $3,312.80 " " $3,229.98 " " $1,863.45 " " $1,697.81 " " $1,739.22 " " $1,656.40 " " $3,105.75 " " $2,691.65 "
WWH LAB/RAD FEE SCHEDULE - 4206 117301 C8910 HCHG RAD MR ANGIO CHEST WO LIMITED "4,141.00" " $3,726.90 " " $1,656.40 " " $3,312.80 " " $2,318.96 " " $2,898.70 " " $2,650.24 " " $3,312.80 " " $3,229.98 " " $1,863.45 " " $1,697.81 " " $1,739.22 " " $1,656.40 " " $3,105.75 " " $2,691.65 "
WWH LAB/RAD FEE SCHEDULE - 4206 117302 C8911 HCHG RAD MR ANGIO CHEST WWO "4,141.00" " $3,726.90 " " $1,656.40 " " $3,312.80 " " $2,318.96 " " $2,898.70 " " $2,650.24 " " $3,312.80 " " $3,229.98 " " $1,863.45 " " $1,697.81 " " $1,739.22 " " $1,656.40 " " $3,105.75 " " $2,691.65 "
WWH LAB/RAD FEE SCHEDULE - 4206 117303 C8912 HCHG RAD MR ANGIO LOWER EXTREMITY W "4,114.00" " $3,702.60 " " $1,645.60 " " $3,291.20 " " $2,303.84 " " $2,879.80 " " $2,632.96 " " $3,291.20 " " $3,208.92 " " $1,851.30 " " $1,686.74 " " $1,727.88 " " $1,645.60 " " $3,085.50 " " $2,674.10 "
WWH LAB/RAD FEE SCHEDULE - 4206 117304 C8913 HCHG RAD MR ANGIO LOWER EXTREMITY WO "4,114.00" " $3,702.60 " " $1,645.60 " " $3,291.20 " " $2,303.84 " " $2,879.80 " " $2,632.96 " " $3,291.20 " " $3,208.92 " " $1,851.30 " " $1,686.74 " " $1,727.88 " " $1,645.60 " " $3,085.50 " " $2,674.10 "
WWH LAB/RAD FEE SCHEDULE - 4206 117305 C8914 HCHG RAD MR ANGIO LOWER EXTREMITY WWO "4,114.00" " $3,702.60 " " $1,645.60 " " $3,291.20 " " $2,303.84 " " $2,879.80 " " $2,632.96 " " $3,291.20 " " $3,208.92 " " $1,851.30 " " $1,686.74 " " $1,727.88 " " $1,645.60 " " $3,085.50 " " $2,674.10 "
WWH LAB/RAD FEE SCHEDULE - 4206 117306 C8918 HCHG RAD MR ANGIO PELVIS W "4,109.00" " $3,698.10 " " $1,643.60 " " $3,287.20 " " $2,301.04 " " $2,876.30 " " $2,629.76 " " $3,287.20 " " $3,205.02 " " $1,849.05 " " $1,684.69 " " $1,725.78 " " $1,643.60 " " $3,081.75 " " $2,670.85 "
WWH LAB/RAD FEE SCHEDULE - 4206 117307 C8919 HCHG RAD MR ANGIO PELVIS WO "4,109.00" " $3,698.10 " " $1,643.60 " " $3,287.20 " " $2,301.04 " " $2,876.30 " " $2,629.76 " " $3,287.20 " " $3,205.02 " " $1,849.05 " " $1,684.69 " " $1,725.78 " " $1,643.60 " " $3,081.75 " " $2,670.85 "
WWH LAB/RAD FEE SCHEDULE - 4206 117308 C8920 HCHG RAD MR ANGIO PELVIS WWO "4,109.00" " $3,698.10 " " $1,643.60 " " $3,287.20 " " $2,301.04 " " $2,876.30 " " $2,629.76 " " $3,287.20 " " $3,205.02 " " $1,849.05 " " $1,684.69 " " $1,725.78 " " $1,643.60 " " $3,081.75 " " $2,670.85 "
WWH LAB/RAD FEE SCHEDULE - 4206 117315 C8937 HCHG RAD MRI BREAST CAD 464.00 $417.60 $185.60 $371.20 $259.84 $324.80 $296.96 $371.20 $361.92 $208.80 $190.24 $194.88 $185.60 $348.00 $301.60
WWH LAB/RAD FEE SCHEDULE - 4206 117320 G0252 HCHG RAD PET CT BREAST CANCER INITIAL DX OR SURG PLAN "3,847.00" " $3,462.30 " " $1,538.80 " " $3,077.60 " " $2,154.32 " " $2,692.90 " " $2,462.08 " " $3,077.60 " " $3,000.66 " " $1,731.15 " " $1,577.27 " " $1,615.74 " " $1,538.80 " " $2,885.25 " " $2,500.55 "
WWH LAB/RAD FEE SCHEDULE - 4206 117321 G0279 HCHG RAD XRAY DIAGNOSTIC MAMMO TOMOSYNTHESIS BILAT 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH LAB/RAD FEE SCHEDULE - 4206 117322 G0279 HCHG RAD XRAY DIAGNOSTIC MAMMO TOMOSYNTHESIS UNILAT 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH LAB/RAD FEE SCHEDULE - 4206 117329 10005 HCHG RAD FINE NEEDLE ASPIRATION BIOPSY W IMAGE GUIDE 1ST LESION 570.00 $513.00 $228.00 $456.00 $319.20 $399.00 $364.80 $456.00 $444.60 $256.50 $233.70 $239.40 $228.00 $427.50 $370.50
WWH LAB/RAD FEE SCHEDULE - 4206 117331 10030 HCHG RAD CATH FLUID COLLECTION DRAINAGE SOFT TISSUE INC GUIDE "1,311.00" " $1,179.90 " $524.40 " $1,048.80 " $734.16 $917.70 $839.04 " $1,048.80 " " $1,022.58 " $589.95 $537.51 $550.62 $524.40 $983.25 $852.15
WWH LAB/RAD FEE SCHEDULE - 4206 117333 10060 HCHG RAD DRAIN SUBCUTANEOUS ABSCESS 412.00 $370.80 $164.80 $329.60 $230.72 $288.40 $263.68 $329.60 $321.36 $185.40 $168.92 $173.04 $164.80 $309.00 $267.80
WWH LAB/RAD FEE SCHEDULE - 4206 117334 10160 HCHG RAD PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA OR CYST 375.00 $337.50 $150.00 $300.00 $210.00 $262.50 $240.00 $300.00 $292.50 $168.75 $153.75 $157.50 $150.00 $281.25 $243.75
WWH LAB/RAD FEE SCHEDULE - 4206 117335 17999 HCHG RAD UNLISTED PROCEDURE SKIN MUCOUS SUBCUTANEOUS "1,535.00" " $1,381.50 " $614.00 " $1,228.00 " $859.60 " $1,074.50 " $982.40 " $1,228.00 " " $1,197.30 " $690.75 $629.35 $644.70 $614.00 " $1,151.25 " $997.75
WWH LAB/RAD FEE SCHEDULE - 4206 117336 19281 HCHG RAD MAMMO BREAST LOC PRQ MARKER 1ST LESION W GUIDE "2,208.00" " $1,987.20 " $883.20 " $1,766.40 " " $1,236.48 " " $1,545.60 " " $1,413.12 " " $1,766.40 " " $1,722.24 " $993.60 $905.28 $927.36 $883.20 " $1,656.00 " " $1,435.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 117337 19282 HCHG RAD MAMMO BREAST LOC PRQ MARKER EA ADDL W GUIDE 471.00 $423.90 $188.40 $376.80 $263.76 $329.70 $301.44 $376.80 $367.38 $211.95 $193.11 $197.82 $188.40 $353.25 $306.15
WWH LAB/RAD FEE SCHEDULE - 4206 117339 20206 HCHG RAD BIOPSY MUSCLE PERCUTANEOUS NEEDLE 788.00 $709.20 $315.20 $630.40 $441.28 $551.60 $504.32 $630.40 $614.64 $354.60 $323.08 $330.96 $315.20 $591.00 $512.20
WWH LAB/RAD FEE SCHEDULE - 4206 117340 20220 HCHG RAD BIOPSY BONE TROCAR OR NEEDLE SUPERFICIAL 713.00 $641.70 $285.20 $570.40 $399.28 $499.10 $456.32 $570.40 $556.14 $320.85 $292.33 $299.46 $285.20 $534.75 $463.45
WWH LAB/RAD FEE SCHEDULE - 4206 117341 20225 HCHG RAD BIOPSY BONE TROCAR OR NEEDLE DEEP "1,247.00" " $1,122.30 " $498.80 $997.60 $698.32 $872.90 $798.08 $997.60 $972.66 $561.15 $511.27 $523.74 $498.80 $935.25 $810.55
WWH LAB/RAD FEE SCHEDULE - 4206 117342 20501 HCHG RAD SINUS TRACT INJECTION DIAGNOSTIC 333.00 $299.70 $133.20 $266.40 $186.48 $233.10 $213.12 $266.40 $259.74 $149.85 $136.53 $139.86 $133.20 $249.75 $216.45
WWH LAB/RAD FEE SCHEDULE - 4206 117343 20550 HCHG RAD INJECTION SINGLE TENDON SHEATH LIGAMENT 247.00 $222.30 $98.80 $197.60 $138.32 $172.90 $158.08 $197.60 $192.66 $111.15 $101.27 $103.74 $98.80 $185.25 $160.55
WWH LAB/RAD FEE SCHEDULE - 4206 117344 20552 HCHG RAD INJECTION(S) SGL/MULI TRIGGER POINT(S) 1 OR 2 MUSCLE 437.00 $393.30 $174.80 $349.60 $244.72 $305.90 $279.68 $349.60 $340.86 $196.65 $179.17 $183.54 $174.80 $327.75 $284.05
WWH LAB/RAD FEE SCHEDULE - 4206 117345 20553 HCHG RAD INJECTION(S) SGL/MULI TRIGGER POINT(S) 3 OR MORE MUSCL 461.00 $414.90 $184.40 $368.80 $258.16 $322.70 $295.04 $368.80 $359.58 $207.45 $189.01 $193.62 $184.40 $345.75 $299.65
WWH LAB/RAD FEE SCHEDULE - 4206 117346 20605 HCHG RAD ARTHROCENTESIS ASPIRATION INJECTION INTERM JOINT BURSA 431.00 $387.90 $172.40 $344.80 $241.36 $301.70 $275.84 $344.80 $336.18 $193.95 $176.71 $181.02 $172.40 $323.25 $280.15
WWH LAB/RAD FEE SCHEDULE - 4206 117347 20610 HCHG RAD ARTHROCENTESIS ASPIRATION INJECTION MAJOR JOINT BURSA 516.00 $464.40 $206.40 $412.80 $288.96 $361.20 $330.24 $412.80 $402.48 $232.20 $211.56 $216.72 $206.40 $387.00 $335.40
WWH LAB/RAD FEE SCHEDULE - 4206 117349 20999 HCHG RAD UNLISTED MUSCULOSKELETAL SYSTEM 308.00 $277.20 $123.20 $246.40 $172.48 $215.60 $197.12 $246.40 $240.24 $138.60 $126.28 $129.36 $123.20 $231.00 $200.20
WWH LAB/RAD FEE SCHEDULE - 4206 117350 21550 HCHG RAD BIOPSY SOFT TISSUE NECK OR THORAX 969.00 $872.10 $387.60 $775.20 $542.64 $678.30 $620.16 $775.20 $755.82 $436.05 $397.29 $406.98 $387.60 $726.75 $629.85
WWH LAB/RAD FEE SCHEDULE - 4206 117352 21925 HCHG RAD BIOPSY SOFT TISSUE BACK FLANK DEEP "1,557.00" " $1,401.30 " $622.80 " $1,245.60 " $871.92 " $1,089.90 " $996.48 " $1,245.60 " " $1,214.46 " $700.65 $638.37 $653.94 $622.80 " $1,167.75 " " $1,012.05 "
WWH LAB/RAD FEE SCHEDULE - 4206 117356 23350 HCHG RAD INJ FOR ARTHROGRAM SHOULDER 701.00 $630.90 $280.40 $560.80 $392.56 $490.70 $448.64 $560.80 $546.78 $315.45 $287.41 $294.42 $280.40 $525.75 $455.65
WWH LAB/RAD FEE SCHEDULE - 4206 117357 24066 HCHG RAD BIOPSY SOFT TISSUE UPPER ARM OR ELBOW DEEP "2,891.00" " $2,601.90 " " $1,156.40 " " $2,312.80 " " $1,618.96 " " $2,023.70 " " $1,850.24 " " $2,312.80 " " $2,254.98 " " $1,300.95 " " $1,185.31 " " $1,214.22 " " $1,156.40 " " $2,168.25 " " $1,879.15 "
WWH LAB/RAD FEE SCHEDULE - 4206 117359 27093 HCHG RAD INJ ARTHROGRAM HIP WO ANESTHESIA 732.00 $658.80 $292.80 $585.60 $409.92 $512.40 $468.48 $585.60 $570.96 $329.40 $300.12 $307.44 $292.80 $549.00 $475.80
WWH LAB/RAD FEE SCHEDULE - 4206 117362 32408 HCHG RAD CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG 930.00 $837.00 $372.00 $744.00 $520.80 $651.00 $595.20 $744.00 $725.40 $418.50 $381.30 $390.60 $372.00 $697.50 $604.50
WWH LAB/RAD FEE SCHEDULE - 4206 117364 32551 HCHG RAD CHEST TUBE INSERTION W WATER SEAL OPEN 711.00 $639.90 $284.40 $568.80 $398.16 $497.70 $455.04 $568.80 $554.58 $319.95 $291.51 $298.62 $284.40 $533.25 $462.15
WWH LAB/RAD FEE SCHEDULE - 4206 117366 32555 HCHG RAD THORACENTESIS PLEURAL SPACE NEEDLE OR CATHETER "2,134.00" " $1,920.60 " $853.60 " $1,707.20 " " $1,195.04 " " $1,493.80 " " $1,365.76 " " $1,707.20 " " $1,664.52 " $960.30 $874.94 $896.28 $853.60 " $1,600.50 " " $1,387.10 "
WWH LAB/RAD FEE SCHEDULE - 4206 117372 36005 HCHG RAD INJECTION EXTREMITY VENOGRAM 828.00 $745.20 $331.20 $662.40 $463.68 $579.60 $529.92 $662.40 $645.84 $372.60 $339.48 $347.76 $331.20 $621.00 $538.20
WWH LAB/RAD FEE SCHEDULE - 4206 117378 36573 HCHG RAD PICC => 5 YRS INSERTION WO SQ PORT W GUIDANCE S&I "1,163.00" " $1,046.70 " $465.20 $930.40 $651.28 $814.10 $744.32 $930.40 $907.14 $523.35 $476.83 $488.46 $465.20 $872.25 $755.95
WWH LAB/RAD FEE SCHEDULE - 4206 117381 36598 HCHG RAD INJECTION FOR CENTRAL VENOUS CATH EVAL 452.00 $406.80 $180.80 $361.60 $253.12 $316.40 $289.28 $361.60 $352.56 $203.40 $185.32 $189.84 $180.80 $339.00 $293.80
WWH LAB/RAD FEE SCHEDULE - 4206 117388 38505 HCHG RAD BIOPSY OR EXCISION LYMPH NODE BY NEEDLE SUPERFICIAL 468.00 $421.20 $187.20 $374.40 $262.08 $327.60 $299.52 $374.40 $365.04 $210.60 $191.88 $196.56 $187.20 $351.00 $304.20
WWH LAB/RAD FEE SCHEDULE - 4206 117389 38792 HCHG RAD INJECTION TRACER FOR SENTINEL NODE 589.00 $530.10 $235.60 $471.20 $329.84 $412.30 $376.96 $471.20 $459.42 $265.05 $241.49 $247.38 $235.60 $441.75 $382.85
WWH LAB/RAD FEE SCHEDULE - 4206 117394 42550 HCHG RAD SIALOGRAM INJECTION 529.00 $476.10 $211.60 $423.20 $296.24 $370.30 $338.56 $423.20 $412.62 $238.05 $216.89 $222.18 $211.60 $396.75 $343.85
WWH LAB/RAD FEE SCHEDULE - 4206 117397 43752 HCHG RAD NG TUBE PLACEMENT INCL FLUORO 330.00 $297.00 $132.00 $264.00 $184.80 $231.00 $211.20 $264.00 $257.40 $148.50 $135.30 $138.60 $132.00 $247.50 $214.50
WWH LAB/RAD FEE SCHEDULE - 4206 117399 44500 HCHG RAD INTRO LONG GI TUBE 208.00 $187.20 $83.20 $166.40 $116.48 $145.60 $133.12 $166.40 $162.24 $93.60 $85.28 $87.36 $83.20 $156.00 $135.20
WWH LAB/RAD FEE SCHEDULE - 4206 117400 45999 HCHG RAD UNLISTED RECTUM PROCEDURE 769.00 $692.10 $307.60 $615.20 $430.64 $538.30 $492.16 $615.20 $599.82 $346.05 $315.29 $322.98 $307.60 $576.75 $499.85
WWH LAB/RAD FEE SCHEDULE - 4206 117401 47000 HCHG RAD BIOPSY LIVER PRQ NEEDLE 909.00 $818.10 $363.60 $727.20 $509.04 $636.30 $581.76 $727.20 $709.02 $409.05 $372.69 $381.78 $363.60 $681.75 $590.85
WWH LAB/RAD FEE SCHEDULE - 4206 117413 49083 HCHG RAD PARACENTESIS ABDOMEN WITH IMAGING "1,630.00" " $1,467.00 " $652.00 " $1,304.00 " $912.80 " $1,141.00 " " $1,043.20 " " $1,304.00 " " $1,271.40 " $733.50 $668.30 $684.60 $652.00 " $1,222.50 " " $1,059.50 "
WWH LAB/RAD FEE SCHEDULE - 4206 117415 49180 HCHG RAD BIOPSY ABDOMEN OR RETROPERITONEAL MASS PRQ NEEDLE 800.00 $720.00 $320.00 $640.00 $448.00 $560.00 $512.00 $640.00 $624.00 $360.00 $328.00 $336.00 $320.00 $600.00 $520.00
WWH LAB/RAD FEE SCHEDULE - 4206 117418 49406 HCHG RAD DRAIN ABSCESS PERITONEAL PERC INC GUIDE "2,562.00" " $2,305.80 " " $1,024.80 " " $2,049.60 " " $1,434.72 " " $1,793.40 " " $1,639.68 " " $2,049.60 " " $1,998.36 " " $1,152.90 " " $1,050.42 " " $1,076.04 " " $1,024.80 " " $1,921.50 " " $1,665.30 "
WWH LAB/RAD FEE SCHEDULE - 4206 117424 49450 HCHG RAD REPLACEMENT GASTROSTOMY OR CECOSTOMY TUBE PRQ "1,246.00" " $1,121.40 " $498.40 $996.80 $697.76 $872.20 $797.44 $996.80 $971.88 $560.70 $510.86 $523.32 $498.40 $934.50 $809.90
WWH LAB/RAD FEE SCHEDULE - 4206 117425 49452 HCHG RAD REPLACEMENT GASTRO JEJUNOSTOMY TUBE PRQ "1,655.00" " $1,489.50 " $662.00 " $1,324.00 " $926.80 " $1,158.50 " " $1,059.20 " " $1,324.00 " " $1,290.90 " $744.75 $678.55 $695.10 $662.00 " $1,241.25 " " $1,075.75 "
WWH LAB/RAD FEE SCHEDULE - 4206 117427 49465 HCHG RAD INJ FOR GASTRO TUBE EVAL PRQ 311.00 $279.90 $124.40 $248.80 $174.16 $217.70 $199.04 $248.80 $242.58 $139.95 $127.51 $130.62 $124.40 $233.25 $202.15
WWH LAB/RAD FEE SCHEDULE - 4206 117428 50200 HCHG RAD BIOPSY RENAL PRQ TROCAR OR NEEDLE "1,188.00" " $1,069.20 " $475.20 $950.40 $665.28 $831.60 $760.32 $950.40 $926.64 $534.60 $487.08 $498.96 $475.20 $891.00 $772.20
WWH LAB/RAD FEE SCHEDULE - 4206 117429 50390 HCHG RAD ASPIRATION INJECTION RENAL CYST PELVIS BY NEEDLE PRQ 968.00 $871.20 $387.20 $774.40 $542.08 $677.60 $619.52 $774.40 $755.04 $435.60 $396.88 $406.56 $387.20 $726.00 $629.20
WWH LAB/RAD FEE SCHEDULE - 4206 117437 51600 HCHG IR INJ CYSTOGRAM OR VOIDING URETHROCYSTOGRAPHY 523.00 $470.70 $209.20 $418.40 $292.88 $366.10 $334.72 $418.40 $407.94 $235.35 $214.43 $219.66 $209.20 $392.25 $339.95
WWH LAB/RAD FEE SCHEDULE - 4206 117438 51610 HCHG RAD INJ FOR RETROGRADE URETHROCYSTOGRAM 542.00 $487.80 $216.80 $433.60 $303.52 $379.40 $346.88 $433.60 $422.76 $243.90 $222.22 $227.64 $216.80 $406.50 $352.30
WWH LAB/RAD FEE SCHEDULE - 4206 117441 55700 HCHG RAD BIOPSY PROSTATE NEEDLE OR PUNCH SNGL OR MULTI "1,010.00" $909.00 $404.00 $808.00 $565.60 $707.00 $646.40 $808.00 $787.80 $454.50 $414.10 $424.20 $404.00 $757.50 $656.50
WWH LAB/RAD FEE SCHEDULE - 4206 117442 58340 HCHG RAD INJ HYSTEROSALPINGOGRAM W CATHETERIZATION 687.00 $618.30 $274.80 $549.60 $384.72 $480.90 $439.68 $549.60 $535.86 $309.15 $281.67 $288.54 $274.80 $515.25 $446.55
WWH LAB/RAD FEE SCHEDULE - 4206 117444 60100 HCHG RAD BIOPSY THYROID PRQ CORE NEEDLE 523.00 $470.70 $209.20 $418.40 $292.88 $366.10 $334.72 $418.40 $407.94 $235.35 $214.43 $219.66 $209.20 $392.25 $339.95
WWH LAB/RAD FEE SCHEDULE - 4206 117450 62284 HCHG RAD INJECTION FOR MYELOGRAM OR CT LUMBAR 719.00 $647.10 $287.60 $575.20 $402.64 $503.30 $460.16 $575.20 $560.82 $323.55 $294.79 $301.98 $287.60 $539.25 $467.35
WWH LAB/RAD FEE SCHEDULE - 4206 117453 62304 HCHG RAD INJ FOR MYELOGRAM LUMBOSACRAL "1,520.00" " $1,368.00 " $608.00 " $1,216.00 " $851.20 " $1,064.00 " $972.80 " $1,216.00 " " $1,185.60 " $684.00 $623.20 $638.40 $608.00 " $1,140.00 " $988.00
WWH LAB/RAD FEE SCHEDULE - 4206 117455 62323 HCHG RAD INJ EPIDURAL LUMBAR OR SACRAL W GUIDE "1,445.00" " $1,300.50 " $578.00 " $1,156.00 " $809.20 " $1,011.50 " $924.80 " $1,156.00 " " $1,127.10 " $650.25 $592.45 $606.90 $578.00 " $1,083.75 " $939.25
WWH LAB/RAD FEE SCHEDULE - 4206 117456 62328 HCHG RAD LUMBAR PUNCTURE DIAGNOSTIC W GUIDANCE 600.00 $540.00 $240.00 $480.00 $336.00 $420.00 $384.00 $480.00 $468.00 $270.00 $246.00 $252.00 $240.00 $450.00 $390.00
WWH LAB/RAD FEE SCHEDULE - 4206 117464 64425 HCHG RAD INJ ANES AGENT STEROID ILIOINGUINAL HYPOGAS NERVE 553.00 $497.70 $221.20 $442.40 $309.68 $387.10 $353.92 $442.40 $431.34 $248.85 $226.73 $232.26 $221.20 $414.75 $359.45
WWH LAB/RAD FEE SCHEDULE - 4206 117466 64450 HCHG RAD INJ ANES AGENT STEROID OTHER PERIPHERAL NERVE BRANCH 558.00 $502.20 $223.20 $446.40 $312.48 $390.60 $357.12 $446.40 $435.24 $251.10 $228.78 $234.36 $223.20 $418.50 $362.70
WWH LAB/RAD FEE SCHEDULE - 4206 117467 64451 HCHG RAD INJ ANES STEROID INNERVATING SACROILIAC INC GUIDE "2,754.00" " $2,478.60 " " $1,101.60 " " $2,203.20 " " $1,542.24 " " $1,927.80 " " $1,762.56 " " $2,203.20 " " $2,148.12 " " $1,239.30 " " $1,129.14 " " $1,156.68 " " $1,101.60 " " $2,065.50 " " $1,790.10 "
WWH LAB/RAD FEE SCHEDULE - 4206 117468 64479 HCHG RAD INJ TRANS EPIDURAL CERVICAL/THORACIC ONE LEVEL W GUIDE "1,628.00" " $1,465.20 " $651.20 " $1,302.40 " $911.68 " $1,139.60 " " $1,041.92 " " $1,302.40 " " $1,269.84 " $732.60 $667.48 $683.76 $651.20 " $1,221.00 " " $1,058.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 117469 64480 HCHG RAD INJ TRANS EPIDURAL CERVICAL/THORACIC EA ADDL W GUIDE 735.00 $661.50 $294.00 $588.00 $411.60 $514.50 $470.40 $588.00 $573.30 $330.75 $301.35 $308.70 $294.00 $551.25 $477.75
WWH LAB/RAD FEE SCHEDULE - 4206 117470 64483 HCHG RAD INJ TRANS EPIDURAL LUMBAR/SACRAL ONE LEVEL W GUIDE "1,422.00" " $1,279.80 " $568.80 " $1,137.60 " $796.32 $995.40 $910.08 " $1,137.60 " " $1,109.16 " $639.90 $583.02 $597.24 $568.80 " $1,066.50 " $924.30
WWH LAB/RAD FEE SCHEDULE - 4206 117471 64484 HCHG RAD INJ TRANS EPIDURAL LUMBAR/SACRAL EA ADDL W GUIDE 812.00 $730.80 $324.80 $649.60 $454.72 $568.40 $519.68 $649.60 $633.36 $365.40 $332.92 $341.04 $324.80 $609.00 $527.80
WWH LAB/RAD FEE SCHEDULE - 4206 117472 64490 HCHG RAD INJ FACET JOINT CERVICAL/THORACIC ONE LEVEL W GUIDE 869.00 $782.10 $347.60 $695.20 $486.64 $608.30 $556.16 $695.20 $677.82 $391.05 $356.29 $364.98 $347.60 $651.75 $564.85
WWH LAB/RAD FEE SCHEDULE - 4206 117473 64491 HCHG RAD INJ FACET JOINT CERVICAL/THORACIC SECOND LEVEL W GUIDE 543.00 $488.70 $217.20 $434.40 $304.08 $380.10 $347.52 $434.40 $423.54 $244.35 $222.63 $228.06 $217.20 $407.25 $352.95
WWH LAB/RAD FEE SCHEDULE - 4206 117475 64493 HCHG RAD INJ FACET JOINT LUMBAR/SACRAL ONE LEVEL W GUIDE "1,332.00" " $1,198.80 " $532.80 " $1,065.60 " $745.92 $932.40 $852.48 " $1,065.60 " " $1,038.96 " $599.40 $546.12 $559.44 $532.80 $999.00 $865.80
WWH LAB/RAD FEE SCHEDULE - 4206 117476 64494 HCHG RAD INJ FACET JOINT LUMBAR/SACRAL SECOND LEVEL W GUIDE 414.00 $372.60 $165.60 $331.20 $231.84 $289.80 $264.96 $331.20 $322.92 $186.30 $169.74 $173.88 $165.60 $310.50 $269.10
WWH LAB/RAD FEE SCHEDULE - 4206 117477 64495 HCHG RAD INJ FACET JOINT LUMBAR/SACRAL 3 MORE LEVEL W GUIDE 398.00 $358.20 $159.20 $318.40 $222.88 $278.60 $254.72 $318.40 $310.44 $179.10 $163.18 $167.16 $159.20 $298.50 $258.70
WWH LAB/RAD FEE SCHEDULE - 4206 117480 64624 HCHG RAD DESTRUCTION GENICULAR NERVE BRANCH W NEUROLYTIC AGENT "4,729.00" " $4,256.10 " " $1,891.60 " " $3,783.20 " " $2,648.24 " " $3,310.30 " " $3,026.56 " " $3,783.20 " " $3,688.62 " " $2,128.05 " " $1,938.89 " " $1,986.18 " " $1,891.60 " " $3,546.75 " " $3,073.85 "
WWH LAB/RAD FEE SCHEDULE - 4206 117481 64640 HCHG RAD DESTRUCTION PERIPHERAL NERVE BRANCH W NEUROLYTIC AGENT "1,577.00" " $1,419.30 " $630.80 " $1,261.60 " $883.12 " $1,103.90 " " $1,009.28 " " $1,261.60 " " $1,230.06 " $709.65 $646.57 $662.34 $630.80 " $1,182.75 " " $1,025.05 "
WWH LAB/RAD FEE SCHEDULE - 4206 117483 64999 HCHG RAD NERVOUS SYSTEM PROCEDURE 490.00 $441.00 $196.00 $392.00 $274.40 $343.00 $313.60 $392.00 $382.20 $220.50 $200.90 $205.80 $196.00 $367.50 $318.50
WWH LAB/RAD FEE SCHEDULE - 4206 117491 93306 HCHG RAD ECHO 2D COMP WO CONT W SPECTRAL-COLOR "2,754.00" " $2,478.60 " " $1,101.60 " " $2,203.20 " " $1,542.24 " " $1,927.80 " " $1,762.56 " " $2,203.20 " " $2,148.12 " " $1,239.30 " " $1,129.14 " " $1,156.68 " " $1,101.60 " " $2,065.50 " " $1,790.10 "
WWH LAB/RAD FEE SCHEDULE - 4206 117492 93308 HCHG RAD ECHO TRANSTHORACIC 2D F-U OR LTD STUDY "1,094.00" $984.60 $437.60 $875.20 $612.64 $765.80 $700.16 $875.20 $853.32 $492.30 $448.54 $459.48 $437.60 $820.50 $711.10
WWH LAB/RAD FEE SCHEDULE - 4206 117497 C8929 HCHG RAD ECHO TRANSTHORACIC 2D COMP SPECTRAL-COLOR W CONTRAST "2,754.00" " $2,478.60 " " $1,101.60 " " $2,203.20 " " $1,542.24 " " $1,927.80 " " $1,762.56 " " $2,203.20 " " $2,148.12 " " $1,239.30 " " $1,129.14 " " $1,156.68 " " $1,101.60 " " $2,065.50 " " $1,790.10 "
WWH LAB/RAD FEE SCHEDULE - 4206 117499 G0260 HCHG RAD INJ ANESTHETIC OR STEROID SACROILIAC JOINT "1,749.00" " $1,574.10 " $699.60 " $1,399.20 " $979.44 " $1,224.30 " " $1,119.36 " " $1,399.20 " " $1,364.22 " $787.05 $717.09 $734.58 $699.60 " $1,311.75 " " $1,136.85 "
WWH LAB/RAD FEE SCHEDULE - 4206 17001225 88323TRACK HCHG CONSULT MATERIAL 659.00 $593.10 $263.60 $527.20 $369.04 $461.30 $421.76 $527.20 $514.02 $296.55 $270.19 $276.78 $263.60 $494.25 $428.35
WWH LAB/RAD FEE SCHEDULE - 4206 17001250 88321TRACK HCHG CONSULT SLIDES PREP 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH LAB/RAD FEE SCHEDULE - 4206 17001255 88325TRACK HCHG CONSULT EXTENDED 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH LAB/RAD FEE SCHEDULE - 4206 17001270 85060 HCHG PERIPH BLOOD SMR 130.00 $117.00 $52.00 $104.00 $72.80 $91.00 $83.20 $104.00 $101.40 $58.50 $53.30 $54.60 $52.00 $97.50 $84.50
WWH LAB/RAD FEE SCHEDULE - 4206 17001300 88141TRACK HCHG CYTO PAP PATH REVW 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH LAB/RAD FEE SCHEDULE - 4206 17001335 84182 HCHG 68 KD (HSP-70) ANTIBODY 363.00 $326.70 $145.20 $290.40 $203.28 $254.10 $232.32 $290.40 $283.14 $163.35 $148.83 $152.46 $145.20 $272.25 $235.95
WWH LAB/RAD FEE SCHEDULE - 4206 17001365 80053 HCHG COMPREHENSIVE METABOLIC PANE 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 17001395 80061 HCHG LIPID PANEL 167.00 $150.30 $66.80 $133.60 $93.52 $116.90 $106.88 $133.60 $130.26 $75.15 $68.47 $70.14 $66.80 $125.25 $108.55
WWH LAB/RAD FEE SCHEDULE - 4206 17001405 80069 HCHG RENAL FUNCTION PANEL 56.00 $50.40 $22.40 $44.80 $31.36 $39.20 $35.84 $44.80 $43.68 $25.20 $22.96 $23.52 $22.40 $42.00 $36.40
WWH LAB/RAD FEE SCHEDULE - 4206 17001410 80074 HCHG GENERAL LAB 8007400 381.00 $342.90 $152.40 $304.80 $213.36 $266.70 $243.84 $304.80 $297.18 $171.45 $156.21 $160.02 $152.40 $285.75 $247.65
WWH LAB/RAD FEE SCHEDULE - 4206 17001415 80076 HCHG HEPATIC FUNCTION PANEL 94.00 $84.60 $37.60 $75.20 $52.64 $65.80 $60.16 $75.20 $73.32 $42.30 $38.54 $39.48 $37.60 $70.50 $61.10
WWH LAB/RAD FEE SCHEDULE - 4206 17001450 80143 HCHG ACETAMINOPHEN 201.00 $180.90 $80.40 $160.80 $112.56 $140.70 $128.64 $160.80 $156.78 $90.45 $82.41 $84.42 $80.40 $150.75 $130.65
WWH LAB/RAD FEE SCHEDULE - 4206 17001460 82009 HCHG KETONE BLOOD 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH LAB/RAD FEE SCHEDULE - 4206 17001485 82040 HCHG ALBUMIN 48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
WWH LAB/RAD FEE SCHEDULE - 4206 17001490 82040 HCHG ALBUMIN SERUM 32.00 $28.80 $12.80 $25.60 $17.92 $22.40 $20.48 $25.60 $24.96 $14.40 $13.12 $13.44 $12.80 $24.00 $20.80
WWH LAB/RAD FEE SCHEDULE - 4206 17001505 82042 HCHG ALBUMIN BODY FLUID 35.00 $31.50 $14.00 $28.00 $19.60 $24.50 $22.40 $28.00 $27.30 $15.75 $14.35 $14.70 $14.00 $26.25 $22.75
WWH LAB/RAD FEE SCHEDULE - 4206 17001510 82043 "HCHG URINE ALBUMIN TO CREATININE RATIO, RANDOM" 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 17001525 82077 HCHG ETHANOLBLOOD 49.00 $44.10 $19.60 $39.20 $27.44 $34.30 $31.36 $39.20 $38.22 $22.05 $20.09 $20.58 $19.60 $36.75 $31.85
WWH LAB/RAD FEE SCHEDULE - 4206 17001610 82105 HCHG AFP-PRENATAL 169.00 $152.10 $67.60 $135.20 $94.64 $118.30 $108.16 $135.20 $131.82 $76.05 $69.29 $70.98 $67.60 $126.75 $109.85
WWH LAB/RAD FEE SCHEDULE - 4206 17001620 82105 HCHG AFP BLOOD OPEN SPINA BIFIDA LC 164.00 $147.60 $65.60 $131.20 $91.84 $114.80 $104.96 $131.20 $127.92 $73.80 $67.24 $68.88 $65.60 $123.00 $106.60
WWH LAB/RAD FEE SCHEDULE - 4206 17001625 82105 HCHG AFP TUMOR MARKER SERUM 169.00 $152.10 $67.60 $135.20 $94.64 $118.30 $108.16 $135.20 $131.82 $76.05 $69.29 $70.98 $67.60 $126.75 $109.85
WWH LAB/RAD FEE SCHEDULE - 4206 17001640 82106 HCHG AFP-AMNIOTIC FLUID 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH LAB/RAD FEE SCHEDULE - 4206 17001700 82140 HCHG AMMONIA 149.00 $134.10 $59.60 $119.20 $83.44 $104.30 $95.36 $119.20 $116.22 $67.05 $61.09 $62.58 $59.60 $111.75 $96.85
WWH LAB/RAD FEE SCHEDULE - 4206 17001725 G0480 HCHG AMPHETAMINE URINE 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 17001740 82150 HCHG AMYLASE BODY FLUID 56.00 $50.40 $22.40 $44.80 $31.36 $39.20 $35.84 $44.80 $43.68 $25.20 $22.96 $23.52 $22.40 $42.00 $36.40
WWH LAB/RAD FEE SCHEDULE - 4206 17001750 82150 HCHG AMYLASE 77.00 $69.30 $30.80 $61.60 $43.12 $53.90 $49.28 $61.60 $60.06 $34.65 $31.57 $32.34 $30.80 $57.75 $50.05
WWH LAB/RAD FEE SCHEDULE - 4206 17001810 83695 HCHG LIPOPROTEIN LPA 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH LAB/RAD FEE SCHEDULE - 4206 17001850 82232 HCHG BETA-2 MICROGLOBULIN 174.00 $156.60 $69.60 $139.20 $97.44 $121.80 $111.36 $139.20 $135.72 $78.30 $71.34 $73.08 $69.60 $130.50 $113.10
WWH LAB/RAD FEE SCHEDULE - 4206 17001860 82247 "HCHG BILIRUBIN, TOTAL" 55.00 $49.50 $22.00 $44.00 $30.80 $38.50 $35.20 $44.00 $42.90 $24.75 $22.55 $23.10 $22.00 $41.25 $35.75
WWH LAB/RAD FEE SCHEDULE - 4206 17001865 82247 HCHG BILIRUBIN NEONATAL TOTAL AFFILIATE ONLY 55.00 $49.50 $22.00 $44.00 $30.80 $38.50 $35.20 $44.00 $42.90 $24.75 $22.55 $23.10 $22.00 $41.25 $35.75
WWH LAB/RAD FEE SCHEDULE - 4206 17001890 82248 "HCHG BILIRUBIN,DIRECT" 48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
WWH LAB/RAD FEE SCHEDULE - 4206 17001910 82270 HCHG OCCULT BLOOD -3 DAY 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH LAB/RAD FEE SCHEDULE - 4206 17001915 82272 HCHG OCCULT BLOOD STOOL 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH LAB/RAD FEE SCHEDULE - 4206 17001940 82271 HCHG OCCULT BLOOD GASTRIC 15.00 $13.50 $6.00 $12.00 $8.40 $10.50 $9.60 $12.00 $11.70 $6.75 $6.15 $6.30 $6.00 $11.25 $9.75
WWH LAB/RAD FEE SCHEDULE - 4206 17001945 82300 HCHG CADMIUM BLOOD 126.00 $113.40 $50.40 $100.80 $70.56 $88.20 $80.64 $100.80 $98.28 $56.70 $51.66 $52.92 $50.40 $94.50 $81.90
WWH LAB/RAD FEE SCHEDULE - 4206 17001970 82310 HCHG CALCIUM 55.00 $49.50 $22.00 $44.00 $30.80 $38.50 $35.20 $44.00 $42.90 $24.75 $22.55 $23.10 $22.00 $41.25 $35.75
WWH LAB/RAD FEE SCHEDULE - 4206 17001980 82330 "HCHG CALCIUM, IONIZED" 143.00 $128.70 $57.20 $114.40 $80.08 $100.10 $91.52 $114.40 $111.54 $64.35 $58.63 $60.06 $57.20 $107.25 $92.95
WWH LAB/RAD FEE SCHEDULE - 4206 17001985 82340 "HCHG CALCIUM, TIMED URINE" 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH LAB/RAD FEE SCHEDULE - 4206 17002015 82374 HCHG CO2 TOTAL 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 17002020 82374 HCHG HCO3 49.00 $44.10 $19.60 $39.20 $27.44 $34.30 $31.36 $39.20 $38.22 $22.05 $20.09 $20.58 $19.60 $36.75 $31.85
WWH LAB/RAD FEE SCHEDULE - 4206 17002045 82375 HCHG CARBOXYHEMOGLOBIN 129.00 $116.10 $51.60 $103.20 $72.24 $90.30 $82.56 $103.20 $100.62 $58.05 $52.89 $54.18 $51.60 $96.75 $83.85
WWH LAB/RAD FEE SCHEDULE - 4206 17002050 82378 HCHG CEA 180.00 $162.00 $72.00 $144.00 $100.80 $126.00 $115.20 $144.00 $140.40 $81.00 $73.80 $75.60 $72.00 $135.00 $117.00
WWH LAB/RAD FEE SCHEDULE - 4206 17002085 82390 HCHG CERULOPLASMIN 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 17002095 82435 HCHG CHLORIDE 48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
WWH LAB/RAD FEE SCHEDULE - 4206 17002110 82436 "HCHG CHLORIDE, URINE TIMED" 35.00 $31.50 $14.00 $28.00 $19.60 $24.50 $22.40 $28.00 $27.30 $15.75 $14.35 $14.70 $14.00 $26.25 $22.75
WWH LAB/RAD FEE SCHEDULE - 4206 17002115 82436 "HCHG CHLORIDE, RANDOM URINE" 35.00 $31.50 $14.00 $28.00 $19.60 $24.50 $22.40 $28.00 $27.30 $15.75 $14.35 $14.70 $14.00 $26.25 $22.75
WWH LAB/RAD FEE SCHEDULE - 4206 17002130 82465 HCHG CHOLESTEROL 42.00 $37.80 $16.80 $33.60 $23.52 $29.40 $26.88 $33.60 $32.76 $18.90 $17.22 $17.64 $16.80 $31.50 $27.30
WWH LAB/RAD FEE SCHEDULE - 4206 17002235 80195 HCHG RAPAMYCIN 224.00 $201.60 $89.60 $179.20 $125.44 $156.80 $143.36 $179.20 $174.72 $100.80 $91.84 $94.08 $89.60 $168.00 $145.60
WWH LAB/RAD FEE SCHEDULE - 4206 17002330 G0480 HCHG OLANZEPINE 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 17002350 80203 HCHG ZONISAMIDE 164.00 $147.60 $65.60 $131.20 $91.84 $114.80 $104.96 $131.20 $127.92 $73.80 $67.24 $68.88 $65.60 $123.00 $106.60
WWH LAB/RAD FEE SCHEDULE - 4206 17002440 G0480 HCHG COCAINE QUANT URINE 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 17002475 82533 HCHG CORTISOL 288.00 $259.20 $115.20 $230.40 $161.28 $201.60 $184.32 $230.40 $224.64 $129.60 $118.08 $120.96 $115.20 $216.00 $187.20
WWH LAB/RAD FEE SCHEDULE - 4206 17002495 G0480 HCHG THC METABOLITE QUANT URINE 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 17002505 G0480 HCHG BARBITURATE CONFIRM UR 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 17002525 82550 HCHG CK TOTAL 63.00 $56.70 $25.20 $50.40 $35.28 $44.10 $40.32 $50.40 $49.14 $28.35 $25.83 $26.46 $25.20 $47.25 $40.95
WWH LAB/RAD FEE SCHEDULE - 4206 17002555 82553 HCHG CK-MB 106.00 $95.40 $42.40 $84.80 $59.36 $74.20 $67.84 $84.80 $82.68 $47.70 $43.46 $44.52 $42.40 $79.50 $68.90
WWH LAB/RAD FEE SCHEDULE - 4206 17002560 82565 HCHG CREATININE 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH LAB/RAD FEE SCHEDULE - 4206 17002580 82565 HCHG CREATININE POCT 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH LAB/RAD FEE SCHEDULE - 4206 17002585 82570 "HCHG CREATININE, URINE" 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH LAB/RAD FEE SCHEDULE - 4206 17002590 82570 HCHG CREATININE BODY FLUID 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH LAB/RAD FEE SCHEDULE - 4206 17002595 82570 HCHG CREATININE URINE 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH LAB/RAD FEE SCHEDULE - 4206 17002630 82575 HCHG CREATININE CLEARANCE 94.00 $84.60 $37.60 $75.20 $52.64 $65.80 $60.16 $75.20 $73.32 $42.30 $38.54 $39.48 $37.60 $70.50 $61.10
WWH LAB/RAD FEE SCHEDULE - 4206 17002650 82595 (IA) HCHG CRYOGLOBULINS QUAL 49.00 $44.10 $19.60 $39.20 $27.44 $34.30 $31.36 $39.20 $38.22 $22.05 $20.09 $20.58 $19.60 $36.75 $31.85
WWH LAB/RAD FEE SCHEDULE - 4206 17002660 82607 HCHG VITAMIN B-12 177.00 $159.30 $70.80 $141.60 $99.12 $123.90 $113.28 $141.60 $138.06 $79.65 $72.57 $74.34 $70.80 $132.75 $115.05
WWH LAB/RAD FEE SCHEDULE - 4206 17002710 82668 (IA) HCHG ERYTHROPOIETIN 174.00 $156.60 $69.60 $139.20 $97.44 $121.80 $111.36 $139.20 $135.72 $78.30 $71.34 $73.08 $69.60 $130.50 $113.10
WWH LAB/RAD FEE SCHEDULE - 4206 17002715 82670 HCHG ESTRADIOL SERUM 264.00 $237.60 $105.60 $211.20 $147.84 $184.80 $168.96 $211.20 $205.92 $118.80 $108.24 $110.88 $105.60 $198.00 $171.60
WWH LAB/RAD FEE SCHEDULE - 4206 17002730 82677 HCHG ESTRIOL-PRENATAL 229.00 $206.10 $91.60 $183.20 $128.24 $160.30 $146.56 $183.20 $178.62 $103.05 $93.89 $96.18 $91.60 $171.75 $148.85
WWH LAB/RAD FEE SCHEDULE - 4206 17002765 82728 HCHG FERRITIN 158.00 $142.20 $63.20 $126.40 $88.48 $110.60 $101.12 $126.40 $123.24 $71.10 $64.78 $66.36 $63.20 $118.50 $102.70
WWH LAB/RAD FEE SCHEDULE - 4206 17002780 82731 HCHG FETAL FIBRONECTIN 518.00 $466.20 $207.20 $414.40 $290.08 $362.60 $331.52 $414.40 $404.04 $233.10 $212.38 $217.56 $207.20 $388.50 $336.70
WWH LAB/RAD FEE SCHEDULE - 4206 17002795 82746 HCHG FOLIC ACID 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH LAB/RAD FEE SCHEDULE - 4206 17002825 82784 HCHG IGM 98.00 $88.20 $39.20 $78.40 $54.88 $68.60 $62.72 $78.40 $76.44 $44.10 $40.18 $41.16 $39.20 $73.50 $63.70
WWH LAB/RAD FEE SCHEDULE - 4206 17002835 82784 HCHG IGG (SERUM) 98.00 $88.20 $39.20 $78.40 $54.88 $68.60 $62.72 $78.40 $76.44 $44.10 $40.18 $41.16 $39.20 $73.50 $63.70
WWH LAB/RAD FEE SCHEDULE - 4206 17002840 82784 HCHG IGA 98.00 $88.20 $39.20 $78.40 $54.88 $68.60 $62.72 $78.40 $76.44 $44.10 $40.18 $41.16 $39.20 $73.50 $63.70
WWH LAB/RAD FEE SCHEDULE - 4206 17002845 82784 HCHG IGG (CSF) 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH LAB/RAD FEE SCHEDULE - 4206 17002885 82785 HCHG IGE 148.00 $133.20 $59.20 $118.40 $82.88 $103.60 $94.72 $118.40 $115.44 $66.60 $60.68 $62.16 $59.20 $111.00 $96.20
WWH LAB/RAD FEE SCHEDULE - 4206 17002915 82800 "HCHG PH, BLOOD GAS" 60.00 $54.00 $24.00 $48.00 $33.60 $42.00 $38.40 $48.00 $46.80 $27.00 $24.60 $25.20 $24.00 $45.00 $39.00
WWH LAB/RAD FEE SCHEDULE - 4206 17002920 82803 HCHG BLOOD GAS 114.00 $102.60 $45.60 $91.20 $63.84 $79.80 $72.96 $91.20 $88.92 $51.30 $46.74 $47.88 $45.60 $85.50 $74.10
WWH LAB/RAD FEE SCHEDULE - 4206 17002955 82945 "HCHG GLUCOSE, CSF" 54.00 $48.60 $21.60 $43.20 $30.24 $37.80 $34.56 $43.20 $42.12 $24.30 $22.14 $22.68 $21.60 $40.50 $35.10
WWH LAB/RAD FEE SCHEDULE - 4206 17002960 82945 "HCHG GLUCOSE, BODY FLUID" 54.00 $48.60 $21.60 $43.20 $30.24 $37.80 $34.56 $43.20 $42.12 $24.30 $22.14 $22.68 $21.60 $40.50 $35.10
WWH LAB/RAD FEE SCHEDULE - 4206 17002975 82947 HCHG GLUCOSE 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 17002985 82947 HCHG GLUCOSE POCT 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 17002990 82950 HCHG GLUCOSE 2HPP 48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
WWH LAB/RAD FEE SCHEDULE - 4206 17002995 82950 "HCHG GLUCOSE, GESTATIONAL" 48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
WWH LAB/RAD FEE SCHEDULE - 4206 17003160 82962TRACK HCHG GLUCOSE METER TIMED 29.00 $26.10 $11.60 $23.20 $16.24 $20.30 $18.56 $23.20 $22.62 $13.05 $11.89 $12.18 $11.60 $21.75 $18.85
WWH LAB/RAD FEE SCHEDULE - 4206 17003180 82977 HCHG GAMMA GT 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH LAB/RAD FEE SCHEDULE - 4206 17003200 83001 HCHG FSH-SERUM 220.00 $198.00 $88.00 $176.00 $123.20 $154.00 $140.80 $176.00 $171.60 $99.00 $90.20 $92.40 $88.00 $165.00 $143.00
WWH LAB/RAD FEE SCHEDULE - 4206 17003205 83002 HCHG LUTEINIZING HORMONE 196.00 $176.40 $78.40 $156.80 $109.76 $137.20 $125.44 $156.80 $152.88 $88.20 $80.36 $82.32 $78.40 $147.00 $127.40
WWH LAB/RAD FEE SCHEDULE - 4206 17003220 83010 HCHG HAPTOGLOBIN 132.00 $118.80 $52.80 $105.60 $73.92 $92.40 $84.48 $105.60 $102.96 $59.40 $54.12 $55.44 $52.80 $99.00 $85.80
WWH LAB/RAD FEE SCHEDULE - 4206 17003240 83036 HCHG HEMOGLOBIN A1C 96.00 $86.40 $38.40 $76.80 $53.76 $67.20 $61.44 $76.80 $74.88 $43.20 $39.36 $40.32 $38.40 $72.00 $62.40
WWH LAB/RAD FEE SCHEDULE - 4206 17003260 83050 HCHG METHEMGLOBIN 44.00 $39.60 $17.60 $35.20 $24.64 $30.80 $28.16 $35.20 $34.32 $19.80 $18.04 $18.48 $17.60 $33.00 $28.60
WWH LAB/RAD FEE SCHEDULE - 4206 17003315 83090 "HCHG HOMOCYSTEINE, CARDIAC" 190.00 $171.00 $76.00 $152.00 $106.40 $133.00 $121.60 $152.00 $148.20 $85.50 $77.90 $79.80 $76.00 $142.50 $123.50
WWH LAB/RAD FEE SCHEDULE - 4206 17003360 86341 HCHG GAD 65 ABY ASSAY 194.00 $174.60 $77.60 $155.20 $108.64 $135.80 $124.16 $155.20 $151.32 $87.30 $79.54 $81.48 $77.60 $145.50 $126.10
WWH LAB/RAD FEE SCHEDULE - 4206 17003485 80163 HCHG DIGOXIN UNBOUND 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH LAB/RAD FEE SCHEDULE - 4206 17003490 80165 HCHG VALPROIC ACID UNBOUND 93.00 $83.70 $37.20 $74.40 $52.08 $65.10 $59.52 $74.40 $72.54 $41.85 $38.13 $39.06 $37.20 $69.75 $60.45
WWH LAB/RAD FEE SCHEDULE - 4206 17003515 80161 HCHG CARBAMAZE EPOXIDE 107.00 $96.30 $42.80 $85.60 $59.92 $74.90 $68.48 $85.60 $83.46 $48.15 $43.87 $44.94 $42.80 $80.25 $69.55
WWH LAB/RAD FEE SCHEDULE - 4206 17003575 83525 HCHG INSULIN 146.00 $131.40 $58.40 $116.80 $81.76 $102.20 $93.44 $116.80 $113.88 $65.70 $59.86 $61.32 $58.40 $109.50 $94.90
WWH LAB/RAD FEE SCHEDULE - 4206 17003585 83540 HCHG IRON 63.00 $56.70 $25.20 $50.40 $35.28 $44.10 $40.32 $50.40 $49.14 $28.35 $25.83 $26.46 $25.20 $47.25 $40.95
WWH LAB/RAD FEE SCHEDULE - 4206 17003600 83550 HCHG IRON BINDING CAPACITY (IBC) 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH LAB/RAD FEE SCHEDULE - 4206 17003630 83605 HCHG LACTATE BLOOD 103.00 $92.70 $41.20 $82.40 $57.68 $72.10 $65.92 $82.40 $80.34 $46.35 $42.23 $43.26 $41.20 $77.25 $66.95
WWH LAB/RAD FEE SCHEDULE - 4206 17003645 83615 "HCHG LD, BODY FLUID" 42.00 $37.80 $16.80 $33.60 $23.52 $29.40 $26.88 $33.60 $32.76 $18.90 $17.22 $17.64 $16.80 $31.50 $27.30
WWH LAB/RAD FEE SCHEDULE - 4206 17003650 83615 "HCHG LD, TOTAL" 59.00 $53.10 $23.60 $47.20 $33.04 $41.30 $37.76 $47.20 $46.02 $26.55 $24.19 $24.78 $23.60 $44.25 $38.35
WWH LAB/RAD FEE SCHEDULE - 4206 17003675 83655 "HCHG LEAD, FILTER PAPER" 103.00 $92.70 $41.20 $82.40 $57.68 $72.10 $65.92 $82.40 $80.34 $46.35 $42.23 $43.26 $41.20 $77.25 $66.95
WWH LAB/RAD FEE SCHEDULE - 4206 17003710 83690 HCHG LIPASE 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH LAB/RAD FEE SCHEDULE - 4206 17003740 83718 HCHG HDL CHOLESTEROL 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH LAB/RAD FEE SCHEDULE - 4206 17003760 83721 HCHG LDL DIRECT CHOLESTEROL 99.00 $89.10 $39.60 $79.20 $55.44 $69.30 $63.36 $79.20 $77.22 $44.55 $40.59 $41.58 $39.60 $74.25 $64.35
WWH LAB/RAD FEE SCHEDULE - 4206 17003765 83735 HCHG MAGNESIUM BLOOD 68.00 $61.20 $27.20 $54.40 $38.08 $47.60 $43.52 $54.40 $53.04 $30.60 $27.88 $28.56 $27.20 $51.00 $44.20
WWH LAB/RAD FEE SCHEDULE - 4206 17003820 G0480 HCHG METHADONE GC 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 17003845 83874 "HCHG MYOGLOBIN, SERUM" 102.00 $91.80 $40.80 $81.60 $57.12 $71.40 $65.28 $81.60 $79.56 $45.90 $41.82 $42.84 $40.80 $76.50 $66.30
WWH LAB/RAD FEE SCHEDULE - 4206 17003880 83916 HCHG OLIGOCLONAL BANDS 114.00 $102.60 $45.60 $91.20 $63.84 $79.80 $72.96 $91.20 $88.92 $51.30 $46.74 $47.88 $45.60 $85.50 $74.10
WWH LAB/RAD FEE SCHEDULE - 4206 17003900 83921 (IA) HCHG METHYLMALONIC ACID SERUM 133.00 $119.70 $53.20 $106.40 $74.48 $93.10 $85.12 $106.40 $103.74 $59.85 $54.53 $55.86 $53.20 $99.75 $86.45
WWH LAB/RAD FEE SCHEDULE - 4206 17003940 83930 "HCHG OSMOLALITY,SERUM" 63.00 $56.70 $25.20 $50.40 $35.28 $44.10 $40.32 $50.40 $49.14 $28.35 $25.83 $26.46 $25.20 $47.25 $40.95
WWH LAB/RAD FEE SCHEDULE - 4206 17003945 83935 "HCHG OSMOLALITY,URINE" 71.00 $63.90 $28.40 $56.80 $39.76 $49.70 $45.44 $56.80 $55.38 $31.95 $29.11 $29.82 $28.40 $53.25 $46.15
WWH LAB/RAD FEE SCHEDULE - 4206 17004005 83970 HCHG PTH INTACT 384.00 $345.60 $153.60 $307.20 $215.04 $268.80 $245.76 $307.20 $299.52 $172.80 $157.44 $161.28 $153.60 $288.00 $249.60
WWH LAB/RAD FEE SCHEDULE - 4206 17004010 83986 HCHG PH BODY FLUID 46.00 $41.40 $18.40 $36.80 $25.76 $32.20 $29.44 $36.80 $35.88 $20.70 $18.86 $19.32 $18.40 $34.50 $29.90
WWH LAB/RAD FEE SCHEDULE - 4206 17004085 84075 HCHG ALK PHOSPHATASE 55.00 $49.50 $22.00 $44.00 $30.80 $38.50 $35.20 $44.00 $42.90 $24.75 $22.55 $23.10 $22.00 $41.25 $35.75
WWH LAB/RAD FEE SCHEDULE - 4206 17004115 84100 HCHG PHOSPHORUS 48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
WWH LAB/RAD FEE SCHEDULE - 4206 17004130 84105 HCHG PHOSPHORUS URINE 39.00 $35.10 $15.60 $31.20 $21.84 $27.30 $24.96 $31.20 $30.42 $17.55 $15.99 $16.38 $15.60 $29.25 $25.35
WWH LAB/RAD FEE SCHEDULE - 4206 17004185 84132 HCHG POTASSIUM 59.00 $53.10 $23.60 $47.20 $33.04 $41.30 $37.76 $47.20 $46.02 $26.55 $24.19 $24.78 $23.60 $44.25 $38.35
WWH LAB/RAD FEE SCHEDULE - 4206 17004200 84132 HCHG POTASSIUM POCT 59.00 $53.10 $23.60 $47.20 $33.04 $41.30 $37.76 $47.20 $46.02 $26.55 $24.19 $24.78 $23.60 $44.25 $38.35
WWH LAB/RAD FEE SCHEDULE - 4206 17004205 84133 HCHG POTASSIUM URINE 22.00 $19.80 $8.80 $17.60 $12.32 $15.40 $14.08 $17.60 $17.16 $9.90 $9.02 $9.24 $8.80 $16.50 $14.30
WWH LAB/RAD FEE SCHEDULE - 4206 17004215 84133 "HCHG POTASSIUM, URINE" 30.00 $27.00 $12.00 $24.00 $16.80 $21.00 $19.20 $24.00 $23.40 $13.50 $12.30 $12.60 $12.00 $22.50 $19.50
WWH LAB/RAD FEE SCHEDULE - 4206 17004230 84134 HCHG PREALBUMIN 151.00 $135.90 $60.40 $120.80 $84.56 $105.70 $96.64 $120.80 $117.78 $67.95 $61.91 $63.42 $60.40 $113.25 $98.15
WWH LAB/RAD FEE SCHEDULE - 4206 17004250 84144 HCHG PROGESTERONE BLOOD 173.00 $155.70 $69.20 $138.40 $96.88 $121.10 $110.72 $138.40 $134.94 $77.85 $70.93 $72.66 $69.20 $129.75 $112.45
WWH LAB/RAD FEE SCHEDULE - 4206 17004255 84146 HCHG PROLACTIN 229.00 $206.10 $91.60 $183.20 $128.24 $160.30 $146.56 $183.20 $178.62 $103.05 $93.89 $96.18 $91.60 $171.75 $148.85
WWH LAB/RAD FEE SCHEDULE - 4206 17004265 84153 HCHG PSA-DIAGNOSTIC 169.00 $152.10 $67.60 $135.20 $94.64 $118.30 $108.16 $135.20 $131.82 $76.05 $69.29 $70.98 $67.60 $126.75 $109.85
WWH LAB/RAD FEE SCHEDULE - 4206 17004280 84156 "HCHG PROTEIN, TIMED UR" 37.00 $33.30 $14.80 $29.60 $20.72 $25.90 $23.68 $29.60 $28.86 $16.65 $15.17 $15.54 $14.80 $27.75 $24.05
WWH LAB/RAD FEE SCHEDULE - 4206 17004285 84155 HCHG PROTEIN TOTAL 40.00 $36.00 $16.00 $32.00 $22.40 $28.00 $25.60 $32.00 $31.20 $18.00 $16.40 $16.80 $16.00 $30.00 $26.00
WWH LAB/RAD FEE SCHEDULE - 4206 17004290 84157 "HCHG PROTEIN TOTAL, CSF" 47.00 $42.30 $18.80 $37.60 $26.32 $32.90 $30.08 $37.60 $36.66 $21.15 $19.27 $19.74 $18.80 $35.25 $30.55
WWH LAB/RAD FEE SCHEDULE - 4206 17004295 84157 "HCHG PROTEIN,BODY FLUID" 47.00 $42.30 $18.80 $37.60 $26.32 $32.90 $30.08 $37.60 $36.66 $21.15 $19.27 $19.74 $18.80 $35.25 $30.55
WWH LAB/RAD FEE SCHEDULE - 4206 17004315 84156 HCHG PROTEIN URINE RANDOM 37.00 $33.30 $14.80 $29.60 $20.72 $25.90 $23.68 $29.60 $28.86 $16.65 $15.17 $15.54 $14.80 $27.75 $24.05
WWH LAB/RAD FEE SCHEDULE - 4206 17004335 84165 "HCHG PROTEIN ELP,SERUM" 104.00 $93.60 $41.60 $83.20 $58.24 $72.80 $66.56 $83.20 $81.12 $46.80 $42.64 $43.68 $41.60 $78.00 $67.60
WWH LAB/RAD FEE SCHEDULE - 4206 17004345 84166 HCHG PROTEIN ELP URINE 132.00 $118.80 $52.80 $105.60 $73.92 $92.40 $84.48 $105.60 $102.96 $59.40 $54.12 $55.44 $52.80 $99.00 $85.80
WWH LAB/RAD FEE SCHEDULE - 4206 17004360 G0103 HCHG PSA-SCREEN 67.00 $60.30 $26.80 $53.60 $37.52 $46.90 $42.88 $53.60 $52.26 $30.15 $27.47 $28.14 $26.80 $50.25 $43.55
WWH LAB/RAD FEE SCHEDULE - 4206 17004400 83519 HCHG ACETYLCHOLINE RECEP BIND 171.00 $153.90 $68.40 $136.80 $95.76 $119.70 $109.44 $136.80 $133.38 $76.95 $70.11 $71.82 $68.40 $128.25 $111.15
WWH LAB/RAD FEE SCHEDULE - 4206 17004460 84295 HCHG SODIUM 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 17004480 84295 HCHG SODIUM POCT 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 17004485 84300 HCHG SODIUM URINE 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 17004495 84300 "HCHG SODIUM, URINE" 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 17004565 84403 HCHG TESTOSTERONE 244.00 $219.60 $97.60 $195.20 $136.64 $170.80 $156.16 $195.20 $190.32 $109.80 $100.04 $102.48 $97.60 $183.00 $158.60
WWH LAB/RAD FEE SCHEDULE - 4206 17004595 84436 HCHG T4 (THYROXINE) 71.00 $63.90 $28.40 $56.80 $39.76 $49.70 $45.44 $56.80 $55.38 $31.95 $29.11 $29.82 $28.40 $53.25 $46.15
WWH LAB/RAD FEE SCHEDULE - 4206 17004620 84439 "HCHG T4, FREE" 106.00 $95.40 $42.40 $84.80 $59.36 $74.20 $67.84 $84.80 $82.68 $47.70 $43.46 $44.52 $42.40 $79.50 $68.90
WWH LAB/RAD FEE SCHEDULE - 4206 17004635 84443 HCHG TSH 119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
WWH LAB/RAD FEE SCHEDULE - 4206 17004660 84450 HCHG AST (SGOT) 66.00 $59.40 $26.40 $52.80 $36.96 $46.20 $42.24 $52.80 $51.48 $29.70 $27.06 $27.72 $26.40 $49.50 $42.90
WWH LAB/RAD FEE SCHEDULE - 4206 17004680 84460 HCHG ALT (SGPT) 63.00 $56.70 $25.20 $50.40 $35.28 $44.10 $40.32 $50.40 $49.14 $28.35 $25.83 $26.46 $25.20 $47.25 $40.95
WWH LAB/RAD FEE SCHEDULE - 4206 17004700 84466 HCHG TRANSFERRIN (IBC) 135.00 $121.50 $54.00 $108.00 $75.60 $94.50 $86.40 $108.00 $105.30 $60.75 $55.35 $56.70 $54.00 $101.25 $87.75
WWH LAB/RAD FEE SCHEDULE - 4206 17004715 84478 HCHG TRIGLYCERIDES 46.00 $41.40 $18.40 $36.80 $25.76 $32.20 $29.44 $36.80 $35.88 $20.70 $18.86 $19.32 $18.40 $34.50 $29.90
WWH LAB/RAD FEE SCHEDULE - 4206 17004740 84480 HCHG T3 TOTAL 99.00 $89.10 $39.60 $79.20 $55.44 $69.30 $63.36 $79.20 $77.22 $44.55 $40.59 $41.58 $39.60 $74.25 $64.35
WWH LAB/RAD FEE SCHEDULE - 4206 17004745 84481 "HCHG T3, FREE" 178.00 $160.20 $71.20 $142.40 $99.68 $124.60 $113.92 $142.40 $138.84 $80.10 $72.98 $74.76 $71.20 $133.50 $115.70
WWH LAB/RAD FEE SCHEDULE - 4206 17004755 84520 HCHG BUN 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 17004775 84520 HCHG BUN POCT 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 17004780 84540 HCHG UREA NITROGEN-URINE 26.00 $23.40 $10.40 $20.80 $14.56 $18.20 $16.64 $20.80 $20.28 $11.70 $10.66 $10.92 $10.40 $19.50 $16.90
WWH LAB/RAD FEE SCHEDULE - 4206 17004795 84550 HCHG URIC ACID 48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
WWH LAB/RAD FEE SCHEDULE - 4206 17004805 84560 HCHG URIC ACID URINE 45.00 $40.50 $18.00 $36.00 $25.20 $31.50 $28.80 $36.00 $35.10 $20.25 $18.45 $18.90 $18.00 $33.75 $29.25
WWH LAB/RAD FEE SCHEDULE - 4206 17004815 84578 "HCHG UROBILINOGEN QUAL,UR" 13.00 $11.70 $5.20 $10.40 $7.28 $9.10 $8.32 $10.40 $10.14 $5.85 $5.33 $5.46 $5.20 $9.75 $8.45
WWH LAB/RAD FEE SCHEDULE - 4206 17004825 84586 (IA) HCHG VASO INTEST POLYPEPT 363.00 $326.70 $145.20 $290.40 $203.28 $254.10 $232.32 $290.40 $283.14 $163.35 $148.83 $152.46 $145.20 $272.25 $235.95
WWH LAB/RAD FEE SCHEDULE - 4206 17004830 84588 HCHG ARGININE VASOPRESSIN (ADH) 357.00 $321.30 $142.80 $285.60 $199.92 $249.90 $228.48 $285.60 $278.46 $160.65 $146.37 $149.94 $142.80 $267.75 $232.05
WWH LAB/RAD FEE SCHEDULE - 4206 17004855 80048 HCHG BASIC METABOLIC PANEL 109.00 $98.10 $43.60 $87.20 $61.04 $76.30 $69.76 $87.20 $85.02 $49.05 $44.69 $45.78 $43.60 $81.75 $70.85
WWH LAB/RAD FEE SCHEDULE - 4206 17004885 84681 HCHG C-PEPTIDE SERUM 217.00 $195.30 $86.80 $173.60 $121.52 $151.90 $138.88 $173.60 $169.26 $97.65 $88.97 $91.14 $86.80 $162.75 $141.05
WWH LAB/RAD FEE SCHEDULE - 4206 17004895 84702 HCHG GENERAL LAB 8470201 132.00 $118.80 $52.80 $105.60 $73.92 $92.40 $84.48 $105.60 $102.96 $59.40 $54.12 $55.44 $52.80 $99.00 $85.80
WWH LAB/RAD FEE SCHEDULE - 4206 17004905 84702 HCHG GENERAL LAB 8470202 132.00 $118.80 $52.80 $105.60 $73.92 $92.40 $84.48 $105.60 $102.96 $59.40 $54.12 $55.44 $52.80 $99.00 $85.80
WWH LAB/RAD FEE SCHEDULE - 4206 17005045 80051 HCHG ELECTROLYTE PANEL 70.00 $63.00 $28.00 $56.00 $39.20 $49.00 $44.80 $56.00 $54.60 $31.50 $28.70 $29.40 $28.00 $52.50 $45.50
WWH LAB/RAD FEE SCHEDULE - 4206 17005315 G0480 HCHG AMITRIPTYLINE 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 17005375 G0480 HCHG BENZODIAZ CONFIRM 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 17005380 80156 HCHG CARBAMAZEPINE 164.00 $147.60 $65.60 $131.20 $91.84 $114.80 $104.96 $131.20 $127.92 $73.80 $67.24 $68.88 $65.60 $123.00 $106.60
WWH LAB/RAD FEE SCHEDULE - 4206 17005420 80162 HCHG DIGOXIN 141.00 $126.90 $56.40 $112.80 $78.96 $98.70 $90.24 $112.80 $109.98 $63.45 $57.81 $59.22 $56.40 $105.75 $91.65
WWH LAB/RAD FEE SCHEDULE - 4206 17005430 80164 HCHG VALPROIC ACID 141.00 $126.90 $56.40 $112.80 $78.96 $98.70 $90.24 $112.80 $109.98 $63.45 $57.81 $59.22 $56.40 $105.75 $91.65
WWH LAB/RAD FEE SCHEDULE - 4206 17005450 80168 HCHG ETHOSUXIMIDE 165.00 $148.50 $66.00 $132.00 $92.40 $115.50 $105.60 $132.00 $128.70 $74.25 $67.65 $69.30 $66.00 $123.75 $107.25
WWH LAB/RAD FEE SCHEDULE - 4206 17005455 80170 HCHG GENTAMICIN KINETICS 135.00 $121.50 $54.00 $108.00 $75.60 $94.50 $86.40 $108.00 $105.30 $60.75 $55.35 $56.70 $54.00 $101.25 $87.75
WWH LAB/RAD FEE SCHEDULE - 4206 17005460 80170 HCHG GENTAMICIN 161.00 $144.90 $64.40 $128.80 $90.16 $112.70 $103.04 $128.80 $125.58 $72.45 $66.01 $67.62 $64.40 $120.75 $104.65
WWH LAB/RAD FEE SCHEDULE - 4206 17005500 80178 HCHG LITHIUM 67.00 $60.30 $26.80 $53.60 $37.52 $46.90 $42.88 $53.60 $52.26 $30.15 $27.47 $28.14 $26.80 $50.25 $43.55
WWH LAB/RAD FEE SCHEDULE - 4206 17005515 G0480 HCHG NORTRIPTYLINE NOR 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 17005525 80184 HCHG PHENOBARBITAL 114.00 $102.60 $45.60 $91.20 $63.84 $79.80 $72.96 $91.20 $88.92 $51.30 $46.74 $47.88 $45.60 $85.50 $74.10
WWH LAB/RAD FEE SCHEDULE - 4206 17005540 80185 HCHG PHENYTOIN 136.00 $122.40 $54.40 $108.80 $76.16 $95.20 $87.04 $108.80 $106.08 $61.20 $55.76 $57.12 $54.40 $102.00 $88.40
WWH LAB/RAD FEE SCHEDULE - 4206 17005550 80186 HCHG PHENYTOIN FREE 137.00 $123.30 $54.80 $109.60 $76.72 $95.90 $87.68 $109.60 $106.86 $61.65 $56.17 $57.54 $54.80 $102.75 $89.05
WWH LAB/RAD FEE SCHEDULE - 4206 17005590 80179 HCHG SALICYLATE 70.00 $63.00 $28.00 $56.00 $39.20 $49.00 $44.80 $56.00 $54.60 $31.50 $28.70 $29.40 $28.00 $52.50 $45.50
WWH LAB/RAD FEE SCHEDULE - 4206 17005610 80200 HCHG TOBRAMICIN KINETICS 169.00 $152.10 $67.60 $135.20 $94.64 $118.30 $108.16 $135.20 $131.82 $76.05 $69.29 $70.98 $67.60 $126.75 $109.85
WWH LAB/RAD FEE SCHEDULE - 4206 17005625 80202 HCHG VANCOMYCIN KINETICS 142.00 $127.80 $56.80 $113.60 $79.52 $99.40 $90.88 $113.60 $110.76 $63.90 $58.22 $59.64 $56.80 $106.50 $92.30
WWH LAB/RAD FEE SCHEDULE - 4206 17005705 99001 HCHG PROCESSING 39.00 $35.10 $15.60 $31.20 $21.84 $27.30 $24.96 $31.20 $30.42 $17.55 $15.99 $16.38 $15.60 $29.25 $25.35
WWH LAB/RAD FEE SCHEDULE - 4206 17005710 99001 HCHG PROCESSING 1 39.00 $35.10 $15.60 $31.20 $21.84 $27.30 $24.96 $31.20 $30.42 $17.55 $15.99 $16.38 $15.60 $29.25 $25.35
WWH LAB/RAD FEE SCHEDULE - 4206 17005715 99001 HCHG PROCESSING 2 39.00 $35.10 $15.60 $31.20 $21.84 $27.30 $24.96 $31.20 $30.42 $17.55 $15.99 $16.38 $15.60 $29.25 $25.35
WWH LAB/RAD FEE SCHEDULE - 4206 17005725 36415 HCHG VENIPUNCTURE 26.00 $23.40 $10.40 $20.80 $14.56 $18.20 $16.64 $20.80 $20.28 $11.70 $10.66 $10.92 $10.40 $19.50 $16.90
WWH LAB/RAD FEE SCHEDULE - 4206 17005745 89055 HCHG WBC STOOL 45.00 $40.50 $18.00 $36.00 $25.20 $31.50 $28.80 $36.00 $35.10 $20.25 $18.45 $18.90 $18.00 $33.75 $29.25
WWH LAB/RAD FEE SCHEDULE - 4206 17005760 81001 HCHG URINALYSIS COMPLETE 38.00 $34.20 $15.20 $30.40 $21.28 $26.60 $24.32 $30.40 $29.64 $17.10 $15.58 $15.96 $15.20 $28.50 $24.70
WWH LAB/RAD FEE SCHEDULE - 4206 17005775 81003 HCHG SPECIFIC GRAVITY URINE 28.00 $25.20 $11.20 $22.40 $15.68 $19.60 $17.92 $22.40 $21.84 $12.60 $11.48 $11.76 $11.20 $21.00 $18.20
WWH LAB/RAD FEE SCHEDULE - 4206 17005780 81003 HCHG URINALYSIS 28.00 $25.20 $11.20 $22.40 $15.68 $19.60 $17.92 $22.40 $21.84 $12.60 $11.48 $11.76 $11.20 $21.00 $18.20
WWH LAB/RAD FEE SCHEDULE - 4206 17005785 81003 HCHG PROTEIN QUAL URINE 28.00 $25.20 $11.20 $22.40 $15.68 $19.60 $17.92 $22.40 $21.84 $12.60 $11.48 $11.76 $11.20 $21.00 $18.20
WWH LAB/RAD FEE SCHEDULE - 4206 17005790 81003 HCHG KETONES URINE 28.00 $25.20 $11.20 $22.40 $15.68 $19.60 $17.92 $22.40 $21.84 $12.60 $11.48 $11.76 $11.20 $21.00 $18.20
WWH LAB/RAD FEE SCHEDULE - 4206 17005800 81003 HCHG GLUCOSE QUAL URINE 28.00 $25.20 $11.20 $22.40 $15.68 $19.60 $17.92 $22.40 $21.84 $12.60 $11.48 $11.76 $11.20 $21.00 $18.20
WWH LAB/RAD FEE SCHEDULE - 4206 17005815 81015 HCHG MICROSCOPIC URINE 30.00 $27.00 $12.00 $24.00 $16.80 $21.00 $19.20 $24.00 $23.40 $13.50 $12.30 $12.60 $12.00 $22.50 $19.50
WWH LAB/RAD FEE SCHEDULE - 4206 17005830 89060 HCHG CRYSTAL IDENTIFICATION 68.00 $61.20 $27.20 $54.40 $38.08 $47.60 $43.52 $54.40 $53.04 $30.60 $27.88 $28.56 $27.20 $51.00 $44.20
WWH LAB/RAD FEE SCHEDULE - 4206 17005845 81025 HCHG GENERAL LAB 8102500 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH LAB/RAD FEE SCHEDULE - 4206 17005860 81025 HCHG GENERAL LAB 8102501 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH LAB/RAD FEE SCHEDULE - 4206 17005870 84703 HCHG GENERAL LAB 8470300 73.00 $65.70 $29.20 $58.40 $40.88 $51.10 $46.72 $58.40 $56.94 $32.85 $29.93 $30.66 $29.20 $54.75 $47.45
WWH LAB/RAD FEE SCHEDULE - 4206 17006025 85130 HCHG FACTOR X CHROMOGENIC 186.00 $167.40 $74.40 $148.80 $104.16 $130.20 $119.04 $148.80 $145.08 $83.70 $76.26 $78.12 $74.40 $139.50 $120.90
WWH LAB/RAD FEE SCHEDULE - 4206 17006055 85004 HCHG DIFFERENTIAL 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH LAB/RAD FEE SCHEDULE - 4206 17006085 85014 HCHG HEMATOCRIT 29.00 $26.10 $11.60 $23.20 $16.24 $20.30 $18.56 $23.20 $22.62 $13.05 $11.89 $12.18 $11.60 $21.75 $18.85
WWH LAB/RAD FEE SCHEDULE - 4206 17006120 85018 HCHG HEMOGLOBIN 32.00 $28.80 $12.80 $25.60 $17.92 $22.40 $20.48 $25.60 $24.96 $14.40 $13.12 $13.44 $12.80 $24.00 $20.80
WWH LAB/RAD FEE SCHEDULE - 4206 17006135 85018 HCHG BLOOD GAS HGB 32.00 $28.80 $12.80 $25.60 $17.92 $22.40 $20.48 $25.60 $24.96 $14.40 $13.12 $13.44 $12.80 $24.00 $20.80
WWH LAB/RAD FEE SCHEDULE - 4206 17006180 85025 HCHG CBC W/DIFF 96.00 $86.40 $38.40 $76.80 $53.76 $67.20 $61.44 $76.80 $74.88 $43.20 $39.36 $40.32 $38.40 $72.00 $62.40
WWH LAB/RAD FEE SCHEDULE - 4206 17006210 85027 HCHG CBC 74.00 $66.60 $29.60 $59.20 $41.44 $51.80 $47.36 $59.20 $57.72 $33.30 $30.34 $31.08 $29.60 $55.50 $48.10
WWH LAB/RAD FEE SCHEDULE - 4206 17006225 85041 HCHG RBC 30.00 $27.00 $12.00 $24.00 $16.80 $21.00 $19.20 $24.00 $23.40 $13.50 $12.30 $12.60 $12.00 $22.50 $19.50
WWH LAB/RAD FEE SCHEDULE - 4206 17006230 85045 HCHG RETIC COUNT 47.00 $42.30 $18.80 $37.60 $26.32 $32.90 $30.08 $37.60 $36.66 $21.15 $19.27 $19.74 $18.80 $35.25 $30.55
WWH LAB/RAD FEE SCHEDULE - 4206 17006255 85048 HCHG WBC 25.00 $22.50 $10.00 $20.00 $14.00 $17.50 $16.00 $20.00 $19.50 $11.25 $10.25 $10.50 $10.00 $18.75 $16.25
WWH LAB/RAD FEE SCHEDULE - 4206 17006305 85240 HCHG FACTOR 8 ASSAY 186.00 $167.40 $74.40 $148.80 $104.16 $130.20 $119.04 $148.80 $145.08 $83.70 $76.26 $78.12 $74.40 $139.50 $120.90
WWH LAB/RAD FEE SCHEDULE - 4206 17006370 85300 HCHG ANTITHROMBIN III 146.00 $131.40 $58.40 $116.80 $81.76 $102.20 $93.44 $116.80 $113.88 $65.70 $59.86 $61.32 $58.40 $109.50 $94.90
WWH LAB/RAD FEE SCHEDULE - 4206 17006380 85303 HCHG PROTEIN C ACTIVITY 201.00 $180.90 $80.40 $160.80 $112.56 $140.70 $128.64 $160.80 $156.78 $90.45 $82.41 $84.42 $80.40 $150.75 $130.65
WWH LAB/RAD FEE SCHEDULE - 4206 17006395 85306 HCHG PROTEIN S FREE 153.00 $137.70 $61.20 $122.40 $85.68 $107.10 $97.92 $122.40 $119.34 $68.85 $62.73 $64.26 $61.20 $114.75 $99.45
WWH LAB/RAD FEE SCHEDULE - 4206 17006400 85306 HCHG PROTEIN S FUNCTIONAL 162.00 $145.80 $64.80 $129.60 $90.72 $113.40 $103.68 $129.60 $126.36 $72.90 $66.42 $68.04 $64.80 $121.50 $105.30
WWH LAB/RAD FEE SCHEDULE - 4206 17006425 85379 HCHG D-DIMER QUANT 79.00 $71.10 $31.60 $63.20 $44.24 $55.30 $50.56 $63.20 $61.62 $35.55 $32.39 $33.18 $31.60 $59.25 $51.35
WWH LAB/RAD FEE SCHEDULE - 4206 17006435 85384 HCHG FIBRINOGEN QUANTITATIVE 88.00 $79.20 $35.20 $70.40 $49.28 $61.60 $56.32 $70.40 $68.64 $39.60 $36.08 $36.96 $35.20 $66.00 $57.20
WWH LAB/RAD FEE SCHEDULE - 4206 17006460 85441 HCHG HEINZ BODIES 35.00 $31.50 $14.00 $28.00 $19.60 $24.50 $22.40 $28.00 $27.30 $15.75 $14.35 $14.70 $14.00 $26.25 $22.75
WWH LAB/RAD FEE SCHEDULE - 4206 17006470 85460 HCHG KLEIHAUER STAIN 125.00 $112.50 $50.00 $100.00 $70.00 $87.50 $80.00 $100.00 $97.50 $56.25 $51.25 $52.50 $50.00 $93.75 $81.25
WWH LAB/RAD FEE SCHEDULE - 4206 17006495 85520 HCHG HEPARIN-QUANT 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH LAB/RAD FEE SCHEDULE - 4206 17006505 85520 HCHG LOW MOL WT HEPARIN 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH LAB/RAD FEE SCHEDULE - 4206 17006560 85049 HCHG PLATELET COUNT 43.00 $38.70 $17.20 $34.40 $24.08 $30.10 $27.52 $34.40 $33.54 $19.35 $17.63 $18.06 $17.20 $32.25 $27.95
WWH LAB/RAD FEE SCHEDULE - 4206 17006580 85613 HCHG DVVT CONFIRM 68.00 $61.20 $27.20 $54.40 $38.08 $47.60 $43.52 $54.40 $53.04 $30.60 $27.88 $28.56 $27.20 $51.00 $44.20
WWH LAB/RAD FEE SCHEDULE - 4206 17006585 85598 HCHG STACLOT LA 161.00 $144.90 $64.40 $128.80 $90.16 $112.70 $103.04 $128.80 $125.58 $72.45 $66.01 $67.62 $64.40 $120.75 $104.65
WWH LAB/RAD FEE SCHEDULE - 4206 17006600 85610 HCHG PROTHOMBIN TIME 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH LAB/RAD FEE SCHEDULE - 4206 17006610 85613 HCHG DRVVT SCREEN 88.00 $79.20 $35.20 $70.40 $49.28 $61.60 $56.32 $70.40 $68.64 $39.60 $36.08 $36.96 $35.20 $66.00 $57.20
WWH LAB/RAD FEE SCHEDULE - 4206 17006630 85660 HCHG SICKLE CELL TEST 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH LAB/RAD FEE SCHEDULE - 4206 17006635 85670 HCHG THROMBIN TIME 62.00 $55.80 $24.80 $49.60 $34.72 $43.40 $39.68 $49.60 $48.36 $27.90 $25.42 $26.04 $24.80 $46.50 $40.30
WWH LAB/RAD FEE SCHEDULE - 4206 17006670 85730 HCHG PTT-LA SCREEN 60.00 $54.00 $24.00 $48.00 $33.60 $42.00 $38.40 $48.00 $46.80 $27.00 $24.60 $25.20 $24.00 $45.00 $39.00
WWH LAB/RAD FEE SCHEDULE - 4206 17006675 85730 HCHG ACTIVATED PTT 60.00 $54.00 $24.00 $48.00 $33.60 $42.00 $38.40 $48.00 $46.80 $27.00 $24.60 $25.20 $24.00 $45.00 $39.00
WWH LAB/RAD FEE SCHEDULE - 4206 17006680 85307 HCHG ACT. PROTEIN C RESIST 174.00 $156.60 $69.60 $139.20 $97.44 $121.80 $111.36 $139.20 $135.72 $78.30 $71.34 $73.08 $69.60 $130.50 $113.10
WWH LAB/RAD FEE SCHEDULE - 4206 17006685 85732 HCHG EQUAL MIX APTT 38.00 $34.20 $15.20 $30.40 $21.28 $26.60 $24.32 $30.40 $29.64 $17.10 $15.58 $15.96 $15.20 $28.50 $24.70
WWH LAB/RAD FEE SCHEDULE - 4206 17006695 85652 HCHG SED RATE 28.00 $25.20 $11.20 $22.40 $15.68 $19.60 $17.92 $22.40 $21.84 $12.60 $11.48 $11.76 $11.20 $21.00 $18.20
WWH LAB/RAD FEE SCHEDULE - 4206 17006735 89051 HCHG CELL COUNT & DIFF B.F. ST 55.00 $49.50 $22.00 $44.00 $30.80 $38.50 $35.20 $44.00 $42.90 $24.75 $22.55 $23.10 $22.00 $41.25 $35.75
WWH LAB/RAD FEE SCHEDULE - 4206 17006740 89051 HCHG CELL COUNT & DIFF CSF-STA 55.00 $49.50 $22.00 $44.00 $30.80 $38.50 $35.20 $44.00 $42.90 $24.75 $22.55 $23.10 $22.00 $41.25 $35.75
WWH LAB/RAD FEE SCHEDULE - 4206 17006750 81099 HCHG EOSINOPHIL SMEAR 10.00 $9.00 $4.00 $8.00 $5.60 $7.00 $6.40 $8.00 $7.80 $4.50 $4.10 $4.20 $4.00 $7.50 $6.50
WWH LAB/RAD FEE SCHEDULE - 4206 17006845 86023 HCHG PLT ASSOC IMMUNO 1 104.00 $93.60 $41.60 $83.20 $58.24 $72.80 $66.56 $83.20 $81.12 $46.80 $42.64 $43.68 $41.60 $78.00 $67.60
WWH LAB/RAD FEE SCHEDULE - 4206 17006850 86023 HCHG PLAT ASSOC IMMUNO 1 104.00 $93.60 $41.60 $83.20 $58.24 $72.80 $66.56 $83.20 $81.12 $46.80 $42.64 $43.68 $41.60 $78.00 $67.60
WWH LAB/RAD FEE SCHEDULE - 4206 17006860 86038 HCHG ANA 141.00 $126.90 $56.40 $112.80 $78.96 $98.70 $90.24 $112.80 $109.98 $63.45 $57.81 $59.22 $56.40 $105.75 $91.65
WWH LAB/RAD FEE SCHEDULE - 4206 17006875 86039 HCHG FANA TITER 118.00 $106.20 $47.20 $94.40 $66.08 $82.60 $75.52 $94.40 $92.04 $53.10 $48.38 $49.56 $47.20 $88.50 $76.70
WWH LAB/RAD FEE SCHEDULE - 4206 17006885 86140 HCHG C-REACTIVE PROTEIN 77.00 $69.30 $30.80 $61.60 $43.12 $53.90 $49.28 $61.60 $60.06 $34.65 $31.57 $32.34 $30.80 $57.75 $50.05
WWH LAB/RAD FEE SCHEDULE - 4206 17006910 86141 HCHG HIGH SENS CRP 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH LAB/RAD FEE SCHEDULE - 4206 17006955 86160 HCHG C3 COMPLEMENT COMPONENT 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH LAB/RAD FEE SCHEDULE - 4206 17006960 86160 HCHG C4 COMPLEMENT COMPONENT 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH LAB/RAD FEE SCHEDULE - 4206 17007010 86225 HCHG NATIVE DNA ABY 143.00 $128.70 $57.20 $114.40 $80.08 $100.10 $91.52 $114.40 $111.54 $64.35 $58.63 $60.06 $57.20 $107.25 $92.95
WWH LAB/RAD FEE SCHEDULE - 4206 17007025 86235 HCHG SM ANTIBODY 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 17007030 86235 HCHG RNP ANTIBODY 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 17007045 86381 HCHG MITOCHONDRIAL ABY 156.00 $140.40 $62.40 $124.80 $87.36 $109.20 $99.84 $124.80 $121.68 $70.20 $63.96 $65.52 $62.40 $117.00 $101.40
WWH LAB/RAD FEE SCHEDULE - 4206 17007050 86015 HCHG SMOOTH MUSCLE ABY 156.00 $140.40 $62.40 $124.80 $87.36 $109.20 $99.84 $124.80 $121.68 $70.20 $63.96 $65.52 $62.40 $117.00 $101.40
WWH LAB/RAD FEE SCHEDULE - 4206 17007175 86301 HCHG CA 19-9 217.00 $195.30 $86.80 $173.60 $121.52 $151.90 $138.88 $173.60 $169.26 $97.65 $88.97 $91.14 $86.80 $162.75 $141.05
WWH LAB/RAD FEE SCHEDULE - 4206 17007180 86304 HCHG CA 125 212.00 $190.80 $84.80 $169.60 $118.72 $148.40 $135.68 $169.60 $165.36 $95.40 $86.92 $89.04 $84.80 $159.00 $137.80
WWH LAB/RAD FEE SCHEDULE - 4206 17007185 87340 HCHG GENERAL LAB 8734000 122.00 $109.80 $48.80 $97.60 $68.32 $85.40 $78.08 $97.60 $95.16 $54.90 $50.02 $51.24 $48.80 $91.50 $79.30
WWH LAB/RAD FEE SCHEDULE - 4206 17007190 87341 HCHG GENERAL LAB 8734100 67.00 $60.30 $26.80 $53.60 $37.52 $46.90 $42.88 $53.60 $52.26 $30.15 $27.47 $28.14 $26.80 $50.25 $43.55
WWH LAB/RAD FEE SCHEDULE - 4206 17007195 86704 HCHG GENERAL LAB 8670400 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH LAB/RAD FEE SCHEDULE - 4206 17007200 86705 HCHG GENERAL LAB 8670500 122.00 $109.80 $48.80 $97.60 $68.32 $85.40 $78.08 $97.60 $95.16 $54.90 $50.02 $51.24 $48.80 $91.50 $79.30
WWH LAB/RAD FEE SCHEDULE - 4206 17007205 86706 HCHG GENERAL LAB 8670600 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 17007220 86708 HCHG GENERAL LAB 8670800 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH LAB/RAD FEE SCHEDULE - 4206 17007225 86709 HCHG GENERAL LAB 8670900 119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
WWH LAB/RAD FEE SCHEDULE - 4206 17007230 86803 HCHG GENERAL LAB 8680300 148.00 $133.20 $59.20 $118.40 $82.88 $103.60 $94.72 $118.40 $115.44 $66.60 $60.68 $62.16 $59.20 $111.00 $96.20
WWH LAB/RAD FEE SCHEDULE - 4206 17007240 86308 HCHG HETEROPHILE 55.00 $49.50 $22.00 $44.00 $30.80 $38.50 $35.20 $44.00 $42.90 $24.75 $22.55 $23.10 $22.00 $41.25 $35.75
WWH LAB/RAD FEE SCHEDULE - 4206 17007355 86334 HCHG IMMUNOFIXATION 169.00 $152.10 $67.60 $135.20 $94.64 $118.30 $108.16 $135.20 $131.82 $76.05 $69.29 $70.98 $67.60 $126.75 $109.85
WWH LAB/RAD FEE SCHEDULE - 4206 17007360 86335 HCHG IMMUNOFIXATION URINE 309.00 $278.10 $123.60 $247.20 $173.04 $216.30 $197.76 $247.20 $241.02 $139.05 $126.69 $129.78 $123.60 $231.75 $200.85
WWH LAB/RAD FEE SCHEDULE - 4206 17007375 86336 HCHG INHIBIN A 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH LAB/RAD FEE SCHEDULE - 4206 17007420 86376 HCHG THY PEROXIDASE ABY 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH LAB/RAD FEE SCHEDULE - 4206 17007440 86431 HCHG RA QUANT 59.00 $53.10 $23.60 $47.20 $33.04 $41.30 $37.76 $47.20 $46.02 $26.55 $24.19 $24.78 $23.60 $44.25 $38.35
WWH LAB/RAD FEE SCHEDULE - 4206 17007460 86592 HCHG GENERAL LAB 8659200 47.00 $42.30 $18.80 $37.60 $26.32 $32.90 $30.08 $37.60 $36.66 $21.15 $19.27 $19.74 $18.80 $35.25 $30.55
WWH LAB/RAD FEE SCHEDULE - 4206 17007470 86592 HCHG GENERAL LAB 8659201 29.00 $26.10 $11.60 $23.20 $16.24 $20.30 $18.56 $23.20 $22.62 $13.05 $11.89 $12.18 $11.60 $21.75 $18.85
WWH LAB/RAD FEE SCHEDULE - 4206 17007580 86618 HCHG LYME (FIA) POLYVALENT 164.00 $147.60 $65.60 $131.20 $91.84 $114.80 $104.96 $131.20 $127.92 $73.80 $67.24 $68.88 $65.60 $123.00 $106.60
WWH LAB/RAD FEE SCHEDULE - 4206 17007595 86618 HCHG LYME NO REFLEX 75.00 $67.50 $30.00 $60.00 $42.00 $52.50 $48.00 $60.00 $58.50 $33.75 $30.75 $31.50 $30.00 $56.25 $48.75
WWH LAB/RAD FEE SCHEDULE - 4206 17007960 86677 HCHG HELICOBACTER PYLORI IGG AFFILIATE ONLY 160.00 $144.00 $64.00 $128.00 $89.60 $112.00 $102.40 $128.00 $124.80 $72.00 $65.60 $67.20 $64.00 $120.00 $104.00
WWH LAB/RAD FEE SCHEDULE - 4206 17008050 87389 HCHG GENERAL LAB 8738900 162.00 $145.80 $64.80 $129.60 $90.72 $113.40 $103.68 $129.60 $126.36 $72.90 $66.42 $68.04 $64.80 $121.50 $105.30
WWH LAB/RAD FEE SCHEDULE - 4206 17008145 86735 HCHG MUMPS IGG 134.00 $120.60 $53.60 $107.20 $75.04 $93.80 $85.76 $107.20 $104.52 $60.30 $54.94 $56.28 $53.60 $100.50 $87.10
WWH LAB/RAD FEE SCHEDULE - 4206 17008220 86762 HCHG RUBELLA IMMUNE STATUS 115.00 $103.50 $46.00 $92.00 $64.40 $80.50 $73.60 $92.00 $89.70 $51.75 $47.15 $48.30 $46.00 $86.25 $74.75
WWH LAB/RAD FEE SCHEDULE - 4206 17008225 86765 HCHG RUBEOLA IMMUNITY 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH LAB/RAD FEE SCHEDULE - 4206 17008250 86780 HCHG GENERAL LAB 8678001 70.00 $63.00 $28.00 $56.00 $39.20 $49.00 $44.80 $56.00 $54.60 $31.50 $28.70 $29.40 $28.00 $52.50 $45.50
WWH LAB/RAD FEE SCHEDULE - 4206 17008270 86787 HCHG VZV IMMUNE ASSAY 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH LAB/RAD FEE SCHEDULE - 4206 17008390 87536 HCHG GENERAL LAB 8753600 338.00 $304.20 $135.20 $270.40 $189.28 $236.60 $216.32 $270.40 $263.64 $152.10 $138.58 $141.96 $135.20 $253.50 $219.70
WWH LAB/RAD FEE SCHEDULE - 4206 17008445 87015 HCHG AFB CONCENTRATION 45.00 $40.50 $18.00 $36.00 $25.20 $31.50 $28.80 $36.00 $35.10 $20.25 $18.45 $18.90 $18.00 $33.75 $29.25
WWH LAB/RAD FEE SCHEDULE - 4206 17008450 87015 HCHG THICK SMEAR 21.00 $18.90 $8.40 $16.80 $11.76 $14.70 $13.44 $16.80 $16.38 $9.45 $8.61 $8.82 $8.40 $15.75 $13.65
WWH LAB/RAD FEE SCHEDULE - 4206 17008455 87040 HCHG BLOOD CULTURE-BACTEC 103.00 $92.70 $41.20 $82.40 $57.68 $72.10 $65.92 $82.40 $80.34 $46.35 $42.23 $43.26 $41.20 $77.25 $66.95
WWH LAB/RAD FEE SCHEDULE - 4206 17008505 87070 HCHG THROAT CULTURE 90.00 $81.00 $36.00 $72.00 $50.40 $63.00 $57.60 $72.00 $70.20 $40.50 $36.90 $37.80 $36.00 $67.50 $58.50
WWH LAB/RAD FEE SCHEDULE - 4206 17008510 87070 HCHG IV CATHETER CULTURE 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH LAB/RAD FEE SCHEDULE - 4206 17008575 87070 HCHG BODY FLUID CULTURE 90.00 $81.00 $36.00 $72.00 $50.40 $63.00 $57.60 $72.00 $70.20 $40.50 $36.90 $37.80 $36.00 $67.50 $58.50
WWH LAB/RAD FEE SCHEDULE - 4206 17008580 87070 HCHG SPINAL FLUID CULTURE 90.00 $81.00 $36.00 $72.00 $50.40 $63.00 $57.60 $72.00 $70.20 $40.50 $36.90 $37.80 $36.00 $67.50 $58.50
WWH LAB/RAD FEE SCHEDULE - 4206 17008585 87070 HCHG SPUTUM CULTURE 90.00 $81.00 $36.00 $72.00 $50.40 $63.00 $57.60 $72.00 $70.20 $40.50 $36.90 $37.80 $36.00 $67.50 $58.50
WWH LAB/RAD FEE SCHEDULE - 4206 17008590 87070 HCHG TISSUE CULTURE 81.00 $72.90 $32.40 $64.80 $45.36 $56.70 $51.84 $64.80 $63.18 $36.45 $33.21 $34.02 $32.40 $60.75 $52.65
WWH LAB/RAD FEE SCHEDULE - 4206 17008605 87070 HCHG WOUND CULTURE 90.00 $81.00 $36.00 $72.00 $50.40 $63.00 $57.60 $72.00 $70.20 $40.50 $36.90 $37.80 $36.00 $67.50 $58.50
WWH LAB/RAD FEE SCHEDULE - 4206 17008610 87070 HCHG MISCELLANEOUS BACTERIAL CULT 90.00 $81.00 $36.00 $72.00 $50.40 $63.00 $57.60 $72.00 $70.20 $40.50 $36.90 $37.80 $36.00 $67.50 $58.50
WWH LAB/RAD FEE SCHEDULE - 4206 17008615 87070 HCHG VAG CERV CULTURE 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH LAB/RAD FEE SCHEDULE - 4206 17008640 87071 "HCHG BOWEL CULTURE, AEROBIC" 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 17008645 87071 HCHG BOWEL CULT AEROBIC 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 17008660 87073 HCHG BOWEL CULT ANAEROBIC 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH LAB/RAD FEE SCHEDULE - 4206 17008675 87075 HCHG ANAEROBIC CULTURE 99.00 $89.10 $39.60 $79.20 $55.44 $69.30 $63.36 $79.20 $77.22 $44.55 $40.59 $41.58 $39.60 $74.25 $64.35
WWH LAB/RAD FEE SCHEDULE - 4206 17008690 87076 HCHG ANAEROBE IDENT 81.00 $72.90 $32.40 $64.80 $45.36 $56.70 $51.84 $64.80 $63.18 $36.45 $33.21 $34.02 $32.40 $60.75 $52.65
WWH LAB/RAD FEE SCHEDULE - 4206 17008710 87077 HCHG ID AEROBE 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH LAB/RAD FEE SCHEDULE - 4206 17008725 87081 HCHG GENERAL LAB 8708100 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 17008730 87081 HCHG GENERAL LAB 8708104 68.00 $61.20 $27.20 $54.40 $38.08 $47.60 $43.52 $54.40 $53.04 $30.60 $27.88 $28.56 $27.20 $51.00 $44.20
WWH LAB/RAD FEE SCHEDULE - 4206 17008745 87081 HCHG CLOTEST 45.00 $40.50 $18.00 $36.00 $25.20 $31.50 $28.80 $36.00 $35.10 $20.25 $18.45 $18.90 $18.00 $33.75 $29.25
WWH LAB/RAD FEE SCHEDULE - 4206 17008760 87086 HCHG URINE CULTURE 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH LAB/RAD FEE SCHEDULE - 4206 17008790 87088 HCHG URINE PRESUMPTIVE ID 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH LAB/RAD FEE SCHEDULE - 4206 17008795 87101 "HCHG FUNGUS CUL-SKIN, HAIR, NAIL" 78.00 $70.20 $31.20 $62.40 $43.68 $54.60 $49.92 $62.40 $60.84 $35.10 $31.98 $32.76 $31.20 $58.50 $50.70
WWH LAB/RAD FEE SCHEDULE - 4206 17008800 87102 HCHG FUNGUS CULTURE 61.00 $54.90 $24.40 $48.80 $34.16 $42.70 $39.04 $48.80 $47.58 $27.45 $25.01 $25.62 $24.40 $45.75 $39.65
WWH LAB/RAD FEE SCHEDULE - 4206 17008805 87102 HCHG YEAST CULTURE 61.00 $54.90 $24.40 $48.80 $34.16 $42.70 $39.04 $48.80 $47.58 $27.45 $25.01 $25.62 $24.40 $45.75 $39.65
WWH LAB/RAD FEE SCHEDULE - 4206 17008815 87106 HCHG YEAST IDENT 40.00 $36.00 $16.00 $32.00 $22.40 $28.00 $25.60 $32.00 $31.20 $18.00 $16.40 $16.80 $16.00 $30.00 $26.00
WWH LAB/RAD FEE SCHEDULE - 4206 17008820 87107 HCHG MOLD IDENT 72.00 $64.80 $28.80 $57.60 $40.32 $50.40 $46.08 $57.60 $56.16 $32.40 $29.52 $30.24 $28.80 $54.00 $46.80
WWH LAB/RAD FEE SCHEDULE - 4206 17008845 87116 HCHG AFB CULTURE 61.00 $54.90 $24.40 $48.80 $34.16 $42.70 $39.04 $48.80 $47.58 $27.45 $25.01 $25.62 $24.40 $45.75 $39.65
WWH LAB/RAD FEE SCHEDULE - 4206 17008885 87147 HCHG SEROGROUPING 36.00 $32.40 $14.40 $28.80 $20.16 $25.20 $23.04 $28.80 $28.08 $16.20 $14.76 $15.12 $14.40 $27.00 $23.40
WWH LAB/RAD FEE SCHEDULE - 4206 17008890 87168 HCHG INSECT DIRECT EXAM 39.00 $35.10 $15.60 $31.20 $21.84 $27.30 $24.96 $31.20 $30.42 $17.55 $15.99 $16.38 $15.60 $29.25 $25.35
WWH LAB/RAD FEE SCHEDULE - 4206 17008895 87169 HCHG PARASITE DIRECT EXAM 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH LAB/RAD FEE SCHEDULE - 4206 17008900 87172 HCHG PINWORM PREP 43.00 $38.70 $17.20 $34.40 $24.08 $30.10 $27.52 $34.40 $33.54 $19.35 $17.63 $18.06 $17.20 $32.25 $27.95
WWH LAB/RAD FEE SCHEDULE - 4206 17008905 87176 HCHG TISSUE HOMOGENIZATION 49.00 $44.10 $19.60 $39.20 $27.44 $34.30 $31.36 $39.20 $38.22 $22.05 $20.09 $20.58 $19.60 $36.75 $31.85
WWH LAB/RAD FEE SCHEDULE - 4206 17008910 87177 (IA) HCHG O&P CONCENTRATE 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 17008970 87184 HCHG ADDL DISC SUSCEPT 44.00 $39.60 $17.60 $35.20 $24.64 $30.80 $28.16 $35.20 $34.32 $19.80 $18.04 $18.48 $17.60 $33.00 $28.60
WWH LAB/RAD FEE SCHEDULE - 4206 17008990 87185 HCHG BETA LACTAMASE 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH LAB/RAD FEE SCHEDULE - 4206 17009000 87186 HCHG MIC VITEK 93.00 $83.70 $37.20 $74.40 $52.08 $65.10 $59.52 $74.40 $72.54 $41.85 $38.13 $39.06 $37.20 $69.75 $60.45
WWH LAB/RAD FEE SCHEDULE - 4206 17009005 87186 HCHG MIC MICROTITER 93.00 $83.70 $37.20 $74.40 $52.08 $65.10 $59.52 $74.40 $72.54 $41.85 $38.13 $39.06 $37.20 $69.75 $60.45
WWH LAB/RAD FEE SCHEDULE - 4206 17009075 87205 HCHG GRAM STAIN 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH LAB/RAD FEE SCHEDULE - 4206 17009130 87206 HCHG AFB SMEAR (AFS) 57.00 $51.30 $22.80 $45.60 $31.92 $39.90 $36.48 $45.60 $44.46 $25.65 $23.37 $23.94 $22.80 $42.75 $37.05
WWH LAB/RAD FEE SCHEDULE - 4206 17009155 87207 HCHG MAL/PAR SMEAR 49.00 $44.10 $19.60 $39.20 $27.44 $34.30 $31.36 $39.20 $38.22 $22.05 $20.09 $20.58 $19.60 $36.75 $31.85
WWH LAB/RAD FEE SCHEDULE - 4206 17009160 87207 HCHG EHRLICHIOSIS 49.00 $44.10 $19.60 $39.20 $27.44 $34.30 $31.36 $39.20 $38.22 $22.05 $20.09 $20.58 $19.60 $36.75 $31.85
WWH LAB/RAD FEE SCHEDULE - 4206 17009190 87210 HCHG KOH PREP OTHER SOURCE 30.00 $27.00 $12.00 $24.00 $16.80 $21.00 $19.20 $24.00 $23.40 $13.50 $12.30 $12.60 $12.00 $22.50 $19.50
WWH LAB/RAD FEE SCHEDULE - 4206 17009200 87210 HCHG TRICH/YEAST/CLUE 42.00 $37.80 $16.80 $33.60 $23.52 $29.40 $26.88 $33.60 $32.76 $18.90 $17.22 $17.64 $16.80 $31.50 $27.30
WWH LAB/RAD FEE SCHEDULE - 4206 17009210 87220 "HCHG KOH-SKIN, HAIR, NAILS" 46.00 $41.40 $18.40 $36.80 $25.76 $32.20 $29.44 $36.80 $35.88 $20.70 $18.86 $19.32 $18.40 $34.50 $29.90
WWH LAB/RAD FEE SCHEDULE - 4206 17009840 87449 HCHG LEGIONELLA ANTIGEN URINE 109.00 $98.10 $43.60 $87.20 $61.04 $76.30 $69.76 $87.20 $85.02 $49.05 $44.69 $45.78 $43.60 $81.75 $70.85
WWH LAB/RAD FEE SCHEDULE - 4206 17009875 87329 (IA) HCHG GIARDIA ANTIGEN 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH LAB/RAD FEE SCHEDULE - 4206 17009880 87328 (IA) HCHG CRYTOSPORIDIUM TEST 114.00 $102.60 $45.60 $91.20 $63.84 $79.80 $72.96 $91.20 $88.92 $51.30 $46.74 $47.88 $45.60 $85.50 $74.10
WWH LAB/RAD FEE SCHEDULE - 4206 17009900 87400 HCHG INFLUENZA A AGN 67.00 $60.30 $26.80 $53.60 $37.52 $46.90 $42.88 $53.60 $52.26 $30.15 $27.47 $28.14 $26.80 $50.25 $43.55
WWH LAB/RAD FEE SCHEDULE - 4206 17009905 87400 HCHG INFLUENZA B AGN 67.00 $60.30 $26.80 $53.60 $37.52 $46.90 $42.88 $53.60 $52.26 $30.15 $27.47 $28.14 $26.80 $50.25 $43.55
WWH LAB/RAD FEE SCHEDULE - 4206 17009930 87491 HCHG GENERAL LAB 8749100 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 17009990 87591 HCHG GENERAL LAB 8759100 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 17010005 87880 HCHG RAPID STREP A THROAT-SAT 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH LAB/RAD FEE SCHEDULE - 4206 17010010 87327 HCHG CRYPTOCOCCAL AG-QUAL 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH LAB/RAD FEE SCHEDULE - 4206 17010145 88108 HCHG CYTO FLUID TP 184.00 $165.60 $73.60 $147.20 $103.04 $128.80 $117.76 $147.20 $143.52 $82.80 $75.44 $77.28 $73.60 $138.00 $119.60
WWH LAB/RAD FEE SCHEDULE - 4206 17010255 88172 HCHG FNA STAT ADQ X1 PATH 304.00 $273.60 $121.60 $243.20 $170.24 $212.80 $194.56 $243.20 $237.12 $136.80 $124.64 $127.68 $121.60 $228.00 $197.60
WWH LAB/RAD FEE SCHEDULE - 4206 17010265 88173 HCHG FNA INTERP & REPORT 559.00 $503.10 $223.60 $447.20 $313.04 $391.30 $357.76 $447.20 $436.02 $251.55 $229.19 $234.78 $223.60 $419.25 $363.35
WWH LAB/RAD FEE SCHEDULE - 4206 17010290 88300 HCHG TISSUE LEVEL 1 149.00 $134.10 $59.60 $119.20 $83.44 $104.30 $95.36 $119.20 $116.22 $67.05 $61.09 $62.58 $59.60 $111.75 $96.85
WWH LAB/RAD FEE SCHEDULE - 4206 17010305 88302 HCHG TISSUE LEVEL 2 291.00 $261.90 $116.40 $232.80 $162.96 $203.70 $186.24 $232.80 $226.98 $130.95 $119.31 $122.22 $116.40 $218.25 $189.15
WWH LAB/RAD FEE SCHEDULE - 4206 17010325 88304 HCHG TISSUE LEVEL 3 480.00 $432.00 $192.00 $384.00 $268.80 $336.00 $307.20 $384.00 $374.40 $216.00 $196.80 $201.60 $192.00 $360.00 $312.00
WWH LAB/RAD FEE SCHEDULE - 4206 17010365 88305 HCHG TISSUE LEVEL IV 757.00 $681.30 $302.80 $605.60 $423.92 $529.90 $484.48 $605.60 $590.46 $340.65 $310.37 $317.94 $302.80 $567.75 $492.05
WWH LAB/RAD FEE SCHEDULE - 4206 17010420 88307 HCHG TISSUE LEVEL 5 787.00 $708.30 $314.80 $629.60 $440.72 $550.90 $503.68 $629.60 $613.86 $354.15 $322.67 $330.54 $314.80 $590.25 $511.55
WWH LAB/RAD FEE SCHEDULE - 4206 17010435 88309 HCHG TISSUE LEVEL 6 787.00 $708.30 $314.80 $629.60 $440.72 $550.90 $503.68 $629.60 $613.86 $354.15 $322.67 $330.54 $314.80 $590.25 $511.55
WWH LAB/RAD FEE SCHEDULE - 4206 17010450 88311 HCHG DECALCIFICATION 119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
WWH LAB/RAD FEE SCHEDULE - 4206 17010470 88312 HCHG SP STAIN 1 ORG 282.00 $253.80 $112.80 $225.60 $157.92 $197.40 $180.48 $225.60 $219.96 $126.90 $115.62 $118.44 $112.80 $211.50 $183.30
WWH LAB/RAD FEE SCHEDULE - 4206 17010490 88313 HCHG STAIN SPEC 2 OTHER 387.00 $348.30 $154.80 $309.60 $216.72 $270.90 $247.68 $309.60 $301.86 $174.15 $158.67 $162.54 $154.80 $290.25 $251.55
WWH LAB/RAD FEE SCHEDULE - 4206 17010505 87209 (IA) HCHG O & P STAIN 73.00 $65.70 $29.20 $58.40 $40.88 $51.10 $46.72 $58.40 $56.94 $32.85 $29.93 $30.66 $29.20 $54.75 $47.45
WWH LAB/RAD FEE SCHEDULE - 4206 17010600 88331 HCHG FRZ SECTION 1ST 470.00 $423.00 $188.00 $376.00 $263.20 $329.00 $300.80 $376.00 $366.60 $211.50 $192.70 $197.40 $188.00 $352.50 $305.50
WWH LAB/RAD FEE SCHEDULE - 4206 17010610 88332 HCHG FRZ SECTION ADDTL BLK 291.00 $261.90 $116.40 $232.80 $162.96 $203.70 $186.24 $232.80 $226.98 $130.95 $119.31 $122.22 $116.40 $218.25 $189.15
WWH LAB/RAD FEE SCHEDULE - 4206 17010625 88342 HCHG IHC STAIN FIRST 515.00 $463.50 $206.00 $412.00 $288.40 $360.50 $329.60 $412.00 $401.70 $231.75 $211.15 $216.30 $206.00 $386.25 $334.75
WWH LAB/RAD FEE SCHEDULE - 4206 17010815 88142 HCHG THIN PREP PAP DIAGNOSTIC 100.00 $90.00 $40.00 $80.00 $56.00 $70.00 $64.00 $80.00 $78.00 $45.00 $41.00 $42.00 $40.00 $75.00 $65.00
WWH LAB/RAD FEE SCHEDULE - 4206 17010820 G0123 HCHG THIN PREP PAP ROUTINE 73.00 $65.70 $29.20 $58.40 $40.88 $51.10 $46.72 $58.40 $56.94 $32.85 $29.93 $30.66 $29.20 $54.75 $47.45
WWH LAB/RAD FEE SCHEDULE - 4206 17011880 86359 HCHG TOTAL T CELLS 143.00 $128.70 $57.20 $114.40 $80.08 $100.10 $91.52 $114.40 $111.54 $64.35 $58.63 $60.06 $57.20 $107.25 $92.95
WWH LAB/RAD FEE SCHEDULE - 4206 17011885 86360 HCHG CD4/CD8 157.00 $141.30 $62.80 $125.60 $87.92 $109.90 $100.48 $125.60 $122.46 $70.65 $64.37 $65.94 $62.80 $117.75 $102.05
WWH LAB/RAD FEE SCHEDULE - 4206 17012440 86850 HCHG ABY SCREEN 94.00 $84.60 $37.60 $75.20 $52.64 $65.80 $60.16 $75.20 $73.32 $42.30 $38.54 $39.48 $37.60 $70.50 $61.10
WWH LAB/RAD FEE SCHEDULE - 4206 17012455 86860 HCHG MBC ELUTION STUDY 138.00 $124.20 $55.20 $110.40 $77.28 $96.60 $88.32 $110.40 $107.64 $62.10 $56.58 $57.96 $55.20 $103.50 $89.70
WWH LAB/RAD FEE SCHEDULE - 4206 17012490 86870 HCHG ANTIBODY ID-HP 122.00 $109.80 $48.80 $97.60 $68.32 $85.40 $78.08 $97.60 $95.16 $54.90 $50.02 $51.24 $48.80 $91.50 $79.30
WWH LAB/RAD FEE SCHEDULE - 4206 17012495 86870 HCHG MBC-RED CELL PANEL 187.00 $168.30 $74.80 $149.60 $104.72 $130.90 $119.68 $149.60 $145.86 $84.15 $76.67 $78.54 $74.80 $140.25 $121.55
WWH LAB/RAD FEE SCHEDULE - 4206 17012505 86880 HCHG DIRECT ANTIGLOBULIN TEST 55.00 $49.50 $22.00 $44.00 $30.80 $38.50 $35.20 $44.00 $42.90 $24.75 $22.55 $23.10 $22.00 $41.25 $35.75
WWH LAB/RAD FEE SCHEDULE - 4206 17012525 86880 HCHG FETAL DIRECT COOMBS 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 17012540 86880 HCHG CORD DAT 55.00 $49.50 $22.00 $44.00 $30.80 $38.50 $35.20 $44.00 $42.90 $24.75 $22.55 $23.10 $22.00 $41.25 $35.75
WWH LAB/RAD FEE SCHEDULE - 4206 17012585 86900 HCHG ABO GROUP 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH LAB/RAD FEE SCHEDULE - 4206 17012615 86900 HCHG FETAL ABO 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH LAB/RAD FEE SCHEDULE - 4206 17012645 86900 HCHG CORD ABO GROUP 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH LAB/RAD FEE SCHEDULE - 4206 17012650 86901 HCHG RH (D) TYPE 72.00 $64.80 $28.80 $57.60 $40.32 $50.40 $46.08 $57.60 $56.16 $32.40 $29.52 $30.24 $28.80 $54.00 $46.80
WWH LAB/RAD FEE SCHEDULE - 4206 17012655 86901 HCHG WEAK DU 43.00 $38.70 $17.20 $34.40 $24.08 $30.10 $27.52 $34.40 $33.54 $19.35 $17.63 $18.06 $17.20 $32.25 $27.95
WWH LAB/RAD FEE SCHEDULE - 4206 17012685 86901 HCHG FETAL RH TYPE 70.00 $63.00 $28.00 $56.00 $39.20 $49.00 $44.80 $56.00 $54.60 $31.50 $28.70 $29.40 $28.00 $52.50 $45.50
WWH LAB/RAD FEE SCHEDULE - 4206 17012730 86901 HCHG CORD RH TYPE 72.00 $64.80 $28.80 $57.60 $40.32 $50.40 $46.08 $57.60 $56.16 $32.40 $29.52 $30.24 $28.80 $54.00 $46.80
WWH LAB/RAD FEE SCHEDULE - 4206 17012735 86902 HCHG MBC ANTIGEN TYPING EACH 94.00 $84.60 $37.60 $75.20 $52.64 $65.80 $60.16 $75.20 $73.32 $42.30 $38.54 $39.48 $37.60 $70.50 $61.10
WWH LAB/RAD FEE SCHEDULE - 4206 17012755 86905 HCHG PATIENT ANTIGEN 79.00 $71.10 $31.60 $63.20 $44.24 $55.30 $50.56 $63.20 $61.62 $35.55 $32.39 $33.18 $31.60 $59.25 $51.35
WWH LAB/RAD FEE SCHEDULE - 4206 17012765 86905 HCHG MBC-RED CELL PHENOTYPE 79.00 $71.10 $31.60 $63.20 $44.24 $55.30 $50.56 $63.20 $61.62 $35.55 $32.39 $33.18 $31.60 $59.25 $51.35
WWH LAB/RAD FEE SCHEDULE - 4206 17012815 86922 HCHG MBC CROSSMATCH 174.00 $156.60 $69.60 $139.20 $97.44 $121.80 $111.36 $139.20 $135.72 $78.30 $71.34 $73.08 $69.60 $130.50 $113.10
WWH LAB/RAD FEE SCHEDULE - 4206 17012950 P9044 HCHG PLASMA CRYO REDUCED 320.00 $288.00 $128.00 $256.00 $179.20 $224.00 $204.80 $256.00 $249.60 $144.00 $131.20 $134.40 $128.00 $240.00 $208.00
WWH LAB/RAD FEE SCHEDULE - 4206 17012965 P9040 HCHG RBC LR IRR 344.00 $309.60 $137.60 $275.20 $192.64 $240.80 $220.16 $275.20 $268.32 $154.80 $141.04 $144.48 $137.60 $258.00 $223.60
WWH LAB/RAD FEE SCHEDULE - 4206 17013225 P9012 HCHG CRYOPRECIPITATE 104.00 $93.60 $41.60 $83.20 $58.24 $72.80 $66.56 $83.20 $81.12 $46.80 $42.64 $43.68 $41.60 $78.00 $67.60
WWH LAB/RAD FEE SCHEDULE - 4206 17013265 P9016 HCHG RBC LR UNIT 676.00 $608.40 $270.40 $540.80 $378.56 $473.20 $432.64 $540.80 $527.28 $304.20 $277.16 $283.92 $270.40 $507.00 $439.40
WWH LAB/RAD FEE SCHEDULE - 4206 17020000 87081 HCHG METH RES STAPH CULTURE 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 17020010 87425 (IA) HCHG ROTAVIRUS ANTIGEN STOOL 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH LAB/RAD FEE SCHEDULE - 4206 17020011 82810 HCHG O2 SAT MEASURED 44.00 $39.60 $17.60 $35.20 $24.64 $30.80 $28.16 $35.20 $34.32 $19.80 $18.04 $18.48 $17.60 $33.00 $28.60
WWH LAB/RAD FEE SCHEDULE - 4206 17020012 83880 HCHG BRAIN NATRIURETIC PEPTIDE 217.00 $195.30 $86.80 $173.60 $121.52 $151.90 $138.88 $173.60 $169.26 $97.65 $88.97 $91.14 $86.80 $162.75 $141.05
WWH LAB/RAD FEE SCHEDULE - 4206 17020013 86880 HCHG IGG ANTIHUMAN GLOBULIN 55.00 $49.50 $22.00 $44.00 $30.80 $38.50 $35.20 $44.00 $42.90 $24.75 $22.55 $23.10 $22.00 $41.25 $35.75
WWH LAB/RAD FEE SCHEDULE - 4206 17020033 80156 HCHG CARBAMAZEPINE TOTAL 116.00 $104.40 $46.40 $92.80 $64.96 $81.20 $74.24 $92.80 $90.48 $52.20 $47.56 $48.72 $46.40 $87.00 $75.40
WWH LAB/RAD FEE SCHEDULE - 4206 17020034 80157 HCHG CARBAMAZEPINE FREE 97.00 $87.30 $38.80 $77.60 $54.32 $67.90 $62.08 $77.60 $75.66 $43.65 $39.77 $40.74 $38.80 $72.75 $63.05
WWH LAB/RAD FEE SCHEDULE - 4206 17020067 87624 HCHG GENERAL LAB 8762400 198.00 $178.20 $79.20 $158.40 $110.88 $138.60 $126.72 $158.40 $154.44 $89.10 $81.18 $83.16 $79.20 $148.50 $128.70
WWH LAB/RAD FEE SCHEDULE - 4206 17020126 86922 HCHG CROSSMATCH AHG 144.00 $129.60 $57.60 $115.20 $80.64 $100.80 $92.16 $115.20 $112.32 $64.80 $59.04 $60.48 $57.60 $108.00 $93.60
WWH LAB/RAD FEE SCHEDULE - 4206 17020139 G0480 HCHG PHENCYCLIDINE (PCP) QUAL UR 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 17020143 83018 "HCHG COBALT, SERUM" 139.00 $125.10 $55.60 $111.20 $77.84 $97.30 $88.96 $111.20 $108.42 $62.55 $56.99 $58.38 $55.60 $104.25 $90.35
WWH LAB/RAD FEE SCHEDULE - 4206 17020194 87807 HCHG RSV RAPID ANTIGEN 119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
WWH LAB/RAD FEE SCHEDULE - 4206 17020229 82175 "HCHG ARSENIC,BLOOD" 83.00 $74.70 $33.20 $66.40 $46.48 $58.10 $53.12 $66.40 $64.74 $37.35 $34.03 $34.86 $33.20 $62.25 $53.95
WWH LAB/RAD FEE SCHEDULE - 4206 17020257 82951 HCHG GTT 128.00 $115.20 $51.20 $102.40 $71.68 $89.60 $81.92 $102.40 $99.84 $57.60 $52.48 $53.76 $51.20 $96.00 $83.20
WWH LAB/RAD FEE SCHEDULE - 4206 17020258 82952 HCHG GLUCOSE TOLERANCE 1ST ADDL 40.00 $36.00 $16.00 $32.00 $22.40 $28.00 $25.60 $32.00 $31.20 $18.00 $16.40 $16.80 $16.00 $30.00 $26.00
WWH LAB/RAD FEE SCHEDULE - 4206 17020259 82340 HCHG CALCIUM URINE 62.00 $55.80 $24.80 $49.60 $34.72 $43.40 $39.68 $49.60 $48.36 $27.90 $25.42 $26.04 $24.80 $46.50 $40.30
WWH LAB/RAD FEE SCHEDULE - 4206 17020262 82803 HCHG BLOOD GAS CORD ARTERIAL 114.00 $102.60 $45.60 $91.20 $63.84 $79.80 $72.96 $91.20 $88.92 $51.30 $46.74 $47.88 $45.60 $85.50 $74.10
WWH LAB/RAD FEE SCHEDULE - 4206 17020263 82803 HCHG BLOOD GAS CORD VENOUS 114.00 $102.60 $45.60 $91.20 $63.84 $79.80 $72.96 $91.20 $88.92 $51.30 $46.74 $47.88 $45.60 $85.50 $74.10
WWH LAB/RAD FEE SCHEDULE - 4206 17020271 86317 HCHG TETANUS IMMUNE STATUS 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 17020275 80202 HCHG VANCOMYCIN PEAK 142.00 $127.80 $56.80 $113.60 $79.52 $99.40 $90.88 $113.60 $110.76 $63.90 $58.22 $59.64 $56.80 $106.50 $92.30
WWH LAB/RAD FEE SCHEDULE - 4206 17020276 80202 HCHG VANCOMYCIN TROUGH 142.00 $127.80 $56.80 $113.60 $79.52 $99.40 $90.88 $113.60 $110.76 $63.90 $58.22 $59.64 $56.80 $106.50 $92.30
WWH LAB/RAD FEE SCHEDULE - 4206 17020283 81003 HCHG OCCULT BLOOD URINE 28.00 $25.20 $11.20 $22.40 $15.68 $19.60 $17.92 $22.40 $21.84 $12.60 $11.48 $11.76 $11.20 $21.00 $18.20
WWH LAB/RAD FEE SCHEDULE - 4206 17020293 84154 "HCHG PSA,FREE" 149.00 $134.10 $59.60 $119.20 $83.44 $104.30 $95.36 $119.20 $116.22 $67.05 $61.09 $62.58 $59.60 $111.75 $96.85
WWH LAB/RAD FEE SCHEDULE - 4206 17020305 81003 HCHG PH URINE 28.00 $25.20 $11.20 $22.40 $15.68 $19.60 $17.92 $22.40 $21.84 $12.60 $11.48 $11.76 $11.20 $21.00 $18.20
WWH LAB/RAD FEE SCHEDULE - 4206 17020327 86156 HCHG COLD AGGLUTININ SCREEN AFFILIATE ONLY 29.00 $26.10 $11.60 $23.20 $16.24 $20.30 $18.56 $23.20 $22.62 $13.05 $11.89 $12.18 $11.60 $21.75 $18.85
WWH LAB/RAD FEE SCHEDULE - 4206 17020366 86078 HCHG TRANSFUSION REACTION 352.00 $316.80 $140.80 $281.60 $197.12 $246.40 $225.28 $281.60 $274.56 $158.40 $144.32 $147.84 $140.80 $264.00 $228.80
WWH LAB/RAD FEE SCHEDULE - 4206 17020371 G0480 HCHG BENZODIAZEPHINE QUAL URINE 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 17020373 83520 (IA) HCHG SOLUBLE TRANSFERRIN RECEPTOR 118.00 $106.20 $47.20 $94.40 $66.08 $82.60 $75.52 $94.40 $92.04 $53.10 $48.38 $49.56 $47.20 $88.50 $76.70
WWH LAB/RAD FEE SCHEDULE - 4206 17020379 86695 HCHG GENERAL LAB 8669500 99.00 $89.10 $39.60 $79.20 $55.44 $69.30 $63.36 $79.20 $77.22 $44.55 $40.59 $41.58 $39.60 $74.25 $64.35
WWH LAB/RAD FEE SCHEDULE - 4206 17020380 86696 HCHG GENERAL LAB 8669600 107.00 $96.30 $42.80 $85.60 $59.92 $74.90 $68.48 $85.60 $83.46 $48.15 $43.87 $44.94 $42.80 $80.25 $69.55
WWH LAB/RAD FEE SCHEDULE - 4206 17020384 85576 HCHG COLLAGEN/EPI 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 17020385 85576 HCHG COLLAGEN/ADP 169.00 $152.10 $67.60 $135.20 $94.64 $118.30 $108.16 $135.20 $131.82 $76.05 $69.29 $70.98 $67.60 $126.75 $109.85
WWH LAB/RAD FEE SCHEDULE - 4206 17020436 P9058 HCHG RBC LR IRR CMV NEG 551.00 $495.90 $220.40 $440.80 $308.56 $385.70 $352.64 $440.80 $429.78 $247.95 $225.91 $231.42 $220.40 $413.25 $358.15
WWH LAB/RAD FEE SCHEDULE - 4206 17020439 82042 HCHG ALBUMIN CSF 35.00 $31.50 $14.00 $28.00 $19.60 $24.50 $22.40 $28.00 $27.30 $15.75 $14.35 $14.70 $14.00 $26.25 $22.75
WWH LAB/RAD FEE SCHEDULE - 4206 17020729 G0306 "HCHG CBC WITH DIFF, NO PLATELET" 96.00 $86.40 $38.40 $76.80 $53.76 $67.20 $61.44 $76.80 $74.88 $43.20 $39.36 $40.32 $38.40 $72.00 $62.40
WWH LAB/RAD FEE SCHEDULE - 4206 17020741 86703 HCHG GENERAL LAB 8670301 153.00 $137.70 $61.20 $122.40 $85.68 $107.10 $97.92 $122.40 $119.34 $68.85 $62.73 $64.26 $61.20 $114.75 $99.45
WWH LAB/RAD FEE SCHEDULE - 4206 17020751 88112 HCHG NON-GYN THIN PREP 480.00 $432.00 $192.00 $384.00 $268.80 $336.00 $307.20 $384.00 $374.40 $216.00 $196.80 $201.60 $192.00 $360.00 $312.00
WWH LAB/RAD FEE SCHEDULE - 4206 17020899 J2790 HCHG RHO D IMMUNE GLOB 179.00 $161.10 $71.60 $143.20 $100.24 $125.30 $114.56 $143.20 $139.62 $80.55 $73.39 $75.18 $71.60 $134.25 $116.35
WWH LAB/RAD FEE SCHEDULE - 4206 17020941 80307 HCHG FLUNITRAZEPAM SCREEN URINE 259.00 $233.10 $103.60 $207.20 $145.04 $181.30 $165.76 $207.20 $202.02 $116.55 $106.19 $108.78 $103.60 $194.25 $168.35
WWH LAB/RAD FEE SCHEDULE - 4206 17021131 83520 (IA) HCHG NEURON SPECIFIC ENOLASE CSF 164.00 $147.60 $65.60 $131.20 $91.84 $114.80 $104.96 $131.20 $127.92 $73.80 $67.24 $68.88 $65.60 $123.00 $106.60
WWH LAB/RAD FEE SCHEDULE - 4206 17021303 88184 HCHG FLOW MARKER FIRST 670.00 $603.00 $268.00 $536.00 $375.20 $469.00 $428.80 $536.00 $522.60 $301.50 $274.70 $281.40 $268.00 $502.50 $435.50
WWH LAB/RAD FEE SCHEDULE - 4206 17021304 88185 HCHG FLOW MARKER ADDITIONAL 103.00 $92.70 $41.20 $82.40 $57.68 $72.10 $65.92 $82.40 $80.34 $46.35 $42.23 $43.26 $41.20 $77.25 $66.95
WWH LAB/RAD FEE SCHEDULE - 4206 17021305 88187 "HCHG FLOW MARKER, INTERP 2-8" 216.00 $194.40 $86.40 $172.80 $120.96 $151.20 $138.24 $172.80 $168.48 $97.20 $88.56 $90.72 $86.40 $162.00 $140.40
WWH LAB/RAD FEE SCHEDULE - 4206 17021306 88188 HCHG FLOW MARKER INTERP 9-15 279.00 $251.10 $111.60 $223.20 $156.24 $195.30 $178.56 $223.20 $217.62 $125.55 $114.39 $117.18 $111.60 $209.25 $181.35
WWH LAB/RAD FEE SCHEDULE - 4206 17021307 88189 HCHG FLOW MARKER INTERP 16 OR MORE 362.00 $325.80 $144.80 $289.60 $202.72 $253.40 $231.68 $289.60 $282.36 $162.90 $148.42 $152.04 $144.80 $271.50 $235.30
WWH LAB/RAD FEE SCHEDULE - 4206 17021309 83014 HCHG H PYLORI DRUG ADMINISTRATION 50.00 $45.00 $20.00 $40.00 $28.00 $35.00 $32.00 $40.00 $39.00 $22.50 $20.50 $21.00 $20.00 $37.50 $32.50
WWH LAB/RAD FEE SCHEDULE - 4206 17021434 83013 HCHG H PYLORI BREATH 247.00 $222.30 $98.80 $197.60 $138.32 $172.90 $158.08 $197.60 $192.66 $111.15 $101.27 $103.74 $98.80 $185.25 $160.55
WWH LAB/RAD FEE SCHEDULE - 4206 17021442 88360 HCHG IHC SEMIQUANT 737.00 $663.30 $294.80 $589.60 $412.72 $515.90 $471.68 $589.60 $574.86 $331.65 $302.17 $309.54 $294.80 $552.75 $479.05
WWH LAB/RAD FEE SCHEDULE - 4206 17021474 80307 HCHG NICOTINE SCREEN URINE 259.00 $233.10 $103.60 $207.20 $145.04 $181.30 $165.76 $207.20 $202.02 $116.55 $106.19 $108.78 $103.60 $194.25 $168.35
WWH LAB/RAD FEE SCHEDULE - 4206 17021480 88365 HCHG IN SITU HYBRIDIZATION FIRST 516.00 $464.40 $206.40 $412.80 $288.96 $361.20 $330.24 $412.80 $402.48 $232.20 $211.56 $216.72 $206.40 $387.00 $335.40
WWH LAB/RAD FEE SCHEDULE - 4206 17021618 83520 HCHG MG AD IMMUNO 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH LAB/RAD FEE SCHEDULE - 4206 17021619 83519 HCHG MG AD ABY 171.00 $153.90 $68.40 $136.80 $95.76 $119.70 $109.44 $136.80 $133.38 $76.95 $70.11 $71.82 $68.40 $128.25 $111.15
WWH LAB/RAD FEE SCHEDULE - 4206 17021820 G0480 HCHG METHADONE URINE QUANT 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 17022144 82495 HCHG CHROMIUM BLOOD 148.00 $133.20 $59.20 $118.40 $82.88 $103.60 $94.72 $118.40 $115.44 $66.60 $60.68 $62.16 $59.20 $111.00 $96.20
WWH LAB/RAD FEE SCHEDULE - 4206 17022444 82495 HCHG CHROMIUM SERUM MEDTOX 114.00 $102.60 $45.60 $91.20 $63.84 $79.80 $72.96 $91.20 $88.92 $51.30 $46.74 $47.88 $45.60 $85.50 $74.10
WWH LAB/RAD FEE SCHEDULE - 4206 17022550 83521 HCHG KAPPA FREE LIGHT CHAIN 143.00 $128.70 $57.20 $114.40 $80.08 $100.10 $91.52 $114.40 $111.54 $64.35 $58.63 $60.06 $57.20 $107.25 $92.95
WWH LAB/RAD FEE SCHEDULE - 4206 17022551 83521 HCHG LAMBDA FREE LIGHT CHAIN 143.00 $128.70 $57.20 $114.40 $80.08 $100.10 $91.52 $114.40 $111.54 $64.35 $58.63 $60.06 $57.20 $107.25 $92.95
WWH LAB/RAD FEE SCHEDULE - 4206 17022881 86890 HCHG ARC-AUTO DONATION SF 274.00 $246.60 $109.60 $219.20 $153.44 $191.80 $175.36 $219.20 $213.72 $123.30 $112.34 $115.08 $109.60 $205.50 $178.10
WWH LAB/RAD FEE SCHEDULE - 4206 17023016 80400 HCHG ACTH STIMULATION PANEL 314.00 $282.60 $125.60 $251.20 $175.84 $219.80 $200.96 $251.20 $244.92 $141.30 $128.74 $131.88 $125.60 $235.50 $204.10
WWH LAB/RAD FEE SCHEDULE - 4206 17023087 G0145 HCHG IMAGED THIN PREP PAP SCREEN 96.00 $86.40 $38.40 $76.80 $53.76 $67.20 $61.44 $76.80 $74.88 $43.20 $39.36 $40.32 $38.40 $72.00 $62.40
WWH LAB/RAD FEE SCHEDULE - 4206 17023088 88175 HCHG IMAGED THIN PREP PAP DIAGNOSTIC 101.00 $90.90 $40.40 $80.80 $56.56 $70.70 $64.64 $80.80 $78.78 $45.45 $41.41 $42.42 $40.40 $75.75 $65.65
WWH LAB/RAD FEE SCHEDULE - 4206 17023281 87522 HCHG GENERAL LAB 8752200 449.00 $404.10 $179.60 $359.20 $251.44 $314.30 $287.36 $359.20 $350.22 $202.05 $184.09 $188.58 $179.60 $336.75 $291.85
WWH LAB/RAD FEE SCHEDULE - 4206 17023365 82010 HCHG B-HYDROXYBUTYRATE 62.00 $55.80 $24.80 $49.60 $34.72 $43.40 $39.68 $49.60 $48.36 $27.90 $25.42 $26.04 $24.80 $46.50 $40.30
WWH LAB/RAD FEE SCHEDULE - 4206 17023500 82533 HCHG DEXAMETHASONE SUPP 180.00 $162.00 $72.00 $144.00 $100.80 $126.00 $115.20 $144.00 $140.40 $81.00 $73.80 $75.60 $72.00 $135.00 $117.00
WWH LAB/RAD FEE SCHEDULE - 4206 17023652 86147 HCHG CARDIOLIPIN IGA CRD 165.00 $148.50 $66.00 $132.00 $92.40 $115.50 $105.60 $132.00 $128.70 $74.25 $67.65 $69.30 $66.00 $123.75 $107.25
WWH LAB/RAD FEE SCHEDULE - 4206 17023653 86147 HCHG CARDIOLIPIN IGG CRD 165.00 $148.50 $66.00 $132.00 $92.40 $115.50 $105.60 $132.00 $128.70 $74.25 $67.65 $69.30 $66.00 $123.75 $107.25
WWH LAB/RAD FEE SCHEDULE - 4206 17023654 86147 HCHG CARDIOLIPIN IGM CRD 165.00 $148.50 $66.00 $132.00 $92.40 $115.50 $105.60 $132.00 $128.70 $74.25 $67.65 $69.30 $66.00 $123.75 $107.25
WWH LAB/RAD FEE SCHEDULE - 4206 17023765 85246 HCHG VON WILLEBRAND ANTIGEN 226.00 $203.40 $90.40 $180.80 $126.56 $158.20 $144.64 $180.80 $176.28 $101.70 $92.66 $94.92 $90.40 $169.50 $146.90
WWH LAB/RAD FEE SCHEDULE - 4206 17023766 85245 HCHG RISTOCETIN COFACTOR 171.00 $153.90 $68.40 $136.80 $95.76 $119.70 $109.44 $136.80 $133.38 $76.95 $70.11 $71.82 $68.40 $128.25 $111.15
WWH LAB/RAD FEE SCHEDULE - 4206 17023817 87449 HCHG STREP PNEUMONIAE ANTIGEN 109.00 $98.10 $43.60 $87.20 $61.04 $76.30 $69.76 $87.20 $85.02 $49.05 $44.69 $45.78 $43.60 $81.75 $70.85
WWH LAB/RAD FEE SCHEDULE - 4206 17023818 87660 HCHG TRICHOMONAS PROBE 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH LAB/RAD FEE SCHEDULE - 4206 17023819 87510 HCHG GARDNERELLA PROBE 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH LAB/RAD FEE SCHEDULE - 4206 17023820 87480 HCHG CANDIDA PROBE 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH LAB/RAD FEE SCHEDULE - 4206 17023831 82627 HCHG DHEA-SULFATE 220.00 $198.00 $88.00 $176.00 $123.20 $154.00 $140.80 $176.00 $171.60 $99.00 $90.20 $92.40 $88.00 $165.00 $143.00
WWH LAB/RAD FEE SCHEDULE - 4206 17023852 86200 HCHG CCP ANTIBODY IGG 135.00 $121.50 $54.00 $108.00 $75.60 $94.50 $86.40 $108.00 $105.30 $60.75 $55.35 $56.70 $54.00 $101.25 $87.75
WWH LAB/RAD FEE SCHEDULE - 4206 17023992 83520 "(IA) HCHG NEURON SPECIFIC ENOLASE, SERUM" 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH LAB/RAD FEE SCHEDULE - 4206 17024086 86480 HCHG QUANTIFERON TB GOLD PLUS 193.00 $173.70 $77.20 $154.40 $108.08 $135.10 $123.52 $154.40 $150.54 $86.85 $79.13 $81.06 $77.20 $144.75 $125.45
WWH LAB/RAD FEE SCHEDULE - 4206 17024124 87181 HCHG =E GRADIENT STRIP 36.00 $32.40 $14.40 $28.80 $20.16 $25.20 $23.04 $28.80 $28.08 $16.20 $14.76 $15.12 $14.40 $27.00 $23.40
WWH LAB/RAD FEE SCHEDULE - 4206 17024185 86235 HCHG SSB ANTIBODY 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 17024437 83018 "(IA) HCHG BISMUTH, BLOOD" 105.00 $94.50 $42.00 $84.00 $58.80 $73.50 $67.20 $84.00 $81.90 $47.25 $43.05 $44.10 $42.00 $78.75 $68.25
WWH LAB/RAD FEE SCHEDULE - 4206 17024480 83520 HCHG PNP RIA 100.00 $90.00 $40.00 $80.00 $56.00 $70.00 $64.00 $80.00 $78.00 $45.00 $41.00 $42.00 $40.00 $75.00 $65.00
WWH LAB/RAD FEE SCHEDULE - 4206 17024481 86255 HCHG PARANEOPLASTIC FLUORESCENT ABY SCR 54.00 $48.60 $21.60 $43.20 $30.24 $37.80 $34.56 $43.20 $42.12 $24.30 $22.14 $22.68 $21.60 $40.50 $35.10
WWH LAB/RAD FEE SCHEDULE - 4206 17024482 83519 HCHG PNP IA 171.00 $153.90 $68.40 $136.80 $95.76 $119.70 $109.44 $136.80 $133.38 $76.95 $70.11 $71.82 $68.40 $128.25 $111.15
WWH LAB/RAD FEE SCHEDULE - 4206 17024496 82542 HCHG N METHYLHISTAMINE URINE 142.00 $127.80 $56.80 $113.60 $79.52 $99.40 $90.88 $113.60 $110.76 $63.90 $58.22 $59.64 $56.80 $106.50 $92.30
WWH LAB/RAD FEE SCHEDULE - 4206 17024621 86316 HCHG CHROMOGRANIN A 217.00 $195.30 $86.80 $173.60 $121.52 $151.90 $138.88 $173.60 $169.26 $97.65 $88.97 $91.14 $86.80 $162.75 $141.05
WWH LAB/RAD FEE SCHEDULE - 4206 17024741 82947 HCHG FASTING GLUCOSE 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 17024742 82950 HCHG GLUCOSE 2 HOUR 48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
WWH LAB/RAD FEE SCHEDULE - 4206 17024968 87110 HCHG GENERAL LAB 8711000 78.00 $70.20 $31.20 $62.40 $43.68 $54.60 $49.92 $62.40 $60.84 $35.10 $31.98 $32.76 $31.20 $58.50 $50.70
WWH LAB/RAD FEE SCHEDULE - 4206 17024977 87653 HCHG GROUP B STREP RAPID DNA PCR 62.00 $55.80 $24.80 $49.60 $34.72 $43.40 $39.68 $49.60 $48.36 $27.90 $25.42 $26.04 $24.80 $46.50 $40.30
WWH LAB/RAD FEE SCHEDULE - 4206 17025012 86003 HCHG RAST IN-HOUSE 42.00 $37.80 $16.80 $33.60 $23.52 $29.40 $26.88 $33.60 $32.76 $18.90 $17.22 $17.64 $16.80 $31.50 $27.30
WWH LAB/RAD FEE SCHEDULE - 4206 17025082 82105 HCHG 2TS AFP 145.00 $130.50 $58.00 $116.00 $81.20 $101.50 $92.80 $116.00 $113.10 $65.25 $59.45 $60.90 $58.00 $108.75 $94.25
WWH LAB/RAD FEE SCHEDULE - 4206 17025083 82677 HCHG 2TS ESTRIOL 193.00 $173.70 $77.20 $154.40 $108.08 $135.10 $123.52 $154.40 $150.54 $86.85 $79.13 $81.06 $77.20 $144.75 $125.45
WWH LAB/RAD FEE SCHEDULE - 4206 17025084 84702 HCHG GENERAL LAB 8470203 132.00 $118.80 $52.80 $105.60 $73.92 $92.40 $84.48 $105.60 $102.96 $59.40 $54.12 $55.44 $52.80 $99.00 $85.80
WWH LAB/RAD FEE SCHEDULE - 4206 17025085 86336 HCHG 2TS INHIBIN A 126.00 $113.40 $50.40 $100.80 $70.56 $88.20 $80.64 $100.80 $98.28 $56.70 $51.66 $52.92 $50.40 $94.50 $81.90
WWH LAB/RAD FEE SCHEDULE - 4206 17025091 84560 HCHG URIC ACID BODY FLUID 45.00 $40.50 $18.00 $36.00 $25.20 $31.50 $28.80 $36.00 $35.10 $20.25 $18.45 $18.90 $18.00 $33.75 $29.25
WWH LAB/RAD FEE SCHEDULE - 4206 17025255 87491 HCHG GENERAL LAB 8749101 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 17025337 83519 HCHG NEURONAL (V-G) K+ CHANNEL ABY 171.00 $153.90 $68.40 $136.80 $95.76 $119.70 $109.44 $136.80 $133.38 $76.95 $70.11 $71.82 $68.40 $128.25 $111.15
WWH LAB/RAD FEE SCHEDULE - 4206 17025382 82306 HCHG VITAMIN D TOTAL 220.00 $198.00 $88.00 $176.00 $123.20 $154.00 $140.80 $176.00 $171.60 $99.00 $90.20 $92.40 $88.00 $165.00 $143.00
WWH LAB/RAD FEE SCHEDULE - 4206 17025511 80183 HCHG OXCARBAZEPINE (MEDTOX) TRILEPTAL 141.00 $126.90 $56.40 $112.80 $78.96 $98.70 $90.24 $112.80 $109.98 $63.45 $57.81 $59.22 $56.40 $105.75 $91.65
WWH LAB/RAD FEE SCHEDULE - 4206 17025678 86901 HCHG FETAL WEAK D 70.00 $63.00 $28.00 $56.00 $39.20 $49.00 $44.80 $56.00 $54.60 $31.50 $28.70 $29.40 $28.00 $52.50 $45.50
WWH LAB/RAD FEE SCHEDULE - 4206 17025695 G0480 HCHG BACLOFEN (LIORESAL) 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 17025823 80210 HCHG RUFINAMIDE 266.00 $239.40 $106.40 $212.80 $148.96 $186.20 $170.24 $212.80 $207.48 $119.70 $109.06 $111.72 $106.40 $199.50 $172.90
WWH LAB/RAD FEE SCHEDULE - 4206 17025948 87493 HCHG CLOSTRIDIUM DIFF TOXIN PCR 339.00 $305.10 $135.60 $271.20 $189.84 $237.30 $216.96 $271.20 $264.42 $152.55 $138.99 $142.38 $135.60 $254.25 $220.35
WWH LAB/RAD FEE SCHEDULE - 4206 17025995 80235 HCHG LACOSAMIDE VIMPAT 214.00 $192.60 $85.60 $171.20 $119.84 $149.80 $136.96 $171.20 $166.92 $96.30 $87.74 $89.88 $85.60 $160.50 $139.10
WWH LAB/RAD FEE SCHEDULE - 4206 17026019 86780 HCHG GENERAL LAB 8678000 70.00 $63.00 $28.00 $56.00 $39.20 $49.00 $44.80 $56.00 $54.60 $31.50 $28.70 $29.40 $28.00 $52.50 $45.50
WWH LAB/RAD FEE SCHEDULE - 4206 17026020 86593 HCHG GENERAL LAB 8659300 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH LAB/RAD FEE SCHEDULE - 4206 17026021 83519 (IA) HCHG ACETYLCHOLINE RECEPTOR MOD ABY 171.00 $153.90 $68.40 $136.80 $95.76 $119.70 $109.44 $136.80 $133.38 $76.95 $70.11 $71.82 $68.40 $128.25 $111.15
WWH LAB/RAD FEE SCHEDULE - 4206 17026049 86146 HCHG BETA 2 GLYCOPROTEIN 1 IGA 139.00 $125.10 $55.60 $111.20 $77.84 $97.30 $88.96 $111.20 $108.42 $62.55 $56.99 $58.38 $55.60 $104.25 $90.35
WWH LAB/RAD FEE SCHEDULE - 4206 17026050 86146 HCHG BETA 2 GLYCOPROTEIN 1 IGG 139.00 $125.10 $55.60 $111.20 $77.84 $97.30 $88.96 $111.20 $108.42 $62.55 $56.99 $58.38 $55.60 $104.25 $90.35
WWH LAB/RAD FEE SCHEDULE - 4206 17026051 86146 HCHG BETA 2 GLYCOPROTEIN 1 IGM 139.00 $125.10 $55.60 $111.20 $77.84 $97.30 $88.96 $111.20 $108.42 $62.55 $56.99 $58.38 $55.60 $104.25 $90.35
WWH LAB/RAD FEE SCHEDULE - 4206 17026097 82330 HCHG IONIZED CALCIUM POCT 143.00 $128.70 $57.20 $114.40 $80.08 $100.10 $91.52 $114.40 $111.54 $64.35 $58.63 $60.06 $57.20 $107.25 $92.95
WWH LAB/RAD FEE SCHEDULE - 4206 17026121 87427 HCHG SHIGA TOXIN 1 102.00 $91.80 $40.80 $81.60 $57.12 $71.40 $65.28 $81.60 $79.56 $45.90 $41.82 $42.84 $40.80 $76.50 $66.30
WWH LAB/RAD FEE SCHEDULE - 4206 17026122 87427 HCHG SHIGA TOXIN 2 102.00 $91.80 $40.80 $81.60 $57.12 $71.40 $65.28 $81.60 $79.56 $45.90 $41.82 $42.84 $40.80 $76.50 $66.30
WWH LAB/RAD FEE SCHEDULE - 4206 17026125 87045 HCHG STOOL CULT 88.00 $79.20 $35.20 $70.40 $49.28 $61.60 $56.32 $70.40 $68.64 $39.60 $36.08 $36.96 $35.20 $66.00 $57.20
WWH LAB/RAD FEE SCHEDULE - 4206 17026126 87046 HCHG AEROMONAS PLATE STL 42.00 $37.80 $16.80 $33.60 $23.52 $29.40 $26.88 $33.60 $32.76 $18.90 $17.22 $17.64 $16.80 $31.50 $27.30
WWH LAB/RAD FEE SCHEDULE - 4206 17026127 87046 HCHG E COLI 0157 PLATE STL 42.00 $37.80 $16.80 $33.60 $23.52 $29.40 $26.88 $33.60 $32.76 $18.90 $17.22 $17.64 $16.80 $31.50 $27.30
WWH LAB/RAD FEE SCHEDULE - 4206 17026156 87498 "(IA) HCHG ENTEROVIRUS BY PCR, CSF" 291.00 $261.90 $116.40 $232.80 $162.96 $203.70 $186.24 $232.80 $226.98 $130.95 $119.31 $122.22 $116.40 $218.25 $189.15
WWH LAB/RAD FEE SCHEDULE - 4206 17026157 87338 "HCHG H. PYLORI ANTIGEN, STOOL" 143.00 $128.70 $57.20 $114.40 $80.08 $100.10 $91.52 $114.40 $111.54 $64.35 $58.63 $60.06 $57.20 $107.25 $92.95
WWH LAB/RAD FEE SCHEDULE - 4206 17026159 82105 HCHG INTEGRATED SCREEN AFP 145.00 $130.50 $58.00 $116.00 $81.20 $101.50 $92.80 $116.00 $113.10 $65.25 $59.45 $60.90 $58.00 $108.75 $94.25
WWH LAB/RAD FEE SCHEDULE - 4206 17026160 82677 HCHG INTEGRATED SCREEN ESTRIOL 188.00 $169.20 $75.20 $150.40 $105.28 $131.60 $120.32 $150.40 $146.64 $84.60 $77.08 $78.96 $75.20 $141.00 $122.20
WWH LAB/RAD FEE SCHEDULE - 4206 17026161 84163 HCHG INTEGRATED SCREEN PAPPA 68.00 $61.20 $27.20 $54.40 $38.08 $47.60 $43.52 $54.40 $53.04 $30.60 $27.88 $28.56 $27.20 $51.00 $44.20
WWH LAB/RAD FEE SCHEDULE - 4206 17026162 84702 HCHG GENERAL LAB 8470204 132.00 $118.80 $52.80 $105.60 $73.92 $92.40 $84.48 $105.60 $102.96 $59.40 $54.12 $55.44 $52.80 $99.00 $85.80
WWH LAB/RAD FEE SCHEDULE - 4206 17026163 86336 HCHG INTEGRATED SCREEN INHIBIN 123.00 $110.70 $49.20 $98.40 $68.88 $86.10 $78.72 $98.40 $95.94 $55.35 $50.43 $51.66 $49.20 $92.25 $79.95
WWH LAB/RAD FEE SCHEDULE - 4206 17026167 84145 HCHG PROCALCITONIN 222.00 $199.80 $88.80 $177.60 $124.32 $155.40 $142.08 $177.60 $173.16 $99.90 $91.02 $93.24 $88.80 $166.50 $144.30
WWH LAB/RAD FEE SCHEDULE - 4206 17026170 82805 HCHG BLOOD GAS MEASURED O2 100.00 $90.00 $40.00 $80.00 $56.00 $70.00 $64.00 $80.00 $78.00 $45.00 $41.00 $42.00 $40.00 $75.00 $65.00
WWH LAB/RAD FEE SCHEDULE - 4206 17026171 80167 HCHG FELBAMATE MEDTOX 94.00 $84.60 $37.60 $75.20 $52.64 $65.80 $60.16 $75.20 $73.32 $42.30 $38.54 $39.48 $37.60 $70.50 $61.10
WWH LAB/RAD FEE SCHEDULE - 4206 17026200 P9017 HCHG FRESH FROZEN PLASMA 316.00 $284.40 $126.40 $252.80 $176.96 $221.20 $202.24 $252.80 $246.48 $142.20 $129.56 $132.72 $126.40 $237.00 $205.40
WWH LAB/RAD FEE SCHEDULE - 4206 17026287 80306 HCHG DRUGS OF ABUSE SCREEN RAPID URINE INHOUSE DAS 164.00 $147.60 $65.60 $131.20 $91.84 $114.80 $104.96 $131.20 $127.92 $73.80 $67.24 $68.88 $65.60 $123.00 $106.60
WWH LAB/RAD FEE SCHEDULE - 4206 17026342 G0480 (IA) HCHG COTININE ORAL QUAL 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 17026373 83018 HCHG COBALT BLOOD 139.00 $125.10 $55.60 $111.20 $77.84 $97.30 $88.96 $111.20 $108.42 $62.55 $56.99 $58.38 $55.60 $104.25 $90.35
WWH LAB/RAD FEE SCHEDULE - 4206 17026424 83529 (IA) HCHG INTERLEUKIN 6 IL 6 SERUM 168.00 $151.20 $67.20 $134.40 $94.08 $117.60 $107.52 $134.40 $131.04 $75.60 $68.88 $70.56 $67.20 $126.00 $109.20
WWH LAB/RAD FEE SCHEDULE - 4206 17026445 86053 "HCHG NMO/AQP4-IGG FACS, SERUM" 137.00 $123.30 $54.80 $109.60 $76.72 $95.90 $87.68 $109.60 $106.86 $61.65 $56.17 $57.54 $54.80 $102.75 $89.05
WWH LAB/RAD FEE SCHEDULE - 4206 17026458 86022 HCHG POLYSPECIFIC HEPARIN ANTIBODIES 148.00 $133.20 $59.20 $118.40 $82.88 $103.60 $94.72 $118.40 $115.44 $66.60 $60.68 $62.16 $59.20 $111.00 $96.20
WWH LAB/RAD FEE SCHEDULE - 4206 17026460 86022 HCHG IGG SPECIFIC HEPARIN ANTIBODIES 148.00 $133.20 $59.20 $118.40 $82.88 $103.60 $94.72 $118.40 $115.44 $66.60 $60.68 $62.16 $59.20 $111.00 $96.20
WWH LAB/RAD FEE SCHEDULE - 4206 17026545 83880 HCHG PRO-BNP 327.00 $294.30 $130.80 $261.60 $183.12 $228.90 $209.28 $261.60 $255.06 $147.15 $134.07 $137.34 $130.80 $245.25 $212.55
WWH LAB/RAD FEE SCHEDULE - 4206 17026576 87502 HCHG INFLUENZA A/B PCR 251.00 $225.90 $100.40 $200.80 $140.56 $175.70 $160.64 $200.80 $195.78 $112.95 $102.91 $105.42 $100.40 $188.25 $163.15
WWH LAB/RAD FEE SCHEDULE - 4206 17026577 87503 HCHG INFLUENZA DNA PROBE ADDL 77.00 $69.30 $30.80 $61.60 $43.12 $53.90 $49.28 $61.60 $60.06 $34.65 $31.57 $32.34 $30.80 $57.75 $50.05
WWH LAB/RAD FEE SCHEDULE - 4206 17026595 83704 HCHG NMR LIPOPROFILE 116.00 $104.40 $46.40 $92.80 $64.96 $81.20 $74.24 $92.80 $90.48 $52.20 $47.56 $48.72 $46.40 $87.00 $75.40
WWH LAB/RAD FEE SCHEDULE - 4206 17026612 85576 HCHG P2Y12 INHIBITION 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 17026630 81240 HCHG FACTOR 2 GENE MUTATION 475.00 $427.50 $190.00 $380.00 $266.00 $332.50 $304.00 $380.00 $370.50 $213.75 $194.75 $199.50 $190.00 $356.25 $308.75
WWH LAB/RAD FEE SCHEDULE - 4206 17026631 81241 HCHG FACTOR V LEIDEN MUTATION 396.00 $356.40 $158.40 $316.80 $221.76 $277.20 $253.44 $316.80 $308.88 $178.20 $162.36 $166.32 $158.40 $297.00 $257.40
WWH LAB/RAD FEE SCHEDULE - 4206 17026632 81256 HCHG H HEMACHROMATOSIS 644.00 $579.60 $257.60 $515.20 $360.64 $450.80 $412.16 $515.20 $502.32 $289.80 $264.04 $270.48 $257.60 $483.00 $418.60
WWH LAB/RAD FEE SCHEDULE - 4206 17026633 81270 HCHG JAK2 MUTATION DETECTION 600.00 $540.00 $240.00 $480.00 $336.00 $420.00 $384.00 $480.00 $468.00 $270.00 $246.00 $252.00 $240.00 $450.00 $390.00
WWH LAB/RAD FEE SCHEDULE - 4206 17026635 81291 HCHG MTHFR MUTATION 309.00 $278.10 $123.60 $247.20 $173.04 $216.30 $197.76 $247.20 $241.02 $139.05 $126.69 $129.78 $123.60 $231.75 $200.85
WWH LAB/RAD FEE SCHEDULE - 4206 17026639 81340 HCHG T CELL BETA PCR 647.00 $582.30 $258.80 $517.60 $362.32 $452.90 $414.08 $517.60 $504.66 $291.15 $265.27 $271.74 $258.80 $485.25 $420.55
WWH LAB/RAD FEE SCHEDULE - 4206 17026640 81342 HCHG T CELL GAMMA PCR 574.00 $516.60 $229.60 $459.20 $321.44 $401.80 $367.36 $459.20 $447.72 $258.30 $235.34 $241.08 $229.60 $430.50 $373.10
WWH LAB/RAD FEE SCHEDULE - 4206 17026661 81243 HCHG FRAGILE X SYNDROME 437.00 $393.30 $174.80 $349.60 $244.72 $305.90 $279.68 $349.60 $340.86 $196.65 $179.17 $183.54 $174.80 $327.75 $284.05
WWH LAB/RAD FEE SCHEDULE - 4206 17026667 81375 HCHG HLA DR AND DQ 769.00 $692.10 $307.60 $615.20 $430.64 $538.30 $492.16 $615.20 $599.82 $346.05 $315.29 $322.98 $307.60 $576.75 $499.85
WWH LAB/RAD FEE SCHEDULE - 4206 17026675 81255 (IA) HCHG TAY SACHS DNA AND ENZYME 314.00 $282.60 $125.60 $251.20 $175.84 $219.80 $200.96 $251.20 $244.92 $141.30 $128.74 $131.88 $125.60 $235.50 $204.10
WWH LAB/RAD FEE SCHEDULE - 4206 17026679 81220 (IA) HCHG CYSTIC FIBROSIS SCREEN IN HOUSE "1,033.00" $929.70 $413.20 $826.40 $578.48 $723.10 $661.12 $826.40 $805.74 $464.85 $423.53 $433.86 $413.20 $774.75 $671.45
WWH LAB/RAD FEE SCHEDULE - 4206 17026715 85046 HCHG RETIC HGB CONCENTRATE 46.00 $41.40 $18.40 $36.80 $25.76 $32.20 $29.44 $36.80 $35.88 $20.70 $18.86 $19.32 $18.40 $34.50 $29.90
WWH LAB/RAD FEE SCHEDULE - 4206 17026766 86300 HCHG CA15.3 216.00 $194.40 $86.40 $172.80 $120.96 $151.20 $138.24 $172.80 $168.48 $97.20 $88.56 $90.72 $86.40 $162.00 $140.40
WWH LAB/RAD FEE SCHEDULE - 4206 17026887 87804 HCHG INFLUENZA A&B 128.00 $115.20 $51.20 $102.40 $71.68 $89.60 $81.92 $102.40 $99.84 $57.60 $52.48 $53.76 $51.20 $96.00 $83.20
WWH LAB/RAD FEE SCHEDULE - 4206 17026895 87633 (IA) HCHG RESPIRATORY VIRUS PANEL (RVP) PCR 487.00 $438.30 $194.80 $389.60 $272.72 $340.90 $311.68 $389.60 $379.86 $219.15 $199.67 $204.54 $194.80 $365.25 $316.55
WWH LAB/RAD FEE SCHEDULE - 4206 17026902 82947 HCHG GLUCOSE TOLERANCE FASTING 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 17026984 87324 HCHG C DIFF TOXIN 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH LAB/RAD FEE SCHEDULE - 4206 17026985 87449 HCHG C DIFF ANTIGEN 109.00 $98.10 $43.60 $87.20 $61.04 $76.30 $69.76 $87.20 $85.02 $49.05 $44.69 $45.78 $43.60 $81.75 $70.85
WWH LAB/RAD FEE SCHEDULE - 4206 17026999 17026999 HCHG NO BILL LAB CODE 38.00 $34.20 $15.20 $30.40 $21.28 $26.60 $24.32 $30.40 $29.64 $17.10 $15.58 $15.96 $15.20 $28.50 $24.70
WWH LAB/RAD FEE SCHEDULE - 4206 17027010 86644 HCHG CMV IGG ABY 131.00 $117.90 $52.40 $104.80 $73.36 $91.70 $83.84 $104.80 $102.18 $58.95 $53.71 $55.02 $52.40 $98.25 $85.15
WWH LAB/RAD FEE SCHEDULE - 4206 17027013 86645 HCHG CMV IGM ABY 170.00 $153.00 $68.00 $136.00 $95.20 $119.00 $108.80 $136.00 $132.60 $76.50 $69.70 $71.40 $68.00 $127.50 $110.50
WWH LAB/RAD FEE SCHEDULE - 4206 17027140 87661 HCHG GENERAL LAB 8766100 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH LAB/RAD FEE SCHEDULE - 4206 17027145 G0452 HCHG MOLECULAR PHYS INTERP & RPT 116.00 $104.40 $46.40 $92.80 $64.96 $81.20 $74.24 $92.80 $90.48 $52.20 $47.56 $48.72 $46.40 $87.00 $75.40
WWH LAB/RAD FEE SCHEDULE - 4206 17027152 81329 HCHG SMA CARRIER TESTING LC 314.00 $282.60 $125.60 $251.20 $175.84 $219.80 $200.96 $251.20 $244.92 $141.30 $128.74 $131.88 $125.60 $235.50 $204.10
WWH LAB/RAD FEE SCHEDULE - 4206 17027211 87591 HCHG GENERAL LAB 8759102 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 17027212 86022 HCHG HEPARIN DEPENDENT PLT ABY-SRA UNFRACT 222.00 $199.80 $88.80 $177.60 $124.32 $155.40 $142.08 $177.60 $173.16 $99.90 $91.02 $93.24 $88.80 $166.50 $144.30
WWH LAB/RAD FEE SCHEDULE - 4206 17027223 G0480 HCHG EXPANDED OPIATE CONFIRM 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 17027237 80175 HCHG LAMOTRIGINE LMX 146.00 $131.40 $58.40 $116.80 $81.76 $102.20 $93.44 $116.80 $113.88 $65.70 $59.86 $61.32 $58.40 $109.50 $94.90
WWH LAB/RAD FEE SCHEDULE - 4206 17027238 80177 HCHG LEVETIRACETAM LVX 92.00 $82.80 $36.80 $73.60 $51.52 $64.40 $58.88 $73.60 $71.76 $41.40 $37.72 $38.64 $36.80 $69.00 $59.80
WWH LAB/RAD FEE SCHEDULE - 4206 17027239 80201 HCHG TOPIRAMATE TMX 146.00 $131.40 $58.40 $116.80 $81.76 $102.20 $93.44 $116.80 $113.88 $65.70 $59.86 $61.32 $58.40 $109.50 $94.90
WWH LAB/RAD FEE SCHEDULE - 4206 17027357 86832 HCHG HLA ABY CLASS I 628.00 $565.20 $251.20 $502.40 $351.68 $439.60 $401.92 $502.40 $489.84 $282.60 $257.48 $263.76 $251.20 $471.00 $408.20
WWH LAB/RAD FEE SCHEDULE - 4206 17027358 86833 HCHG HLA ABY CLASS II 501.00 $450.90 $200.40 $400.80 $280.56 $350.70 $320.64 $400.80 $390.78 $225.45 $205.41 $210.42 $200.40 $375.75 $325.65
WWH LAB/RAD FEE SCHEDULE - 4206 17027373 81235 HCHG EGFR "1,277.00" " $1,149.30 " $510.80 " $1,021.60 " $715.12 $893.90 $817.28 " $1,021.60 " $996.06 $574.65 $523.57 $536.34 $510.80 $957.75 $830.05
WWH LAB/RAD FEE SCHEDULE - 4206 17027438 87186 HCHG SUSCEPTIBILITY AEROBIC MAYO 62.00 $55.80 $24.80 $49.60 $34.72 $43.40 $39.68 $49.60 $48.36 $27.90 $25.42 $26.04 $24.80 $46.50 $40.30
WWH LAB/RAD FEE SCHEDULE - 4206 17027439 87077 HCHG ORGANISM REF FOR ID AEROBIC BACTERIA 110.00 $99.00 $44.00 $88.00 $61.60 $77.00 $70.40 $88.00 $85.80 $49.50 $45.10 $46.20 $44.00 $82.50 $71.50
WWH LAB/RAD FEE SCHEDULE - 4206 17027463 88341 HCHG IHC STAIN ADDL 234.00 $210.60 $93.60 $187.20 $131.04 $163.80 $149.76 $187.20 $182.52 $105.30 $95.94 $98.28 $93.60 $175.50 $152.10
WWH LAB/RAD FEE SCHEDULE - 4206 17027596 89190 HCHG EOSINOPHIL SMEAR NASAL 45.00 $40.50 $18.00 $36.00 $25.20 $31.50 $28.80 $36.00 $35.10 $20.25 $18.45 $18.90 $18.00 $33.75 $29.25
WWH LAB/RAD FEE SCHEDULE - 4206 17027667 87070 HCHG HARDWARE CULTURE 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH LAB/RAD FEE SCHEDULE - 4206 17027675 81219 HCHG CALRETICULIN EXON 9 ASSAY 587.00 $528.30 $234.80 $469.60 $328.72 $410.90 $375.68 $469.60 $457.86 $264.15 $240.67 $246.54 $234.80 $440.25 $381.55
WWH LAB/RAD FEE SCHEDULE - 4206 17027676 86036 HCHG ANCA 156.00 $140.40 $62.40 $124.80 $87.36 $109.20 $99.84 $124.80 $121.68 $70.20 $63.96 $65.52 $62.40 $117.00 $101.40
WWH LAB/RAD FEE SCHEDULE - 4206 17027677 86037 HCHG ANCA TITER 137.00 $123.30 $54.80 $109.60 $76.72 $95.90 $87.68 $109.60 $106.86 $61.65 $56.17 $57.54 $54.80 $102.75 $89.05
WWH LAB/RAD FEE SCHEDULE - 4206 17027678 86364 HCHG TISSUE TRANSGLUT IGA 137.00 $123.30 $54.80 $109.60 $76.72 $95.90 $87.68 $109.60 $106.86 $61.65 $56.17 $57.54 $54.80 $102.75 $89.05
WWH LAB/RAD FEE SCHEDULE - 4206 17027679 86364 HCHG TISSUE TRANSGLUTAMINASE IGG 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 17027680 86258 HCHG GLIADIN ABY IGA 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 17027682 86664 HCHG EBV NA 112.00 $100.80 $44.80 $89.60 $62.72 $78.40 $71.68 $89.60 $87.36 $50.40 $45.92 $47.04 $44.80 $84.00 $72.80
WWH LAB/RAD FEE SCHEDULE - 4206 17027683 86665 HCHG EBV VCA IGG 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 17027684 86665 HCHG EBV VCA IGM 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 17027685 86701 HCHG GENERAL LAB 8670101 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH LAB/RAD FEE SCHEDULE - 4206 17027686 86702 HCHG GENERAL LAB 8670200 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH LAB/RAD FEE SCHEDULE - 4206 17027688 87640 HCHG STAPH AUREUS PCR 131.00 $117.90 $52.40 $104.80 $73.36 $91.70 $83.84 $104.80 $102.18 $58.95 $53.71 $55.02 $52.40 $98.25 $85.15
WWH LAB/RAD FEE SCHEDULE - 4206 17027689 87641 HCHG MRSA PCR 133.00 $119.70 $53.20 $106.40 $74.48 $93.10 $85.12 $106.40 $103.74 $59.85 $54.53 $55.86 $53.20 $99.75 $86.45
WWH LAB/RAD FEE SCHEDULE - 4206 17027696 83655 (IA) HCHG LEAD TEST 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH LAB/RAD FEE SCHEDULE - 4206 17027697 82044 HCHG MICROALBUMIN SCREEN 46.00 $41.40 $18.40 $36.80 $25.76 $32.20 $29.44 $36.80 $35.88 $20.70 $18.86 $19.32 $18.40 $34.50 $29.90
WWH LAB/RAD FEE SCHEDULE - 4206 17027716 86617 (IA) HCHG LYMES WESTERN BLOT 102.00 $91.80 $40.80 $81.60 $57.12 $71.40 $65.28 $81.60 $79.56 $45.90 $41.82 $42.84 $40.80 $76.50 $66.30
WWH LAB/RAD FEE SCHEDULE - 4206 17027743 83018 HCHG BARIUM SERUM 201.00 $180.90 $80.40 $160.80 $112.56 $140.70 $128.64 $160.80 $156.78 $90.45 $82.41 $84.42 $80.40 $150.75 $130.65
WWH LAB/RAD FEE SCHEDULE - 4206 17027803 86430 HCHG RA QUAL HHC ONLY 57.00 $51.30 $22.80 $45.60 $31.92 $39.90 $36.48 $45.60 $44.46 $25.65 $23.37 $23.94 $22.80 $42.75 $37.05
WWH LAB/RAD FEE SCHEDULE - 4206 17027841 86703 HCHG GENERAL LAB 8670300 116.00 $104.40 $46.40 $92.80 $64.96 $81.20 $74.24 $92.80 $90.48 $52.20 $47.56 $48.72 $46.40 $87.00 $75.40
WWH LAB/RAD FEE SCHEDULE - 4206 17027897 88365 HCHG IN SITU HYBRIDIZATION FIRST TC ONLY 228.00 $205.20 $91.20 $182.40 $127.68 $159.60 $145.92 $182.40 $177.84 $102.60 $93.48 $95.76 $91.20 $171.00 $148.20
WWH LAB/RAD FEE SCHEDULE - 4206 17027898 88360 HCHG IHC STAIN MORPH ANALYSIS TC ONLY 488.00 $439.20 $195.20 $390.40 $273.28 $341.60 $312.32 $390.40 $380.64 $219.60 $200.08 $204.96 $195.20 $366.00 $317.20
WWH LAB/RAD FEE SCHEDULE - 4206 17027899 84432 (IA) HCHG THYROGLOB TUMOR MARKER 169.00 $152.10 $67.60 $135.20 $94.64 $118.30 $108.16 $135.20 $131.82 $76.05 $69.29 $70.98 $67.60 $126.75 $109.85
WWH LAB/RAD FEE SCHEDULE - 4206 17027900 86800 (IA) HCHG THYROGLOBULIN ABY SCREEN 158.00 $142.20 $63.20 $126.40 $88.48 $110.60 $101.12 $126.40 $123.24 $71.10 $64.78 $66.36 $63.20 $118.50 $102.70
WWH LAB/RAD FEE SCHEDULE - 4206 17027971 88364 HCHG IN SITU HYBRIDIZATION ADDL 731.00 $657.90 $292.40 $584.80 $409.36 $511.70 $467.84 $584.80 $570.18 $328.95 $299.71 $307.02 $292.40 $548.25 $475.15
WWH LAB/RAD FEE SCHEDULE - 4206 17027973 88344 HCHG IHC STAIN MULTIPLEX 637.00 $573.30 $254.80 $509.60 $356.72 $445.90 $407.68 $509.60 $496.86 $286.65 $261.17 $267.54 $254.80 $477.75 $414.05
WWH LAB/RAD FEE SCHEDULE - 4206 17028000 17028000 HCHG MISC VARIABLE CHARGE 108.00 $97.20 $43.20 $86.40 $60.48 $75.60 $69.12 $86.40 $84.24 $48.60 $44.28 $45.36 $43.20 $81.00 $70.20
WWH LAB/RAD FEE SCHEDULE - 4206 17028015 P9053 HCHG CMV NEG IRRAD PLATELETS AFFILIATE ONLY 579.00 $521.10 $231.60 $463.20 $324.24 $405.30 $370.56 $463.20 $451.62 $260.55 $237.39 $243.18 $231.60 $434.25 $376.35
WWH LAB/RAD FEE SCHEDULE - 4206 17028016 P9034 HCHG PLATELET PHERESIS AFFILIATE ONLY "1,614.00" " $1,452.60 " $645.60 " $1,291.20 " $903.84 " $1,129.80 " " $1,032.96 " " $1,291.20 " " $1,258.92 " $726.30 $661.74 $677.88 $645.60 " $1,210.50 " " $1,049.10 "
WWH LAB/RAD FEE SCHEDULE - 4206 17028017 P9019 HCHG PLATELET UNIT AFFILIATE ONLY 648.00 $583.20 $259.20 $518.40 $362.88 $453.60 $414.72 $518.40 $505.44 $291.60 $265.68 $272.16 $259.20 $486.00 $421.20
WWH LAB/RAD FEE SCHEDULE - 4206 17028083 80198 HCHG THEOPHYLLINE MTX 115.00 $103.50 $46.00 $92.00 $64.40 $80.50 $73.60 $92.00 $89.70 $51.75 $47.15 $48.30 $46.00 $86.25 $74.75
WWH LAB/RAD FEE SCHEDULE - 4206 17028101 84150 "HCHG PROSTAGLANDIN D2 (PG D2), SERUM OR URINE" 163.00 $146.70 $65.20 $130.40 $91.28 $114.10 $104.32 $130.40 $127.14 $73.35 $66.83 $68.46 $65.20 $122.25 $105.95
WWH LAB/RAD FEE SCHEDULE - 4206 17028134 86341 HCHG AUTOIMMUNE GAD65 ABY CSF 194.00 $174.60 $77.60 $155.20 $108.64 $135.80 $124.16 $155.20 $151.32 $87.30 $79.54 $81.48 $77.60 $145.50 $126.10
WWH LAB/RAD FEE SCHEDULE - 4206 17028136 86255 HCHG AUTOIMMUNE FLUORESCENT ABY SCR CSF 156.00 $140.40 $62.40 $124.80 $87.36 $109.20 $99.84 $124.80 $121.68 $70.20 $63.96 $65.52 $62.40 $117.00 $101.40
WWH LAB/RAD FEE SCHEDULE - 4206 17028162 86235 HCHG RO52 ANTIBODY 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 17028163 86235 HCHG RO60 ANTIBODY 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 17028226 86341 HCHG ENCEPHALOPATHY AUTOIMMUNE GAD65 ABY CSF 194.00 $174.60 $77.60 $155.20 $108.64 $135.80 $124.16 $155.20 $151.32 $87.30 $79.54 $81.48 $77.60 $145.50 $126.10
WWH LAB/RAD FEE SCHEDULE - 4206 17028227 86255 HCHG ENCEPHALOPATHY AUTOIMMUNE FLUORESCENT ABY SCR CSF 156.00 $140.40 $62.40 $124.80 $87.36 $109.20 $99.84 $124.80 $121.68 $70.20 $63.96 $65.52 $62.40 $117.00 $101.40
WWH LAB/RAD FEE SCHEDULE - 4206 17028232 G0480 HCHG ANTIDEPRESSANT DRUG SCR UR QT 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 17028413 80158 (IA) HCHG CYCLOSPORINE AHL 196.00 $176.40 $78.40 $156.80 $109.76 $137.20 $125.44 $156.80 $152.88 $88.20 $80.36 $82.32 $78.40 $147.00 $127.40
WWH LAB/RAD FEE SCHEDULE - 4206 17028414 80197 HCHG TACROLIMUS AHL 162.00 $145.80 $64.80 $129.60 $90.72 $113.40 $103.68 $129.60 $126.36 $72.90 $66.42 $68.04 $64.80 $121.50 $105.30
WWH LAB/RAD FEE SCHEDULE - 4206 17028418 80307 HCHG MECONIUM DRUG SCREEN HCMC 259.00 $233.10 $103.60 $207.20 $145.04 $181.30 $165.76 $207.20 $202.02 $116.55 $106.19 $108.78 $103.60 $194.25 $168.35
WWH LAB/RAD FEE SCHEDULE - 4206 17028420 80307 HCHG LIMITED COMPLIANCE DRUG SCREEN 259.00 $233.10 $103.60 $207.20 $145.04 $181.30 $165.76 $207.20 $202.02 $116.55 $106.19 $108.78 $103.60 $194.25 $168.35
WWH LAB/RAD FEE SCHEDULE - 4206 17028463 80307 HCHG COMPLIANCE DRUG ANALYSIS CDS 259.00 $233.10 $103.60 $207.20 $145.04 $181.30 $165.76 $207.20 $202.02 $116.55 $106.19 $108.78 $103.60 $194.25 $168.35
WWH LAB/RAD FEE SCHEDULE - 4206 17028464 82600 HCHG CYANIDE MTX 143.00 $128.70 $57.20 $114.40 $80.08 $100.10 $91.52 $114.40 $111.54 $64.35 $58.63 $60.06 $57.20 $107.25 $92.95
WWH LAB/RAD FEE SCHEDULE - 4206 17028492 80307 HCHG DRUG SCREEN BLOOD DSS 259.00 $233.10 $103.60 $207.20 $145.04 $181.30 $165.76 $207.20 $202.02 $116.55 $106.19 $108.78 $103.60 $194.25 $168.35
WWH LAB/RAD FEE SCHEDULE - 4206 17028549 81245 HCHG FLT3 ITD 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH LAB/RAD FEE SCHEDULE - 4206 17028550 81246 HCHG FLT3 TKD 412.00 $370.80 $164.80 $329.60 $230.72 $288.40 $263.68 $329.60 $321.36 $185.40 $168.92 $173.04 $164.80 $309.00 $267.80
WWH LAB/RAD FEE SCHEDULE - 4206 17028551 81310 HCHG NPM1 GENE ANALYSIS 314.00 $282.60 $125.60 $251.20 $175.84 $219.80 $200.96 $251.20 $244.92 $141.30 $128.74 $131.88 $125.60 $235.50 $204.10
WWH LAB/RAD FEE SCHEDULE - 4206 17028554 82952 HCHG GLUCOSE TOLERANCE 2ND ADDL 40.00 $36.00 $16.00 $32.00 $22.40 $28.00 $25.60 $32.00 $31.20 $18.00 $16.40 $16.80 $16.00 $30.00 $26.00
WWH LAB/RAD FEE SCHEDULE - 4206 17028555 82952 HCHG GLUCOSE TOLERANCE 3RD ADDL 40.00 $36.00 $16.00 $32.00 $22.40 $28.00 $25.60 $32.00 $31.20 $18.00 $16.40 $16.80 $16.00 $30.00 $26.00
WWH LAB/RAD FEE SCHEDULE - 4206 17028569 87591 HCHG GENERAL LAB 8759103 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 17028570 87491 HCHG GENERAL LAB 8749102 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 17028596 83876 HCHG MYELOPEROXIDASE AB 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH LAB/RAD FEE SCHEDULE - 4206 17028597 83516 HCHG PROTEINASE 3 AB 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 17028741 87651 HCHG STREP A PCR 78.00 $70.20 $31.20 $62.40 $43.68 $54.60 $49.92 $62.40 $60.84 $35.10 $31.98 $32.76 $31.20 $58.50 $50.70
WWH LAB/RAD FEE SCHEDULE - 4206 17028755 87506 HCHG STOOL PATHOGEN MULTIPLEX PANEL 750.00 $675.00 $300.00 $600.00 $420.00 $525.00 $480.00 $600.00 $585.00 $337.50 $307.50 $315.00 $300.00 $562.50 $487.50
WWH LAB/RAD FEE SCHEDULE - 4206 17028784 86008 HCHG ALLERGEN IGE RECOMBINANT IN HOUSE 42.00 $37.80 $16.80 $33.60 $23.52 $29.40 $26.88 $33.60 $32.76 $18.90 $17.22 $17.64 $16.80 $31.50 $27.30
WWH LAB/RAD FEE SCHEDULE - 4206 17028944 87107 "HCHG ID-YEAST,FUNGUS" 72.00 $64.80 $28.80 $57.60 $40.32 $50.40 $46.08 $57.60 $56.16 $32.40 $29.52 $30.24 $28.80 $54.00 $46.80
WWH LAB/RAD FEE SCHEDULE - 4206 17028952 87118 "HCHG ID-ACTINOMYCETE,MYCOBACTERIA" 49.00 $44.10 $19.60 $39.20 $27.44 $34.30 $31.36 $39.20 $38.22 $22.05 $20.09 $20.58 $19.60 $36.75 $31.85
WWH LAB/RAD FEE SCHEDULE - 4206 17029000 88269 HCHG CYG-AMNIOTIC FLUID IN-SITU CHROMOSOME ANALYSIS 518.00 $466.20 $207.20 $414.40 $290.08 $362.60 $331.52 $414.40 $404.04 $233.10 $212.38 $217.56 $207.20 $388.50 $336.70
WWH LAB/RAD FEE SCHEDULE - 4206 17029002 88262 HCHG CYG-FULL CHROMOSOME ANALYSIS 595.00 $535.50 $238.00 $476.00 $333.20 $416.50 $380.80 $476.00 $464.10 $267.75 $243.95 $249.90 $238.00 $446.25 $386.75
WWH LAB/RAD FEE SCHEDULE - 4206 17029004 88235 HCHG CYG-PRENATAL CULTURE 396.00 $356.40 $158.40 $316.80 $221.76 $277.20 $253.44 $316.80 $308.88 $178.20 $162.36 $166.32 $158.40 $297.00 $257.40
WWH LAB/RAD FEE SCHEDULE - 4206 17029006 88230 HCHG CYG-CONGENITAL BLOOD CULTURE 582.00 $523.80 $232.80 $465.60 $325.92 $407.40 $372.48 $465.60 $453.96 $261.90 $238.62 $244.44 $232.80 $436.50 $378.30
WWH LAB/RAD FEE SCHEDULE - 4206 17029007 88237 HCHG CYG-BONE MARROW/LEUKEMIC BLOOD CULTURE 492.00 $442.80 $196.80 $393.60 $275.52 $344.40 $314.88 $393.60 $383.76 $221.40 $201.72 $206.64 $196.80 $369.00 $319.80
WWH LAB/RAD FEE SCHEDULE - 4206 17029009 88280 HCHG CYG-ADDL KARYOTYPE 118.00 $106.20 $47.20 $94.40 $66.08 $82.60 $75.52 $94.40 $92.04 $53.10 $48.38 $49.56 $47.20 $88.50 $76.70
WWH LAB/RAD FEE SCHEDULE - 4206 17029011 88285 HCHG CYG-ADDITIONAL CELLS COUNTED 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH LAB/RAD FEE SCHEDULE - 4206 17029016 88274 HCHG CYG-FISH GENERAL INTERPHASE ANALYSIS (25-99) 194.00 $174.60 $77.60 $155.20 $108.64 $135.80 $124.16 $155.20 $151.32 $87.30 $79.54 $81.48 $77.60 $145.50 $126.10
WWH LAB/RAD FEE SCHEDULE - 4206 17029018 88275 HCHG CYG-FISH GENERAL INTERPHASE ANALYSIS (100-300) 211.00 $189.90 $84.40 $168.80 $118.16 $147.70 $135.04 $168.80 $164.58 $94.95 $86.51 $88.62 $84.40 $158.25 $137.15
WWH LAB/RAD FEE SCHEDULE - 4206 17029019 88275 HCHG CYG-FISH PANEL INTERPHASE ANALYSIS (100-300) 211.00 $189.90 $84.40 $168.80 $118.16 $147.70 $135.04 $168.80 $164.58 $94.95 $86.51 $88.62 $84.40 $158.25 $137.15
WWH LAB/RAD FEE SCHEDULE - 4206 17029020 88271 HCHG CYG-FDA APPROVED FISH ANEUPLOIDY PROBE 81.00 $72.90 $32.40 $64.80 $45.36 $56.70 $51.84 $64.80 $63.18 $36.45 $33.21 $34.02 $32.40 $60.75 $52.65
WWH LAB/RAD FEE SCHEDULE - 4206 17029022 88271 HCHG CYG-FISH ONCOLOGY INTERPHASE PROBE 70.00 $63.00 $28.00 $56.00 $39.20 $49.00 $44.80 $56.00 $54.60 $31.50 $28.70 $29.40 $28.00 $52.50 $45.50
WWH LAB/RAD FEE SCHEDULE - 4206 17029023 88299 HCHG CYG-CELL ENRICHMENT 143.00 $128.70 $57.20 $114.40 $80.08 $100.10 $91.52 $114.40 $111.54 $64.35 $58.63 $60.06 $57.20 $107.25 $92.95
WWH LAB/RAD FEE SCHEDULE - 4206 17029026 88120 HCHG CYG-URINE FISH MORPHOMETRIC PROBE AND ANALYSIS "1,508.00" " $1,357.20 " $603.20 " $1,206.40 " $844.48 " $1,055.60 " $965.12 " $1,206.40 " " $1,176.24 " $678.60 $618.28 $633.36 $603.20 " $1,131.00 " $980.20
WWH LAB/RAD FEE SCHEDULE - 4206 17029027 88291TRACK HCHG CYG-CYTOGENETIC INTERP 93.00 $83.70 $37.20 $74.40 $52.08 $65.10 $59.52 $74.40 $72.54 $41.85 $38.13 $39.06 $37.20 $69.75 $60.45
WWH LAB/RAD FEE SCHEDULE - 4206 17029065 87556 HCHG MTB PCR 259.00 $233.10 $103.60 $207.20 $145.04 $181.30 $165.76 $207.20 $202.02 $116.55 $106.19 $108.78 $103.60 $194.25 $168.35
WWH LAB/RAD FEE SCHEDULE - 4206 17029089 84702 HCHG GENERAL LAB 8470208 132.00 $118.80 $52.80 $105.60 $73.92 $92.40 $84.48 $105.60 $102.96 $59.40 $54.12 $55.44 $52.80 $99.00 $85.80
WWH LAB/RAD FEE SCHEDULE - 4206 17029115 87798 HCHG BORDETELLA PCR 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH LAB/RAD FEE SCHEDULE - 4206 17029170 87798 HCHG GENERAL LAB 8779837 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH LAB/RAD FEE SCHEDULE - 4206 17029175 87496 "HCHG CYTOMEGALOVIRUS (CMV), QUALITATIVE, PCR LC" 170.00 $153.00 $68.00 $136.00 $95.20 $119.00 $108.80 $136.00 $132.60 $76.50 $69.70 $71.40 $68.00 $127.50 $110.50
WWH LAB/RAD FEE SCHEDULE - 4206 17029183 87385 HCHG HISTOPLASMA QUANTITATIVE ANTIGEN LC 164.00 $147.60 $65.60 $131.20 $91.84 $114.80 $104.96 $131.20 $127.92 $73.80 $67.24 $68.88 $65.60 $123.00 $106.60
WWH LAB/RAD FEE SCHEDULE - 4206 17029185 87449 HCHG BLASTOMYCES ANTIGEN LC 109.00 $98.10 $43.60 $87.20 $61.04 $76.30 $69.76 $87.20 $85.02 $49.05 $44.69 $45.78 $43.60 $81.75 $70.85
WWH LAB/RAD FEE SCHEDULE - 4206 17029187 87798 HCHG GENERAL LAB 8779834 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH LAB/RAD FEE SCHEDULE - 4206 17029199 81225 HCHG CYTOCHROME P450 2C19 LC 665.00 $598.50 $266.00 $532.00 $372.40 $465.50 $425.60 $532.00 $518.70 $299.25 $272.65 $279.30 $266.00 $498.75 $432.25
WWH LAB/RAD FEE SCHEDULE - 4206 17029200 84403 "HCHG TOTAL TESTOSTERONE, LC" 244.00 $219.60 $97.60 $195.20 $136.64 $170.80 $156.16 $195.20 $190.32 $109.80 $100.04 $102.48 $97.60 $183.00 $158.60
WWH LAB/RAD FEE SCHEDULE - 4206 17029201 84402 "HCHG TESTOSTERONE, FREE, EQUILIBRIUM ULTRAFILTRATION LC" 264.00 $237.60 $105.60 $211.20 $147.84 $184.80 $168.96 $211.20 $205.92 $118.80 $108.24 $110.88 $105.60 $198.00 $171.60
WWH LAB/RAD FEE SCHEDULE - 4206 17029204 82365 HCHG STONE ANALYSIS LC 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 17029205 83921 "HCHG METHYLMALONIC ACID, SERUM LC" 133.00 $119.70 $53.20 $106.40 $74.48 $93.10 $85.12 $106.40 $103.74 $59.85 $54.53 $55.86 $53.20 $99.75 $86.45
WWH LAB/RAD FEE SCHEDULE - 4206 17029206 83655 "HCHG LEAD, BLOOD LC" 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH LAB/RAD FEE SCHEDULE - 4206 17029207 84425 "HCHG VITAMIN B1 (THIAMINE), BLOOD LC" 222.00 $199.80 $88.80 $177.60 $124.32 $155.40 $142.08 $177.60 $173.16 $99.90 $91.02 $93.24 $88.80 $166.50 $144.30
WWH LAB/RAD FEE SCHEDULE - 4206 17029208 82397 HCHG ANTI-MULLERIAN HORMONE (AMH) LC 134.00 $120.60 $53.60 $107.20 $75.04 $93.80 $85.76 $107.20 $104.52 $60.30 $54.94 $56.28 $53.60 $100.50 $87.10
WWH LAB/RAD FEE SCHEDULE - 4206 17029209 87484 HCHG EHRLICHIA DETECTION PCR LC 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH LAB/RAD FEE SCHEDULE - 4206 17029210 82525 "HCHG COPPER, SERUM LC" 132.00 $118.80 $52.80 $105.60 $73.92 $92.40 $84.48 $105.60 $102.96 $59.40 $54.12 $55.44 $52.80 $99.00 $85.80
WWH LAB/RAD FEE SCHEDULE - 4206 17029211 87529 HCHG GENERAL LAB 8752902 LC 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH LAB/RAD FEE SCHEDULE - 4206 17029212 84630 "HCHG ZINC, PLASMA OR SERUM LC" 119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
WWH LAB/RAD FEE SCHEDULE - 4206 17029214 84207 "HCHG VITAMIN B6, PLASMA LC" 293.00 $263.70 $117.20 $234.40 $164.08 $205.10 $187.52 $234.40 $228.54 $131.85 $120.13 $123.06 $117.20 $219.75 $190.45
WWH LAB/RAD FEE SCHEDULE - 4206 17029215 84482 "HCHG REVERSE T3, SERUM LC" 166.00 $149.40 $66.40 $132.80 $92.96 $116.20 $106.24 $132.80 $129.48 $74.70 $68.06 $69.72 $66.40 $124.50 $107.90
WWH LAB/RAD FEE SCHEDULE - 4206 17029216 82024 "HCHG ACTH, PLASMA LC" 373.00 $335.70 $149.20 $298.40 $208.88 $261.10 $238.72 $298.40 $290.94 $167.85 $152.93 $156.66 $149.20 $279.75 $242.45
WWH LAB/RAD FEE SCHEDULE - 4206 17029217 86694 (IA) HCHG GENERAL LAB 8669402 LC 134.00 $120.60 $53.60 $107.20 $75.04 $93.80 $85.76 $107.20 $104.52 $60.30 $54.94 $56.28 $53.60 $100.50 $87.10
WWH LAB/RAD FEE SCHEDULE - 4206 17029218 81374 HCHG HLA B 27 DISEASE ASSOCIATION LC 582.00 $523.80 $232.80 $465.60 $325.92 $407.40 $372.48 $465.60 $453.96 $261.90 $238.62 $244.44 $232.80 $436.50 $378.30
WWH LAB/RAD FEE SCHEDULE - 4206 17029219 84305 HCHG IGF-1 LC 202.00 $181.80 $80.80 $161.60 $113.12 $141.40 $129.28 $161.60 $157.56 $90.90 $82.82 $84.84 $80.80 $151.50 $131.30
WWH LAB/RAD FEE SCHEDULE - 4206 17029220 84143 HCHG 17-HYDROXYPREGNENOLONE LC 82.00 $73.80 $32.80 $65.60 $45.92 $57.40 $52.48 $65.60 $63.96 $36.90 $33.62 $34.44 $32.80 $61.50 $53.30
WWH LAB/RAD FEE SCHEDULE - 4206 17029221 82103 "HCHG ALPHA-1-ANTITRYPSIN, SERUM LC" 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH LAB/RAD FEE SCHEDULE - 4206 17029222 82104 HCHG A1A PHENOTYPE (PI) LC 123.00 $110.70 $49.20 $98.40 $68.88 $86.10 $78.72 $98.40 $95.94 $55.35 $50.43 $51.66 $49.20 $92.25 $79.95
WWH LAB/RAD FEE SCHEDULE - 4206 17029223 82139 "HCHG AMINO ACID PROFILE, QN, PLASMA LC" 76.00 $68.40 $30.40 $60.80 $42.56 $53.20 $48.64 $60.80 $59.28 $34.20 $31.16 $31.92 $30.40 $57.00 $49.40
WWH LAB/RAD FEE SCHEDULE - 4206 17029224 82164 HCHG ANGIOTENSIN-CONVERTING ENZYME LC 145.00 $130.50 $58.00 $116.00 $81.20 $101.50 $92.80 $116.00 $113.10 $65.25 $59.45 $60.90 $58.00 $108.75 $94.25
WWH LAB/RAD FEE SCHEDULE - 4206 17029225 86215 HCHG ANTI-DNASE B STREP ANTIBODIES LC 110.00 $99.00 $44.00 $88.00 $61.60 $77.00 $70.40 $88.00 $85.80 $49.50 $45.10 $46.20 $44.00 $82.50 $71.50
WWH LAB/RAD FEE SCHEDULE - 4206 17029226 82088 "HCHG ALDOSTERONE, SERUM LC" 168.00 $151.20 $67.20 $134.40 $94.08 $117.60 $107.52 $134.40 $131.04 $75.60 $68.88 $70.56 $67.20 $126.00 $109.20
WWH LAB/RAD FEE SCHEDULE - 4206 17029228 84080 HCHG ALK PHOS ISOENZYME LC 164.00 $147.60 $65.60 $131.20 $91.84 $114.80 $104.96 $131.20 $127.92 $73.80 $67.24 $68.88 $65.60 $123.00 $106.60
WWH LAB/RAD FEE SCHEDULE - 4206 17029229 84075 HCHG ALK PHOS TOTAL LC 55.00 $49.50 $22.00 $44.00 $30.80 $38.50 $35.20 $44.00 $42.90 $24.75 $22.55 $23.10 $22.00 $41.25 $35.75
WWH LAB/RAD FEE SCHEDULE - 4206 17029230 82085 HCHG ALDOLASE LC 74.00 $66.60 $29.60 $59.20 $41.44 $51.80 $47.36 $59.20 $57.72 $33.30 $30.34 $31.08 $29.60 $55.50 $48.10
WWH LAB/RAD FEE SCHEDULE - 4206 17029231 80151 "HCHG AMIODARONE (CORDARONE(R)), S LC" 22.00 $19.80 $8.80 $17.60 $12.32 $15.40 $14.08 $17.60 $17.16 $9.90 $9.02 $9.24 $8.80 $16.50 $14.30
WWH LAB/RAD FEE SCHEDULE - 4206 17029233 82157 HCHG ANDROSTENEDIONE LC 304.00 $273.60 $121.60 $243.20 $170.24 $212.80 $194.56 $243.20 $237.12 $136.80 $124.64 $127.68 $121.60 $228.00 $197.60
WWH LAB/RAD FEE SCHEDULE - 4206 17029235 82172 HCHG APOLIPOPROTEIN B LC 50.00 $45.00 $20.00 $40.00 $28.00 $35.00 $32.00 $40.00 $39.00 $22.50 $20.50 $21.00 $20.00 $37.50 $32.50
WWH LAB/RAD FEE SCHEDULE - 4206 17029236 86651 HCHG LACROSSE/CALIF ENCEPH IGG/IGM LC 81.00 $72.90 $32.40 $64.80 $45.36 $56.70 $51.84 $64.80 $63.18 $36.45 $33.21 $34.02 $32.40 $60.75 $52.65
WWH LAB/RAD FEE SCHEDULE - 4206 17029237 86652 HCHG E.EQUINE ENCEPH IGG/IGM LC 114.00 $102.60 $45.60 $91.20 $63.84 $79.80 $72.96 $91.20 $88.92 $51.30 $46.74 $47.88 $45.60 $85.50 $74.10
WWH LAB/RAD FEE SCHEDULE - 4206 17029238 86653 HCHG ST.LOUIS EQUINE ENCEP IGG/IGM LC 90.00 $81.00 $36.00 $72.00 $50.40 $63.00 $57.60 $72.00 $70.20 $40.50 $36.90 $37.80 $36.00 $67.50 $58.50
WWH LAB/RAD FEE SCHEDULE - 4206 17029239 86654 HCHG W.EQUINE ENCEPH IGG/IGM LC 93.00 $83.70 $37.20 $74.40 $52.08 $65.10 $59.52 $74.40 $72.54 $41.85 $38.13 $39.06 $37.20 $69.75 $60.45
WWH LAB/RAD FEE SCHEDULE - 4206 17029240 86060 HCHG ANTISTREPTOLYSIN O AB LC 54.00 $48.60 $21.60 $43.20 $30.24 $37.80 $34.56 $43.20 $42.12 $24.30 $22.14 $22.68 $21.60 $40.50 $35.10
WWH LAB/RAD FEE SCHEDULE - 4206 17029242 86003 HCHG ALLERGEN LC 42.00 $37.80 $16.80 $33.60 $23.52 $29.40 $26.88 $33.60 $32.76 $18.90 $17.22 $17.64 $16.80 $31.50 $27.30
WWH LAB/RAD FEE SCHEDULE - 4206 17029243 86008 HCHG ALLERGEN RECOMBINANT LC 42.00 $37.80 $16.80 $33.60 $23.52 $29.40 $26.88 $33.60 $32.76 $18.90 $17.22 $17.64 $16.80 $31.50 $27.30
WWH LAB/RAD FEE SCHEDULE - 4206 17029244 86753 HCHG BABESIA MICROTI ANTIBODY LC 102.00 $91.80 $40.80 $81.60 $57.12 $71.40 $65.28 $81.60 $79.56 $45.90 $41.82 $42.84 $40.80 $76.50 $66.30
WWH LAB/RAD FEE SCHEDULE - 4206 17029245 84080 "HCHG ALK PHOSPHATASE, BONE SPECIFIC LC" 164.00 $147.60 $65.60 $131.20 $91.84 $114.80 $104.96 $131.20 $127.92 $73.80 $67.24 $68.88 $65.60 $123.00 $106.60
WWH LAB/RAD FEE SCHEDULE - 4206 17029246 86611 HCHG BARTONELLA ANTIBODY LC 48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
WWH LAB/RAD FEE SCHEDULE - 4206 17029247 82239 HCHG BILE ACIDS LC 144.00 $129.60 $57.60 $115.20 $80.64 $100.80 $92.16 $115.20 $112.32 $64.80 $59.04 $60.48 $57.60 $108.00 $93.60
WWH LAB/RAD FEE SCHEDULE - 4206 17029249 83993 "HCHG CALPROTECTIN, FECAL LC" 225.00 $202.50 $90.00 $180.00 $126.00 $157.50 $144.00 $180.00 $175.50 $101.25 $92.25 $94.50 $90.00 $168.75 $146.25
WWH LAB/RAD FEE SCHEDULE - 4206 17029250 82379 "HCHG CARNITINE, TOTAL AND FREE LC" 90.00 $81.00 $36.00 $72.00 $50.40 $63.00 $57.60 $72.00 $70.20 $40.50 $36.90 $37.80 $36.00 $67.50 $58.50
WWH LAB/RAD FEE SCHEDULE - 4206 17029254 82308 "HCHG CALCITONIN, SERUM LC" 197.00 $177.30 $78.80 $157.60 $110.32 $137.90 $126.08 $157.60 $153.66 $88.65 $80.77 $82.74 $78.80 $147.75 $128.05
WWH LAB/RAD FEE SCHEDULE - 4206 17029255 86157 "HCHG COLD AGGLUTININ TITER, QUANT LC" 56.00 $50.40 $22.40 $44.80 $31.36 $39.20 $35.84 $44.80 $43.68 $25.20 $22.96 $23.52 $22.40 $42.00 $36.40
WWH LAB/RAD FEE SCHEDULE - 4206 17029257 80159 "HCHG CLOZAPINE (CLOZARIL), SERUM LC" 77.00 $69.30 $30.80 $61.60 $43.12 $53.90 $49.28 $61.60 $60.06 $34.65 $31.57 $32.34 $30.80 $57.75 $50.05
WWH LAB/RAD FEE SCHEDULE - 4206 17029258 87497 HCHG CMV QUANT DNA PCR (PLASMA) LC 222.00 $199.80 $88.80 $177.60 $124.32 $155.40 $142.08 $177.60 $173.16 $99.90 $91.02 $93.24 $88.80 $166.50 $144.30
WWH LAB/RAD FEE SCHEDULE - 4206 17029259 86162 "HCHG COMPLEMENT, TOTAL (CH50) LC" 182.00 $163.80 $72.80 $145.60 $101.92 $127.40 $116.48 $145.60 $141.96 $81.90 $74.62 $76.44 $72.80 $136.50 $118.30
WWH LAB/RAD FEE SCHEDULE - 4206 17029260 82530 "HCHG CORTISOL, URINARY FREE LC" 55.00 $49.50 $22.00 $44.00 $30.80 $38.50 $35.20 $44.00 $42.90 $24.75 $22.55 $23.10 $22.00 $41.25 $35.75
WWH LAB/RAD FEE SCHEDULE - 4206 17029262 82626 "HCHG DHEA, SERUM LC" 266.00 $239.40 $106.40 $212.80 $148.96 $186.20 $170.24 $212.80 $207.48 $119.70 $109.06 $111.72 $106.40 $199.50 $172.90
WWH LAB/RAD FEE SCHEDULE - 4206 17029263 82652 "HCHG CALCITRIOL(1,25 DI-OH VIT D) LC" 332.00 $298.80 $132.80 $265.60 $185.92 $232.40 $212.48 $265.60 $258.96 $149.40 $136.12 $139.44 $132.80 $249.00 $215.80
WWH LAB/RAD FEE SCHEDULE - 4206 17029265 82679 "HCHG ESTRONE, SERUM LC" 249.00 $224.10 $99.60 $199.20 $139.44 $174.30 $159.36 $199.20 $194.22 $112.05 $102.09 $104.58 $99.60 $186.75 $161.85
WWH LAB/RAD FEE SCHEDULE - 4206 17029266 87350 HCHG GENERAL LAB 8735001 LC 116.00 $104.40 $46.40 $92.80 $64.96 $81.20 $74.24 $92.80 $90.48 $52.20 $47.56 $48.72 $46.40 $87.00 $75.40
WWH LAB/RAD FEE SCHEDULE - 4206 17029267 86663 "HCHG EBV EARLY ANTIGEN AB, IGG LC" 128.00 $115.20 $51.20 $102.40 $71.68 $89.60 $81.92 $102.40 $99.84 $57.60 $52.48 $53.76 $51.20 $96.00 $83.20
WWH LAB/RAD FEE SCHEDULE - 4206 17029268 87799 "HCHG EPSTEIN-BARR DNA QUANT, PCR LC" 244.00 $219.60 $97.60 $195.20 $136.64 $170.80 $156.16 $195.20 $190.32 $109.80 $100.04 $102.48 $97.60 $183.00 $158.60
WWH LAB/RAD FEE SCHEDULE - 4206 17029269 86666 HCHG EHRLICHIA AB LC 103.00 $92.70 $41.20 $82.40 $57.68 $72.10 $65.92 $82.40 $80.34 $46.35 $42.23 $43.26 $41.20 $77.25 $66.95
WWH LAB/RAD FEE SCHEDULE - 4206 17029270 86231 HCHG ENDOMYSIAL ANTIBODY IGA LC 156.00 $140.40 $62.40 $124.80 $87.36 $109.20 $99.84 $124.80 $121.68 $70.20 $63.96 $65.52 $62.40 $117.00 $101.40
WWH LAB/RAD FEE SCHEDULE - 4206 17029271 85270 HCHG FACTOR XI ACTIVITY LC 186.00 $167.40 $74.40 $148.80 $104.16 $130.20 $119.04 $148.80 $145.08 $83.70 $76.26 $78.12 $74.40 $139.50 $120.90
WWH LAB/RAD FEE SCHEDULE - 4206 17029273 85250 HCHG FACTOR IX ACTIVITY LC 196.00 $176.40 $78.40 $156.80 $109.76 $137.20 $125.44 $156.80 $152.88 $88.20 $80.36 $82.32 $78.40 $147.00 $127.40
WWH LAB/RAD FEE SCHEDULE - 4206 17029276 82710 "HCHG FECAL FAT, QUANTITATIVE LC" 168.00 $151.20 $67.20 $134.40 $94.08 $117.60 $107.52 $134.40 $131.04 $75.60 $68.88 $70.56 $67.20 $126.00 $109.20
WWH LAB/RAD FEE SCHEDULE - 4206 17029277 86161 "HCHG C1 ESTERASE INHIBITOR, FUNC LC" 93.00 $83.70 $37.20 $74.40 $52.08 $65.10 $59.52 $74.40 $72.54 $41.85 $38.13 $39.06 $37.20 $69.75 $60.45
WWH LAB/RAD FEE SCHEDULE - 4206 17029279 81596 HCHG GENERAL LAB 8159601 LC 87.00 $78.30 $34.80 $69.60 $48.72 $60.90 $55.68 $69.60 $67.86 $39.15 $35.67 $36.54 $34.80 $65.25 $56.55
WWH LAB/RAD FEE SCHEDULE - 4206 17029280 82653 "HCHG PANCREATIC ELASTASE, FECAL LC" 115.00 $103.50 $46.00 $92.00 $64.40 $80.50 $73.60 $92.00 $89.70 $51.75 $47.15 $48.30 $46.00 $86.25 $74.75
WWH LAB/RAD FEE SCHEDULE - 4206 17029282 82985 HCHG FRUCTOSAMINE LC 74.00 $66.60 $29.60 $59.20 $41.44 $51.80 $47.36 $59.20 $57.72 $33.30 $30.34 $31.08 $29.60 $55.50 $48.10
WWH LAB/RAD FEE SCHEDULE - 4206 17029283 82955 "HCHG G-6-PD, QUANT, BLOOD LC" 108.00 $97.20 $43.20 $86.40 $60.48 $75.60 $69.12 $86.40 $84.24 $48.60 $44.28 $45.36 $43.20 $81.00 $70.20
WWH LAB/RAD FEE SCHEDULE - 4206 17029284 85041 HCHG RBC LC 30.00 $27.00 $12.00 $24.00 $16.80 $21.00 $19.20 $24.00 $23.40 $13.50 $12.30 $12.60 $12.00 $22.50 $19.50
WWH LAB/RAD FEE SCHEDULE - 4206 17029285 80171 "HCHG GABAPENTIN (NEURONTIN), SERUM LC" 119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
WWH LAB/RAD FEE SCHEDULE - 4206 17029286 82941 "HCHG GASTRIN, SERUM LC" 178.00 $160.20 $71.20 $142.40 $99.68 $124.60 $113.92 $142.40 $138.84 $80.10 $72.98 $74.76 $71.20 $133.50 $115.70
WWH LAB/RAD FEE SCHEDULE - 4206 17029287 83516 HCHG ANTIGLOMERULAR BM AB LC 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 17029288 86341 HCHG GAD-65 AUTOANTIBODY LC 194.00 $174.60 $77.60 $155.20 $108.64 $135.80 $124.16 $155.20 $151.32 $87.30 $79.54 $81.48 $77.60 $145.50 $126.10
WWH LAB/RAD FEE SCHEDULE - 4206 17029289 87902 HCHG GENERAL LAB 8790202 LC 671.00 $603.90 $268.40 $536.80 $375.76 $469.70 $429.44 $536.80 $523.38 $301.95 $275.11 $281.82 $268.40 $503.25 $436.15
WWH LAB/RAD FEE SCHEDULE - 4206 17029290 86707 HCHG GENERAL LAB 308670701 LC 104.00 $93.60 $41.60 $83.20 $58.24 $72.80 $66.56 $83.20 $81.12 $46.80 $42.64 $43.68 $41.60 $78.00 $67.60
WWH LAB/RAD FEE SCHEDULE - 4206 17029291 83825 "HCHG MERCURY, BLOOD LC" 76.00 $68.40 $30.40 $60.80 $42.56 $53.20 $48.64 $60.80 $59.28 $34.20 $31.16 $31.92 $30.40 $57.00 $49.40
WWH LAB/RAD FEE SCHEDULE - 4206 17029292 83003 "HCHG GROWTH HORMONE, SERUM LC" 166.00 $149.40 $66.40 $132.80 $92.96 $116.20 $106.24 $132.80 $129.48 $74.70 $68.06 $69.72 $66.40 $124.50 $107.90
WWH LAB/RAD FEE SCHEDULE - 4206 17029293 87532 HCHG GENERAL LAB 8753202 LC 314.00 $282.60 $125.60 $251.20 $175.84 $219.80 $200.96 $251.20 $244.92 $141.30 $128.74 $131.88 $125.60 $235.50 $204.10
WWH LAB/RAD FEE SCHEDULE - 4206 17029294 83497 "HCHG 5-HIAA,QUANT,24 HR URINE LC" 54.00 $48.60 $21.60 $43.20 $30.24 $37.80 $34.56 $43.20 $42.12 $24.30 $22.14 $22.68 $21.60 $40.50 $35.10
WWH LAB/RAD FEE SCHEDULE - 4206 17029297 82175 "HCHG ARSENIC HEAVY METALS PROFILE II, BLOOD LC" 83.00 $74.70 $33.20 $66.40 $46.48 $58.10 $53.12 $66.40 $64.74 $37.35 $34.03 $34.86 $33.20 $62.25 $53.95
WWH LAB/RAD FEE SCHEDULE - 4206 17029298 82300 "HCHG CADMIUM HEAVY METALS PROFILE II, BLOOD LC" 126.00 $113.40 $50.40 $100.80 $70.56 $88.20 $80.64 $100.80 $98.28 $56.70 $51.66 $52.92 $50.40 $94.50 $81.90
WWH LAB/RAD FEE SCHEDULE - 4206 17029299 83655 "HCHG LEAD HEAVY METALS PROFILE II, BLOOD LC" 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH LAB/RAD FEE SCHEDULE - 4206 17029300 83825 "HCHG MERCURY HEAVY METALS PROFILE II, BLOOD LC" 76.00 $68.40 $30.40 $60.80 $42.56 $53.20 $48.64 $60.80 $59.28 $34.20 $31.16 $31.92 $30.40 $57.00 $49.40
WWH LAB/RAD FEE SCHEDULE - 4206 17029307 86790 HCHG GENERAL LAB 8679001 LC 303.00 $272.70 $121.20 $242.40 $169.68 $212.10 $193.92 $242.40 $236.34 $136.35 $124.23 $127.26 $121.20 $227.25 $196.95
WWH LAB/RAD FEE SCHEDULE - 4206 17029308 86037 HCHG ATYPICAL P-ANCA LC 137.00 $123.30 $54.80 $109.60 $76.72 $95.90 $87.68 $109.60 $106.86 $61.65 $56.17 $57.54 $54.80 $102.75 $89.05
WWH LAB/RAD FEE SCHEDULE - 4206 17029309 86671 "HCHG SACCHAROMYCES CEREVISIAE, IGA AND IGG LC" 137.00 $123.30 $54.80 $109.60 $76.72 $95.90 $87.68 $109.60 $106.86 $61.65 $56.17 $57.54 $54.80 $102.75 $89.05
WWH LAB/RAD FEE SCHEDULE - 4206 17029310 86340 "HCHG INTRINSIC FACTOR ABS, SERUM LC" 150.00 $135.00 $60.00 $120.00 $84.00 $105.00 $96.00 $120.00 $117.00 $67.50 $61.50 $63.00 $60.00 $112.50 $97.50
WWH LAB/RAD FEE SCHEDULE - 4206 17029312 82784 HCHG IGG LC 98.00 $88.20 $39.20 $78.40 $54.88 $68.60 $62.72 $78.40 $76.44 $44.10 $40.18 $41.16 $39.20 $73.50 $63.70
WWH LAB/RAD FEE SCHEDULE - 4206 17029313 82787 "HCHG IGG, SUBCLASSES (1-4) LC" 95.00 $85.50 $38.00 $76.00 $53.20 $66.50 $60.80 $76.00 $74.10 $42.75 $38.95 $39.90 $38.00 $71.25 $61.75
WWH LAB/RAD FEE SCHEDULE - 4206 17029314 86337 HCHG INSULIN ANTIBODIES LC 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 17029315 83789 "HCHG IODINE, RANDOM URINE LC" 87.00 $78.30 $34.80 $69.60 $48.72 $60.90 $55.68 $69.60 $67.86 $39.15 $35.67 $36.54 $34.80 $65.25 $56.55
WWH LAB/RAD FEE SCHEDULE - 4206 17029316 80189 "HCHG ITRACONAZOLE, SERUM/PLASMA LC" 224.00 $201.60 $89.60 $179.20 $125.44 $156.80 $143.36 $179.20 $174.72 $100.80 $91.84 $94.08 $89.60 $168.00 $145.60
WWH LAB/RAD FEE SCHEDULE - 4206 17029317 86235 HCHG ANTI-JO-1 LC 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 17029319 87798 HCHG WEST NILE VIRUS RT PCR LC 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH LAB/RAD FEE SCHEDULE - 4206 17029320 87798 HCHG EPSTEIN-BARR VIRUS PCR LC 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH LAB/RAD FEE SCHEDULE - 4206 17029322 86376 HCHG LIVER-KIDNEY MICROSOMAL AB LC 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH LAB/RAD FEE SCHEDULE - 4206 17029323 87798 HCHG VZV REAL TIME PCR LC 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH LAB/RAD FEE SCHEDULE - 4206 17029324 83835 "HCHG METANEPHRINES, FRAC, QN, 24-HR LC" 206.00 $185.40 $82.40 $164.80 $115.36 $144.20 $131.84 $164.80 $160.68 $92.70 $84.46 $86.52 $82.40 $154.50 $133.90
WWH LAB/RAD FEE SCHEDULE - 4206 17029325 86735 "HCHG MUMPS ANTIBODIES, IGM LC" 134.00 $120.60 $53.60 $107.20 $75.04 $93.80 $85.76 $107.20 $104.52 $60.30 $54.94 $56.28 $53.60 $100.50 $87.10
WWH LAB/RAD FEE SCHEDULE - 4206 17029327 83785 "HCHG MANGANESE, PLASMA LC" 92.00 $82.80 $36.80 $73.60 $51.52 $64.40 $58.88 $73.60 $71.76 $41.40 $37.72 $38.64 $36.80 $69.00 $59.80
WWH LAB/RAD FEE SCHEDULE - 4206 17029328 80180 HCHG MYCOPHENOLIC ACID AND METABO LC 191.00 $171.90 $76.40 $152.80 $106.96 $133.70 $122.24 $152.80 $148.98 $85.95 $78.31 $80.22 $76.40 $143.25 $124.15
WWH LAB/RAD FEE SCHEDULE - 4206 17029332 86738 HCHG MYCOPLASMA PNEU IGG/IGM ABS LC 134.00 $120.60 $53.60 $107.20 $75.04 $93.80 $85.76 $107.20 $104.52 $60.30 $54.94 $56.28 $53.60 $100.50 $87.10
WWH LAB/RAD FEE SCHEDULE - 4206 17029334 82523 "HCHG N-TELOPEPTIDE, URINE LC" 156.00 $140.40 $62.40 $124.80 $87.36 $109.20 $99.84 $124.80 $121.68 $70.20 $63.96 $65.52 $62.40 $117.00 $101.40
WWH LAB/RAD FEE SCHEDULE - 4206 17029336 83516 HCHG 21-HYDROXYLASE ANTIBODIES LC 117.00 $105.30 $46.80 $93.60 $65.52 $81.90 $74.88 $93.60 $91.26 $52.65 $47.97 $49.14 $46.80 $87.75 $76.05
WWH LAB/RAD FEE SCHEDULE - 4206 17029337 83498 HCHG 17-OH PROGESTERONE LC 157.00 $141.30 $62.80 $125.60 $87.92 $109.90 $100.48 $125.60 $122.46 $70.65 $64.37 $65.94 $62.80 $117.75 $102.05
WWH LAB/RAD FEE SCHEDULE - 4206 17029338 83937 "HCHG OSTEOCALCIN, SERUM LC" 140.00 $126.00 $56.00 $112.00 $78.40 $98.00 $89.60 $112.00 $109.20 $63.00 $57.40 $58.80 $56.00 $105.00 $91.00
WWH LAB/RAD FEE SCHEDULE - 4206 17029341 87798 HCHG PARVOVIRUS B19 PCR LC 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH LAB/RAD FEE SCHEDULE - 4206 17029342 86747 "HCHG PARVOVIRUS B19, HUMAN, IGG/IGM LC" 82.00 $73.80 $32.80 $65.60 $45.92 $57.40 $52.48 $65.60 $63.96 $36.90 $33.62 $34.44 $32.80 $61.50 $53.30
WWH LAB/RAD FEE SCHEDULE - 4206 17029343 83516 HCHG ANTIPARIETAL CELL ANTIBODY LC 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH LAB/RAD FEE SCHEDULE - 4206 17029345 83835 "HCHG METANEPHRINES, FRAC, PL FREE LC" 206.00 $185.40 $82.40 $164.80 $115.36 $144.20 $131.84 $164.80 $160.68 $92.70 $84.46 $86.52 $82.40 $154.50 $133.90
WWH LAB/RAD FEE SCHEDULE - 4206 17029348 84244 "HCHG RENIN ACTIVITY, PLASMA LC" 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 17029349 82397 HCHG PTHRP (PTH-RELATED PEPTIDE) LC 134.00 $120.60 $53.60 $107.20 $75.04 $93.80 $85.76 $107.20 $104.52 $60.30 $54.94 $56.28 $53.60 $100.50 $87.10
WWH LAB/RAD FEE SCHEDULE - 4206 17029350 87799 HCHG BK QUANT PCR (PLASMA/SERUM) LC 244.00 $219.60 $97.60 $195.20 $136.64 $170.80 $156.16 $195.20 $190.32 $109.80 $100.04 $102.48 $97.60 $183.00 $158.60
WWH LAB/RAD FEE SCHEDULE - 4206 17029351 86765 "HCHG RUBEOLA ANTIBODIES, IGM LC" 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH LAB/RAD FEE SCHEDULE - 4206 17029352 82533 HCHG SALIVARY CORTISOL LC 180.00 $162.00 $72.00 $144.00 $100.80 $126.00 $115.20 $144.00 $140.40 $81.00 $73.80 $75.60 $72.00 $135.00 $117.00
WWH LAB/RAD FEE SCHEDULE - 4206 17029353 86606 "HCHG A.FUMIGATUS PRECIPITATING ABS, IGG LC" 75.00 $67.50 $30.00 $60.00 $42.00 $52.50 $48.00 $60.00 $58.50 $33.75 $30.75 $31.50 $30.00 $56.25 $48.75
WWH LAB/RAD FEE SCHEDULE - 4206 17029354 81003 "(IA) HCHG UA KIDNEY STONE, URINE/SATURATION LC" 28.00 $25.20 $11.20 $22.40 $15.68 $19.60 $17.92 $22.40 $21.84 $12.60 $11.48 $11.76 $11.20 $21.00 $18.20
WWH LAB/RAD FEE SCHEDULE - 4206 17029355 82131 "(IA) HCHG CYSTINE KIDNEY STONE, URINE/SATURATION LC" 139.00 $125.10 $55.60 $111.20 $77.84 $97.30 $88.96 $111.20 $108.42 $62.55 $56.99 $58.38 $55.60 $104.25 $90.35
WWH LAB/RAD FEE SCHEDULE - 4206 17029356 82140 "(IA) HCHG AMMONIUM KIDNEY STONE, URINE/SATURATION LC" 149.00 $134.10 $59.60 $119.20 $83.44 $104.30 $95.36 $119.20 $116.22 $67.05 $61.09 $62.58 $59.60 $111.75 $96.85
WWH LAB/RAD FEE SCHEDULE - 4206 17029357 82340 "(IA) HCHG CALCIUM KIDNEY STONE, URINE/SATURATION LC" 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH LAB/RAD FEE SCHEDULE - 4206 17029358 82436 "(IA) HCHG CHLORIDE KIDNEY STONE, URINE/SATURATION LC" 35.00 $31.50 $14.00 $28.00 $19.60 $24.50 $22.40 $28.00 $27.30 $15.75 $14.35 $14.70 $14.00 $26.25 $22.75
WWH LAB/RAD FEE SCHEDULE - 4206 17029359 82507 "(IA) HCHG CITRATE KIDNEY STONE, URINE/SATURATION LC" 132.00 $118.80 $52.80 $105.60 $73.92 $92.40 $84.48 $105.60 $102.96 $59.40 $54.12 $55.44 $52.80 $99.00 $85.80
WWH LAB/RAD FEE SCHEDULE - 4206 17029360 82570 "(IA) HCHG CREATININE KIDNEY STONE, URINE/SATURATION LC" 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH LAB/RAD FEE SCHEDULE - 4206 17029361 83735 "(IA) HCHG MAGNESIUM KIDNEY STONE, URINE/SATURATION LC" 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 17029362 83935 "(IA) HCHG OSMOLALITY KIDNEY STONE, URINE/SATURATION LC" 71.00 $63.90 $28.40 $56.80 $39.76 $49.70 $45.44 $56.80 $55.38 $31.95 $29.11 $29.82 $28.40 $53.25 $46.15
WWH LAB/RAD FEE SCHEDULE - 4206 17029363 83945 "(IA) HCHG OXALATE KIDNEY STONE, URINE/SATURATION LC" 93.00 $83.70 $37.20 $74.40 $52.08 $65.10 $59.52 $74.40 $72.54 $41.85 $38.13 $39.06 $37.20 $69.75 $60.45
WWH LAB/RAD FEE SCHEDULE - 4206 17029364 84105 "(IA) HCHG PHOSPHORUS KIDNEY STONE, URINE/SATURATION LC" 39.00 $35.10 $15.60 $31.20 $21.84 $27.30 $24.96 $31.20 $30.42 $17.55 $15.99 $16.38 $15.60 $29.25 $25.35
WWH LAB/RAD FEE SCHEDULE - 4206 17029365 84133 "(IA) HCHG POTASSIUM KIDNEY STONE, URINE/SATURATION LC" 35.00 $31.50 $14.00 $28.00 $19.60 $24.50 $22.40 $28.00 $27.30 $15.75 $14.35 $14.70 $14.00 $26.25 $22.75
WWH LAB/RAD FEE SCHEDULE - 4206 17029366 84300 "(IA) HCHG SODIUM KIDNEY STONE, URINE/SATURATION LC" 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 17029367 84392 "(IA) HCHG SULFATE KIDNEY STONE, URINE/SATURATION LC" 35.00 $31.50 $14.00 $28.00 $19.60 $24.50 $22.40 $28.00 $27.30 $15.75 $14.35 $14.70 $14.00 $26.25 $22.75
WWH LAB/RAD FEE SCHEDULE - 4206 17029368 84560 "(IA) HCHG URIC ACID KIDNEY STONE, URINE/SATURATION LC" 45.00 $40.50 $18.00 $36.00 $25.20 $31.50 $28.80 $36.00 $35.10 $20.25 $18.45 $18.90 $18.00 $33.75 $29.25
WWH LAB/RAD FEE SCHEDULE - 4206 17029370 86235 HCHG ANTISCLERODERMA-70 ANTIBODIES LC 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 17029374 84255 "HCHG SELENIUM, SERUM/PLASMA LC" 224.00 $201.60 $89.60 $179.20 $125.44 $156.80 $143.36 $179.20 $174.72 $100.80 $91.84 $94.08 $89.60 $168.00 $145.60
WWH LAB/RAD FEE SCHEDULE - 4206 17029375 84270 "HCHG SEX HORM BINDING GLOB, SERUM LC" 216.00 $194.40 $86.40 $172.80 $120.96 $151.20 $138.24 $172.80 $168.48 $97.20 $88.56 $90.72 $86.40 $162.00 $140.40
WWH LAB/RAD FEE SCHEDULE - 4206 17029379 84442 HCHG THYROXINE BINDING GLOBULIN LC 98.00 $88.20 $39.20 $78.40 $54.88 $68.60 $62.72 $78.40 $76.44 $44.10 $40.18 $41.16 $39.20 $73.50 $63.70
WWH LAB/RAD FEE SCHEDULE - 4206 17029380 83520 "HCHG THYROTROPIN RECEPTOR AB, SERUM LC" 118.00 $106.20 $47.20 $94.40 $66.08 $82.60 $75.52 $94.40 $92.04 $53.10 $48.38 $49.56 $47.20 $88.50 $76.70
WWH LAB/RAD FEE SCHEDULE - 4206 17029382 86777 "HCHG TOXOPLASMA GONDII AB, IGG, QN LC" 104.00 $93.60 $41.60 $83.20 $58.24 $72.80 $66.56 $83.20 $81.12 $46.80 $42.64 $43.68 $41.60 $78.00 $67.60
WWH LAB/RAD FEE SCHEDULE - 4206 17029383 83520 HCHG TRYPTASE LC 118.00 $106.20 $47.20 $94.40 $66.08 $82.60 $75.52 $94.40 $92.04 $53.10 $48.38 $49.56 $47.20 $88.50 $76.70
WWH LAB/RAD FEE SCHEDULE - 4206 17029384 84445 HCHG THYROID STIM IMMUNOGLOBULIN LC 410.00 $369.00 $164.00 $328.00 $229.60 $287.00 $262.40 $328.00 $319.80 $184.50 $168.10 $172.20 $164.00 $307.50 $266.50
WWH LAB/RAD FEE SCHEDULE - 4206 17029386 86778 "HCHG TOXOPLASMA GONDII AB,IGM,QN LC" 108.00 $97.20 $43.20 $86.40 $60.48 $75.60 $69.12 $86.40 $84.24 $48.60 $44.28 $45.36 $43.20 $81.00 $70.20
WWH LAB/RAD FEE SCHEDULE - 4206 17029388 85810 "HCHG VISCOSITY, SERUM LC" 87.00 $78.30 $34.80 $69.60 $48.72 $60.90 $55.68 $69.60 $67.86 $39.15 $35.67 $36.54 $34.80 $65.25 $56.55
WWH LAB/RAD FEE SCHEDULE - 4206 17029389 84590 "HCHG VITAMIN A, SERUM LC" 122.00 $109.80 $48.80 $97.60 $68.32 $85.40 $78.08 $97.60 $95.16 $54.90 $50.02 $51.24 $48.80 $91.50 $79.30
WWH LAB/RAD FEE SCHEDULE - 4206 17029391 82180 HCHG VITAMIN C LC 103.00 $92.70 $41.20 $82.40 $57.68 $72.10 $65.92 $82.40 $80.34 $46.35 $42.23 $43.26 $41.20 $77.25 $66.95
WWH LAB/RAD FEE SCHEDULE - 4206 17029392 84446 HCHG VITAMIN E LC 150.00 $135.00 $60.00 $120.00 $84.00 $105.00 $96.00 $120.00 $117.00 $67.50 $61.50 $63.00 $60.00 $112.50 $97.50
WWH LAB/RAD FEE SCHEDULE - 4206 17029393 84597 HCHG VITAMIN K1 LC 63.00 $56.70 $25.20 $50.40 $35.28 $44.10 $40.32 $50.40 $49.14 $28.35 $25.83 $26.46 $25.20 $47.25 $40.95
WWH LAB/RAD FEE SCHEDULE - 4206 17029394 84585 "HCHG VANILLYLMANDELIC ACID, 24-HR U LC" 67.00 $60.30 $26.80 $53.60 $37.52 $46.90 $42.88 $53.60 $52.26 $30.15 $27.47 $28.14 $26.80 $50.25 $43.55
WWH LAB/RAD FEE SCHEDULE - 4206 17029396 87252 "HCHG VIRAL CULTURE, GENERAL LC" 118.00 $106.20 $47.20 $94.40 $66.08 $82.60 $75.52 $94.40 $92.04 $53.10 $48.38 $49.56 $47.20 $88.50 $76.70
WWH LAB/RAD FEE SCHEDULE - 4206 17029397 86787 "HCHG VARICELLA-ZOSTER AB, IGM LC" 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH LAB/RAD FEE SCHEDULE - 4206 17029398 86788 "HCHG WEST NILE VIRUS ANTIBODY IGM, SERUM LC" 89.00 $80.10 $35.60 $71.20 $49.84 $62.30 $56.96 $71.20 $69.42 $40.05 $36.49 $37.38 $35.60 $66.75 $57.85
WWH LAB/RAD FEE SCHEDULE - 4206 17029399 86789 HCHG WEST NILE VIRUS ANTIBODY IGG SERUM LC 83.00 $74.70 $33.20 $66.40 $46.48 $58.10 $53.12 $66.40 $64.74 $37.35 $34.03 $34.86 $33.20 $62.25 $53.95
WWH LAB/RAD FEE SCHEDULE - 4206 17029402 82384 "HCHG CATECHOLAMINES,UR,FREE,24 HR LC" 78.00 $70.20 $31.20 $62.40 $43.68 $54.60 $49.92 $62.40 $60.84 $35.10 $31.98 $32.76 $31.20 $58.50 $50.70
WWH LAB/RAD FEE SCHEDULE - 4206 17029403 86331 HCHG IMMUNODIFFUSION OUCHTERLONY LC 55.00 $49.50 $22.00 $44.00 $30.80 $38.50 $35.20 $44.00 $42.90 $24.75 $22.55 $23.10 $22.00 $41.25 $35.75
WWH LAB/RAD FEE SCHEDULE - 4206 17029404 86602 HCHG ACTINOMYCES ABYS LC 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH LAB/RAD FEE SCHEDULE - 4206 17029405 86606 HCHG ASPERGILLUS FUMIGATUS ANTIBODY LC 75.00 $67.50 $30.00 $60.00 $42.00 $52.50 $48.00 $60.00 $58.50 $33.75 $30.75 $31.50 $30.00 $56.25 $48.75
WWH LAB/RAD FEE SCHEDULE - 4206 17029406 86609 HCHG BACTERIUM ANTIBODY LC 44.00 $39.60 $17.60 $35.20 $24.64 $30.80 $28.16 $35.20 $34.32 $19.80 $18.04 $18.48 $17.60 $33.00 $28.60
WWH LAB/RAD FEE SCHEDULE - 4206 17029407 86671 HCHG FUNGUS NES ANTIBODY LC 137.00 $123.30 $54.80 $109.60 $76.72 $95.90 $87.68 $109.60 $106.86 $61.65 $56.17 $57.54 $54.80 $102.75 $89.05
WWH LAB/RAD FEE SCHEDULE - 4206 17029408 87517 HCHG GENERAL LAB 8751701 LC 358.00 $322.20 $143.20 $286.40 $200.48 $250.60 $229.12 $286.40 $279.24 $161.10 $146.78 $150.36 $143.20 $268.50 $232.70
WWH LAB/RAD FEE SCHEDULE - 4206 17029409 80299 HCHG THIOPURINE METABOLITES LC 22.00 $19.80 $8.80 $17.60 $12.32 $15.40 $14.08 $17.60 $17.16 $9.90 $9.02 $9.24 $8.80 $16.50 $14.30
WWH LAB/RAD FEE SCHEDULE - 4206 17029410 84433 HCHG THIOPURINE METHYLTRANSFERASE LC 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH LAB/RAD FEE SCHEDULE - 4206 17029411 86658 HCHG COXSACKIE A ABYS IGG & IGM LC 48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
WWH LAB/RAD FEE SCHEDULE - 4206 17029417 81377 HCHG CELIAC DISEASE HLA DQ ASSOC LC 357.00 $321.30 $142.80 $285.60 $199.92 $249.90 $228.48 $285.60 $278.46 $160.65 $146.37 $149.94 $142.80 $267.75 $232.05
WWH LAB/RAD FEE SCHEDULE - 4206 17029418 81383 (IA) HCHG CELIAC DISEASE HLA DQ ASSOC ALLELE LC 304.00 $273.60 $121.60 $243.20 $170.24 $212.80 $194.56 $243.20 $237.12 $136.80 $124.64 $127.68 $121.60 $228.00 $197.60
WWH LAB/RAD FEE SCHEDULE - 4206 17029419 82642 HCHG DIHYDROTESTOSTERONE LC 109.00 $98.10 $43.60 $87.20 $61.04 $76.30 $69.76 $87.20 $85.02 $49.05 $44.69 $45.78 $43.60 $81.75 $70.85
WWH LAB/RAD FEE SCHEDULE - 4206 17029420 80169 HCHG EVEROLIMUS LC 182.00 $163.80 $72.80 $145.60 $101.92 $127.40 $116.48 $145.60 $141.96 $81.90 $74.62 $76.44 $72.80 $136.50 $118.30
WWH LAB/RAD FEE SCHEDULE - 4206 17029423 82945 "HCHG GLUCOSE, BODY FLUID LC" 54.00 $48.60 $21.60 $43.20 $30.24 $37.80 $34.56 $43.20 $42.12 $24.30 $22.14 $22.68 $21.60 $40.50 $35.10
WWH LAB/RAD FEE SCHEDULE - 4206 17029424 86341 HCHG IA-2 AUTOANTIBODIES LC 194.00 $174.60 $77.60 $155.20 $108.64 $135.80 $124.16 $155.20 $151.32 $87.30 $79.54 $81.48 $77.60 $145.50 $126.10
WWH LAB/RAD FEE SCHEDULE - 4206 17029425 83520 HCHG IGF-BP3 LC 118.00 $106.20 $47.20 $94.40 $66.08 $82.60 $75.52 $94.40 $92.04 $53.10 $48.38 $49.56 $47.20 $88.50 $76.70
WWH LAB/RAD FEE SCHEDULE - 4206 17029426 80230 HCHG INFLIXIMAB (IFX) CONC LC 117.00 $105.30 $46.80 $93.60 $65.52 $81.90 $74.88 $93.60 $91.26 $52.65 $47.97 $49.14 $46.80 $87.75 $76.05
WWH LAB/RAD FEE SCHEDULE - 4206 17029427 82397 HCHG INFLIXIMAB (IFX) AB LC 134.00 $120.60 $53.60 $107.20 $75.04 $93.80 $85.76 $107.20 $104.52 $60.30 $54.94 $56.28 $53.60 $100.50 $87.10
WWH LAB/RAD FEE SCHEDULE - 4206 17029429 G0480 "HCHG NICOTINE AND METABOLITE, QUANT LC" 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 17029431 84120 "HCHG PORPHYRINS, QN, RANDOM U LC" 136.00 $122.40 $54.40 $108.80 $76.16 $95.20 $87.04 $108.80 $106.08 $61.20 $55.76 $57.12 $54.40 $102.00 $88.40
WWH LAB/RAD FEE SCHEDULE - 4206 17029432 84157 "HCHG PROTEIN, BODY FLUID LC" 47.00 $42.30 $18.80 $37.60 $26.32 $32.90 $30.08 $37.60 $36.66 $21.15 $19.27 $19.74 $18.80 $35.25 $30.55
WWH LAB/RAD FEE SCHEDULE - 4206 17029434 86757 "HCHG ROCKY MOUNTAIN SPOTTED FEVER (RMSF), IGG LC" 76.00 $68.40 $30.40 $60.80 $42.56 $53.20 $48.64 $60.80 $59.28 $34.20 $31.16 $31.92 $30.40 $57.00 $49.40
WWH LAB/RAD FEE SCHEDULE - 4206 17029438 86622 "HCHG BRUCELLA ANTIBODY, IGG, EIA LC" 66.00 $59.40 $26.40 $52.80 $36.96 $46.20 $42.24 $52.80 $51.48 $29.70 $27.06 $27.72 $26.40 $49.50 $42.90
WWH LAB/RAD FEE SCHEDULE - 4206 17029442 82247 "HCHG BILIRUBIN, TOTAL BODY FLUID LC" 55.00 $49.50 $22.00 $44.00 $30.80 $38.50 $35.20 $44.00 $42.90 $24.75 $22.55 $23.10 $22.00 $41.25 $35.75
WWH LAB/RAD FEE SCHEDULE - 4206 17029444 85660 HCHG HGB SOLUBILITY LC 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH LAB/RAD FEE SCHEDULE - 4206 17029445 84478 "HCHG TRIGLYCERIDES, FLUID LC" 46.00 $41.40 $18.40 $36.80 $25.76 $32.20 $29.44 $36.80 $35.88 $20.70 $18.86 $19.32 $18.40 $34.50 $29.90
WWH LAB/RAD FEE SCHEDULE - 4206 17029447 86008 HCHG ALPHA GAL IGE LC 42.00 $37.80 $16.80 $33.60 $23.52 $29.40 $26.88 $33.60 $32.76 $18.90 $17.22 $17.64 $16.80 $31.50 $27.30
WWH LAB/RAD FEE SCHEDULE - 4206 17029449 86720 HCHG LEPTOSPIRA IGM LC 139.00 $125.10 $55.60 $111.20 $77.84 $97.30 $88.96 $111.20 $108.42 $62.55 $56.99 $58.38 $55.60 $104.25 $90.35
WWH LAB/RAD FEE SCHEDULE - 4206 17029450 83070 "HCHG HEMOSIDERIN, URINE LC" 63.00 $56.70 $25.20 $50.40 $35.28 $44.10 $40.32 $50.40 $49.14 $28.35 $25.83 $26.46 $25.20 $47.25 $40.95
WWH LAB/RAD FEE SCHEDULE - 4206 17029451 87476 HCHG LYME (B. BURGDORFERI) PCR LC 142.00 $127.80 $56.80 $113.60 $79.52 $99.40 $90.88 $113.60 $110.76 $63.90 $58.22 $59.64 $56.80 $106.50 $92.30
WWH LAB/RAD FEE SCHEDULE - 4206 17029452 81206 "HCHG BCR-ABL1, CML/ALL, PCR, MAJOR BP LC" 699.00 $629.10 $279.60 $559.20 $391.44 $489.30 $447.36 $559.20 $545.22 $314.55 $286.59 $293.58 $279.60 $524.25 $454.35
WWH LAB/RAD FEE SCHEDULE - 4206 17029453 81207 "HCHG BCR-ABL1, CML/ALL, PCR, MINOR BP LC" 380.00 $342.00 $152.00 $304.00 $212.80 $266.00 $243.20 $304.00 $296.40 $171.00 $155.80 $159.60 $152.00 $285.00 $247.00
WWH LAB/RAD FEE SCHEDULE - 4206 17029455 81279 HCHG JAK2 EXONS 12-15 LC 649.00 $584.10 $259.60 $519.20 $363.44 $454.30 $415.36 $519.20 $506.22 $292.05 $266.09 $272.58 $259.60 $486.75 $421.85
WWH LAB/RAD FEE SCHEDULE - 4206 17029456 86258 "HCHG ANTIGLIADIN ABS, IGG LC" 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 17029458 87469 "HCHG BABESIA MICROTI, PCR LC" 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH LAB/RAD FEE SCHEDULE - 4206 17029461 86800 HCHG THYROGLOBULIN ABY LC 158.00 $142.20 $63.20 $126.40 $88.48 $110.60 $101.12 $126.40 $123.24 $71.10 $64.78 $66.36 $63.20 $118.50 $102.70
WWH LAB/RAD FEE SCHEDULE - 4206 17029462 84432 HCHG THYROGLOBULIN BY IMA LC 169.00 $152.10 $67.60 $135.20 $94.64 $118.30 $108.16 $135.20 $131.82 $76.05 $69.29 $70.98 $67.60 $126.75 $109.85
WWH LAB/RAD FEE SCHEDULE - 4206 17029464 87045 HCHG STOOL CULTURE AEROBIC BACTERIA LC 88.00 $79.20 $35.20 $70.40 $49.28 $61.60 $56.32 $70.40 $68.64 $39.60 $36.08 $36.96 $35.20 $66.00 $57.20
WWH LAB/RAD FEE SCHEDULE - 4206 17029465 87046 HCHG STOOL CULTURE AEROBIC BACTERIA ADDL PATHOGEN LC 42.00 $37.80 $16.80 $33.60 $23.52 $29.40 $26.88 $33.60 $32.76 $18.90 $17.22 $17.64 $16.80 $31.50 $27.30
WWH LAB/RAD FEE SCHEDULE - 4206 17029466 87427 HCHG E COLI SHIGA TOXIN EIA LC 102.00 $91.80 $40.80 $81.60 $57.12 $71.40 $65.28 $81.60 $79.56 $45.90 $41.82 $42.84 $40.80 $76.50 $66.30
WWH LAB/RAD FEE SCHEDULE - 4206 17029468 82384 "HCHG CATECHOLAMINES, PLASMA LC" 253.00 $227.70 $101.20 $202.40 $141.68 $177.10 $161.92 $202.40 $197.34 $113.85 $103.73 $106.26 $101.20 $189.75 $164.45
WWH LAB/RAD FEE SCHEDULE - 4206 17029473 86335 HCHG BETA-2 TRANSFERRIN LC 309.00 $278.10 $123.60 $247.20 $173.04 $216.30 $197.76 $247.20 $241.02 $139.05 $126.69 $129.78 $123.60 $231.75 $200.85
WWH LAB/RAD FEE SCHEDULE - 4206 17029474 82378 "HCHG CEA, FLUID LC" 180.00 $162.00 $72.00 $144.00 $100.80 $126.00 $115.20 $144.00 $140.40 $81.00 $73.80 $75.60 $72.00 $135.00 $117.00
WWH LAB/RAD FEE SCHEDULE - 4206 17029481 84311 "HCHG PORPHYRINS, TOTAL PLASMA LC" 32.00 $28.80 $12.80 $25.60 $17.92 $22.40 $20.48 $25.60 $24.96 $14.40 $13.12 $13.44 $12.80 $24.00 $20.80
WWH LAB/RAD FEE SCHEDULE - 4206 17029485 86235 HCHG RNA POLYMERASE III IGG ABS LC 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 17029487 86682 HCHG SCHISTOSOMA IGG ANTIBODY LC 174.00 $156.60 $69.60 $139.20 $97.44 $121.80 $111.36 $139.20 $135.72 $78.30 $71.34 $73.08 $69.60 $130.50 $113.10
WWH LAB/RAD FEE SCHEDULE - 4206 17029488 84402 HCHG TESTOSTERONE FREE LC 264.00 $237.60 $105.60 $211.20 $147.84 $184.80 $168.96 $211.20 $205.92 $118.80 $108.24 $110.88 $105.60 $198.00 $171.60
WWH LAB/RAD FEE SCHEDULE - 4206 17029490 84410 HCHG TESTOSTERONE BIOAVAIL LC 368.00 $331.20 $147.20 $294.40 $206.08 $257.60 $235.52 $294.40 $287.04 $165.60 $150.88 $154.56 $147.20 $276.00 $239.20
WWH LAB/RAD FEE SCHEDULE - 4206 17029527 82610 HCHG CYSTATIN C LC 66.00 $59.40 $26.40 $52.80 $36.96 $46.20 $42.24 $52.80 $51.48 $29.70 $27.06 $27.72 $26.40 $49.50 $42.90
WWH LAB/RAD FEE SCHEDULE - 4206 17029528 82523 HCHG C-TELOPEPTIDE SERUM LC 157.00 $141.30 $62.80 $125.60 $87.92 $109.90 $100.48 $125.60 $122.46 $70.65 $64.37 $65.94 $62.80 $117.75 $102.05
WWH LAB/RAD FEE SCHEDULE - 4206 17029532 80299 HCHG CLOBAZAM (ONFI) LC 153.00 $137.70 $61.20 $122.40 $85.68 $107.10 $97.92 $122.40 $119.34 $68.85 $62.73 $64.26 $61.20 $114.75 $99.45
WWH LAB/RAD FEE SCHEDULE - 4206 17029540 82306 HCHG 25-HYDROXY VITAMIN D (D2+D3 FRACTIONATED) LC 220.00 $198.00 $88.00 $176.00 $123.20 $154.00 $140.80 $176.00 $171.60 $99.00 $90.20 $92.40 $88.00 $165.00 $143.00
WWH LAB/RAD FEE SCHEDULE - 4206 17029544 83615 HCHG LACTIC ACID DEHYDROGENASE BODY FLUID LC 42.00 $37.80 $16.80 $33.60 $23.52 $29.40 $26.88 $33.60 $32.76 $18.90 $17.22 $17.64 $16.80 $31.50 $27.30
WWH LAB/RAD FEE SCHEDULE - 4206 17029545 86255 HCHG STRIATIONAL ANTIBODIES LC 156.00 $140.40 $62.40 $124.80 $87.36 $109.20 $99.84 $124.80 $121.68 $70.20 $63.96 $65.52 $62.40 $117.00 $101.40
WWH LAB/RAD FEE SCHEDULE - 4206 17029569 82705 "HCHG FECAL FAT, QUAL LC" 55.00 $49.50 $22.00 $44.00 $30.80 $38.50 $35.20 $44.00 $42.90 $24.75 $22.55 $23.10 $22.00 $41.25 $35.75
WWH LAB/RAD FEE SCHEDULE - 4206 17029588 83516 HCHG PHOSPHOLIPASE A2 RECEPTOR AUTOABY LC 123.00 $110.70 $49.20 $98.40 $68.88 $86.10 $78.72 $98.40 $95.94 $55.35 $50.43 $51.66 $49.20 $92.25 $79.95
WWH LAB/RAD FEE SCHEDULE - 4206 17029653 87150 HCHG VAGINAL/RECTAL OB STREP PCR 115.00 $103.50 $46.00 $92.00 $64.40 $80.50 $73.60 $92.00 $89.70 $51.75 $47.15 $48.30 $46.00 $86.25 $74.75
WWH LAB/RAD FEE SCHEDULE - 4206 17029679 86790 HCHG GENERAL LAB 8679000 103.00 $92.70 $41.20 $82.40 $57.68 $72.10 $65.92 $82.40 $80.34 $46.35 $42.23 $43.26 $41.20 $77.25 $66.95
WWH LAB/RAD FEE SCHEDULE - 4206 17029752 83519 HCHG ACHR BINDING ABY LC 171.00 $153.90 $68.40 $136.80 $95.76 $119.70 $109.44 $136.80 $133.38 $76.95 $70.11 $71.82 $68.40 $128.25 $111.15
WWH LAB/RAD FEE SCHEDULE - 4206 17029753 86255 HCHG STRIATIONAL ABY LC 156.00 $140.40 $62.40 $124.80 $87.36 $109.20 $99.84 $124.80 $121.68 $70.20 $63.96 $65.52 $62.40 $117.00 $101.40
WWH LAB/RAD FEE SCHEDULE - 4206 17029754 83519 HCHG ACHR MODULATING ABY LC 171.00 $153.90 $68.40 $136.80 $95.76 $119.70 $109.44 $136.80 $133.38 $76.95 $70.11 $71.82 $68.40 $128.25 $111.15
WWH LAB/RAD FEE SCHEDULE - 4206 17029772 85247 HCHG VON WILLEBRAND FACTOR MULTIMERS LC 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH LAB/RAD FEE SCHEDULE - 4206 17029806 83735 HCHG MAGNESIUM URINE LC 40.00 $36.00 $16.00 $32.00 $22.40 $28.00 $25.60 $32.00 $31.20 $18.00 $16.40 $16.80 $16.00 $30.00 $26.00
WWH LAB/RAD FEE SCHEDULE - 4206 17029809 83520 (IA) HCHG MYELIN ASSOC GLYCOPROTEIN IGM AUTOABY LC 131.00 $117.90 $52.40 $104.80 $73.36 $91.70 $83.84 $104.80 $102.18 $58.95 $53.71 $55.02 $52.40 $98.25 $85.15
WWH LAB/RAD FEE SCHEDULE - 4206 17029870 87563 "HB GENITAL MYCOPLASMA GENITALIUM, SWAB LC" 134.00 $120.60 $53.60 $107.20 $75.04 $93.80 $85.76 $107.20 $104.52 $60.30 $54.94 $56.28 $53.60 $100.50 $87.10
WWH LAB/RAD FEE SCHEDULE - 4206 17029871 87563 "HB GENITAL MYCOPLASMA GENITALIUM, URINE LC" 134.00 $120.60 $53.60 $107.20 $75.04 $93.80 $85.76 $107.20 $104.52 $60.30 $54.94 $56.28 $53.60 $100.50 $87.10
WWH LAB/RAD FEE SCHEDULE - 4206 17029905 82103 HCHG ALPHA 1 ANTITRYPSIN LC 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH LAB/RAD FEE SCHEDULE - 4206 17029920 86355 HCHG B CELL TOTAL COUNT 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH LAB/RAD FEE SCHEDULE - 4206 17029921 86357 HCHG NK CELLS TOTAL COUNT 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 17029922 86359 HCHG T CELLS TOTAL COUNT 143.00 $128.70 $57.20 $114.40 $80.08 $100.10 $91.52 $114.40 $111.54 $64.35 $58.63 $60.06 $57.20 $107.25 $92.95
WWH LAB/RAD FEE SCHEDULE - 4206 17029923 86360 HCHG ABSOLUTE CD4 CD8 COUNT $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH LAB/RAD FEE SCHEDULE - 4206 17029975 87635 HCHG COVID 19 NAA LC 216.00 $194.40 $86.40 $172.80 $120.96 $151.20 $138.24 $172.80 $168.48 $97.20 $88.56 $90.72 $86.40 $162.00 $140.40
WWH LAB/RAD FEE SCHEDULE - 4206 17029978 87635 HCHG COVID 19 MML 216.00 $194.40 $86.40 $172.80 $120.96 $151.20 $138.24 $172.80 $168.48 $97.20 $88.56 $90.72 $86.40 $162.00 $140.40
WWH LAB/RAD FEE SCHEDULE - 4206 17029986 87635 HCHG COVID 19 INHOUSE 216.00 $194.40 $86.40 $172.80 $120.96 $151.20 $138.24 $172.80 $168.48 $97.20 $88.56 $90.72 $86.40 $162.00 $140.40
WWH LAB/RAD FEE SCHEDULE - 4206 17030000 U0003 (IA) HCHG COVID 19 HIGH THROUGHPUT LC 216.00 $194.40 $86.40 $172.80 $120.96 $151.20 $138.24 $172.80 $168.48 $97.20 $88.56 $90.72 $86.40 $162.00 $140.40
WWH LAB/RAD FEE SCHEDULE - 4206 17030001 U0003 (IA) HCHG COVID 19 HIGH THROUGHPUT MAYO 216.00 $194.40 $86.40 $172.80 $120.96 $151.20 $138.24 $172.80 $168.48 $97.20 $88.56 $90.72 $86.40 $162.00 $140.40
WWH LAB/RAD FEE SCHEDULE - 4206 17030002 U0003 (IA) HCHG COVID 19 HIGH THROUGHPUT INHOUSE 216.00 $194.40 $86.40 $172.80 $120.96 $151.20 $138.24 $172.80 $168.48 $97.20 $88.56 $90.72 $86.40 $162.00 $140.40
WWH LAB/RAD FEE SCHEDULE - 4206 17030004 86769 (IA) HCHG COVID 19 ANTIBODY IGG INHOUSE 81.00 $72.90 $32.40 $64.80 $45.36 $56.70 $51.84 $64.80 $63.18 $36.45 $33.21 $34.02 $32.40 $60.75 $52.65
WWH LAB/RAD FEE SCHEDULE - 4206 17030014 81220 "HCHG CYSTIC FIBROSIS PROFILE, 32 MUTATIONS" "1,033.00" $929.70 $413.20 $826.40 $578.48 $723.10 $661.12 $826.40 $805.74 $464.85 $423.53 $433.86 $413.20 $774.75 $671.45
WWH LAB/RAD FEE SCHEDULE - 4206 17030021 87426 HCHG COVID 19 ANTIGEN 60.00 $54.00 $24.00 $48.00 $33.60 $42.00 $38.40 $48.00 $46.80 $27.00 $24.60 $25.20 $24.00 $45.00 $39.00
WWH LAB/RAD FEE SCHEDULE - 4206 17030029 86235 "HCHG MYO 3 PLUS, NUCLEAR ANTIGEN ABY LC" 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 17030030 83516 "HCHG MYO 3 PLUS, IMMUNOASSAY ABY LC" 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 17030031 83520 "(IA) HCHG MYO 3 PLUS, IMMUNOASSAY QT ABY LC" 118.00 $106.20 $47.20 $94.40 $66.08 $82.60 $75.52 $94.40 $92.04 $53.10 $48.38 $49.56 $47.20 $88.50 $76.70
WWH LAB/RAD FEE SCHEDULE - 4206 17030044 87801 HCHG GENERAL LAB 8780104 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH LAB/RAD FEE SCHEDULE - 4206 17030045 87481 HCHG GENERAL LAB 8748100 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH LAB/RAD FEE SCHEDULE - 4206 17030046 87661 HCHG GENERAL LAB 8766103 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH LAB/RAD FEE SCHEDULE - 4206 17030068 U0003 (IA) HCHG COVID 19 SEEGENE INHOUSE 216.00 $194.40 $86.40 $172.80 $120.96 $151.20 $138.24 $172.80 $168.48 $97.20 $88.56 $90.72 $86.40 $162.00 $140.40
WWH LAB/RAD FEE SCHEDULE - 4206 17030069 U0003 (IA) HCHG COVID 19 PANTHER INHOUSE 216.00 $194.40 $86.40 $172.80 $120.96 $151.20 $138.24 $172.80 $168.48 $97.20 $88.56 $90.72 $86.40 $162.00 $140.40
WWH LAB/RAD FEE SCHEDULE - 4206 17030077 0241U HCHG COVID INF RSV RESP PANEL CEPHEID 227.00 $204.30 $90.80 $181.60 $127.12 $158.90 $145.28 $181.60 $177.06 $102.15 $93.07 $95.34 $90.80 $170.25 $147.55
WWH LAB/RAD FEE SCHEDULE - 4206 17030095 81378 HCHG HLA ABC DR NGS "1,329.00" " $1,196.10 " $531.60 " $1,063.20 " $744.24 $930.30 $850.56 " $1,063.20 " " $1,036.62 " $598.05 $544.89 $558.18 $531.60 $996.75 $863.85
WWH LAB/RAD FEE SCHEDULE - 4206 17030096 81382 HCHG HLA CLASS II NGS 483.00 $434.70 $193.20 $386.40 $270.48 $338.10 $309.12 $386.40 $376.74 $217.35 $198.03 $202.86 $193.20 $362.25 $313.95
WWH LAB/RAD FEE SCHEDULE - 4206 17030110 83695 HCHG LIPOPROTEIN LPA LC 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH LAB/RAD FEE SCHEDULE - 4206 17030151 83020 HCHG HGB FRACTIONATION CASCADE LC 98.00 $88.20 $39.20 $78.40 $54.88 $68.60 $62.72 $78.40 $76.44 $44.10 $40.18 $41.16 $39.20 $73.50 $63.70
WWH LAB/RAD FEE SCHEDULE - 4206 17030156 86592 HCHG GENERAL LAB 8659203 38.00 $34.20 $15.20 $30.40 $21.28 $26.60 $24.32 $30.40 $29.64 $17.10 $15.58 $15.96 $15.20 $28.50 $24.70
WWH LAB/RAD FEE SCHEDULE - 4206 17030157 86255 HCHG MG STRIATIONAL ABY LC 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH LAB/RAD FEE SCHEDULE - 4206 17030158 83519 HCHG MG ACHR ABYS LC 171.00 $153.90 $68.40 $136.80 $95.76 $119.70 $109.44 $136.80 $133.38 $76.95 $70.11 $71.82 $68.40 $128.25 $111.15
WWH LAB/RAD FEE SCHEDULE - 4206 17030208 U0003 (IA) HCHG COVID 19 BIOFIRE INHOUSE 216.00 $194.40 $86.40 $172.80 $120.96 $151.20 $138.24 $172.80 $168.48 $97.20 $88.56 $90.72 $86.40 $162.00 $140.40
WWH LAB/RAD FEE SCHEDULE - 4206 17030211 83655 "HCHG LEAD, CAPILLARY, BLOOD LC" 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH LAB/RAD FEE SCHEDULE - 4206 17030236 87328 HCHG CRYPTOSPORIDIUM ANTIGEN 114.00 $102.60 $45.60 $91.20 $63.84 $79.80 $72.96 $91.20 $88.92 $51.30 $46.74 $47.88 $45.60 $85.50 $74.10
WWH LAB/RAD FEE SCHEDULE - 4206 17030237 87329 HCHG GIARDIA LAMBLIA ANTIGEN 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH LAB/RAD FEE SCHEDULE - 4206 17030264 87634 HCHG RSV BY NAAT CEPHEID 79.00 $71.10 $31.60 $63.20 $44.24 $55.30 $50.56 $63.20 $61.62 $35.55 $32.39 $33.18 $31.60 $59.25 $51.35
WWH LAB/RAD FEE SCHEDULE - 4206 17030274 87177 HCHG O&P EXAM LC 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH LAB/RAD FEE SCHEDULE - 4206 17030275 87209 HCHG O&P STAIN LC 72.00 $64.80 $28.80 $57.60 $40.32 $50.40 $46.08 $57.60 $56.16 $32.40 $29.52 $30.24 $28.80 $54.00 $46.80
WWH LAB/RAD FEE SCHEDULE - 4206 17030345 81514 HCHG GENERAL LAB 8151400 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH LAB/RAD FEE SCHEDULE - 4206 17030398 87483 HCHG MENINGITIS ENCEPHALITIS PATHOGEN PANEL PCR CSF 636.00 $572.40 $254.40 $508.80 $356.16 $445.20 $407.04 $508.80 $496.08 $286.20 $260.76 $267.12 $254.40 $477.00 $413.40
WWH LAB/RAD FEE SCHEDULE - 4206 17030418 82595 "HCHG CRYOGLOBULIN, QUAL WITH REFLEX" 74.00 $66.60 $29.60 $59.20 $41.44 $51.80 $47.36 $59.20 $57.72 $33.30 $30.34 $31.08 $29.60 $55.50 $48.10
WWH LAB/RAD FEE SCHEDULE - 4206 17030426 86617 HCHG LYME IGM/IGG CONFIRMATION EACH 102.00 $91.80 $40.80 $81.60 $57.12 $71.40 $65.28 $81.60 $79.56 $45.90 $41.82 $42.84 $40.80 $76.50 $66.30
WWH LAB/RAD FEE SCHEDULE - 4206 17030475 87593 "HCHG MONKEYPOX (ORTHOPOXVIRUS), DNA, PCR" 169.00 $152.10 $67.60 $135.20 $94.64 $118.30 $108.16 $135.20 $131.82 $76.05 $69.29 $70.98 $67.60 $126.75 $109.85
WWH LAB/RAD FEE SCHEDULE - 4206 17030526 87468 HCHG ANAPLASMA PHAGOCYTOPHILUM PCR LC 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH LAB/RAD FEE SCHEDULE - 4206 17030565 86359 "HCHG T CELLS, TOTAL COUNT MML" 143.00 $128.70 $57.20 $114.40 $80.08 $100.10 $91.52 $114.40 $111.54 $64.35 $58.63 $60.06 $57.20 $107.25 $92.95
WWH LAB/RAD FEE SCHEDULE - 4206 17030566 86360 HCHG ABSOLUTE CD4/CD8 COUNT WITH RATIO MML 157.00 $141.30 $62.80 $125.60 $87.92 $109.90 $100.48 $125.60 $122.46 $70.65 $64.37 $65.94 $62.80 $117.75 $102.05
WWH LAB/RAD FEE SCHEDULE - 4206 17100029 87077TRACK HCHG REFERRAL ID & SUSC NONURINE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH LAB/RAD FEE SCHEDULE - 4206 17100043 87077TRACK HCHG REFERRAL ID AND SUSC URINE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH LAB/RAD FEE SCHEDULE - 4206 17100064 84484 HCHG TROPONIN I 164.00 $147.60 $65.60 $131.20 $91.84 $114.80 $104.96 $131.20 $127.92 $73.80 $67.24 $68.88 $65.60 $123.00 $106.60
WWH LAB/RAD FEE SCHEDULE - 4206 17100070 85610 HCHG INR POCT 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH LAB/RAD FEE SCHEDULE - 4206 17100173 36416 HCHG CAPILLARY COLLECTION 24.00 $21.60 $9.60 $19.20 $13.44 $16.80 $15.36 $19.20 $18.72 $10.80 $9.84 $10.08 $9.60 $18.00 $15.60
WWH LAB/RAD FEE SCHEDULE - 4206 17100196 89321 HCHG POST VAS 116.00 $104.40 $46.40 $92.80 $64.96 $81.20 $74.24 $92.80 $90.48 $52.20 $47.56 $48.72 $46.40 $87.00 $75.40
WWH LAB/RAD FEE SCHEDULE - 4206 17100249 84112 HCHG AMNISURE 246.00 $221.40 $98.40 $196.80 $137.76 $172.20 $157.44 $196.80 $191.88 $110.70 $100.86 $103.32 $98.40 $184.50 $159.90
WWH LAB/RAD FEE SCHEDULE - 4206 17100252 Q0114 HCHG FERN TESTING PROVIDER PERFORMED 21.00 $18.90 $8.40 $16.80 $11.76 $14.70 $13.44 $16.80 $16.38 $9.45 $8.61 $8.82 $8.40 $15.75 $13.65
WWH LAB/RAD FEE SCHEDULE - 4206 17100309 83789 HCHG MASS SPEC WISC 87.00 $78.30 $34.80 $69.60 $48.72 $60.90 $55.68 $69.60 $67.86 $39.15 $35.67 $36.54 $34.80 $65.25 $56.55
WWH LAB/RAD FEE SCHEDULE - 4206 17100313 82017 HCHG FATTY ACID OXIDATION 74.00 $66.60 $29.60 $59.20 $41.44 $51.80 $47.36 $59.20 $57.72 $33.30 $30.34 $31.08 $29.60 $55.50 $48.10
WWH LAB/RAD FEE SCHEDULE - 4206 17100314 82017 HCHG ORGANIC ACIDEMIA 74.00 $66.60 $29.60 $59.20 $41.44 $51.80 $47.36 $59.20 $57.72 $33.30 $30.34 $31.08 $29.60 $55.50 $48.10
WWH LAB/RAD FEE SCHEDULE - 4206 17100315 82261 HCHG BIOTINIDASE NSW 42.00 $37.80 $16.80 $33.60 $23.52 $29.40 $26.88 $33.60 $32.76 $18.90 $17.22 $17.64 $16.80 $31.50 $27.30
WWH LAB/RAD FEE SCHEDULE - 4206 17100316 83498 HCHG CONGENITAL ADRENAL HYPERPLAS NSW 157.00 $141.30 $62.80 $125.60 $87.92 $109.90 $100.48 $125.60 $122.46 $70.65 $64.37 $65.94 $62.80 $117.75 $102.05
WWH LAB/RAD FEE SCHEDULE - 4206 17100317 83516 HCHG CYSTIC FIBROSIS WISC 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 17100318 82775 HCHG GALACTOSEMIA NSW 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH LAB/RAD FEE SCHEDULE - 4206 17100319 83020 HCHG HEMOGLOBINOPATHIES NSW 98.00 $88.20 $39.20 $78.40 $54.88 $68.60 $62.72 $78.40 $76.44 $44.10 $40.18 $41.16 $39.20 $73.50 $63.70
WWH LAB/RAD FEE SCHEDULE - 4206 17100320 84443 HCHG HYPOTHYROIDISM WISC 119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
WWH LAB/RAD FEE SCHEDULE - 4206 17100321 84510 HCHG TYROSINEMIA 116.00 $104.40 $46.40 $92.80 $64.96 $81.20 $74.24 $92.80 $90.48 $52.20 $47.56 $48.72 $46.40 $87.00 $75.40
WWH LAB/RAD FEE SCHEDULE - 4206 17100322 84030 HCHG PHENYLKETONURIA 48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
WWH LAB/RAD FEE SCHEDULE - 4206 17100344 36600 HCHG ARTERIAL COLLECTION ART 192.00 $172.80 $76.80 $153.60 $107.52 $134.40 $122.88 $153.60 $149.76 $86.40 $78.72 $80.64 $76.80 $144.00 $124.80
WWH LAB/RAD FEE SCHEDULE - 4206 17100525 80158 HCHG CYCLOSPORINE HCC 196.00 $176.40 $78.40 $156.80 $109.76 $137.20 $125.44 $156.80 $152.88 $88.20 $80.36 $82.32 $78.40 $147.00 $127.40
WWH LAB/RAD FEE SCHEDULE - 4206 17100526 82306 HCHG VITAMIN D D2D3 LCC 161.00 $144.90 $64.40 $128.80 $90.16 $112.70 $103.04 $128.80 $125.58 $72.45 $66.01 $67.62 $64.40 $120.75 $104.65
WWH LAB/RAD FEE SCHEDULE - 4206 17100527 82607 HCHG VITAMIN B12 LCC 124.00 $111.60 $49.60 $99.20 $69.44 $86.80 $79.36 $99.20 $96.72 $55.80 $50.84 $52.08 $49.60 $93.00 $80.60
WWH LAB/RAD FEE SCHEDULE - 4206 17100533 86803 HCHG ANTI HCV LCC 148.00 $133.20 $59.20 $118.40 $82.88 $103.60 $94.72 $118.40 $115.44 $66.60 $60.68 $62.16 $59.20 $111.00 $96.20
WWH LAB/RAD FEE SCHEDULE - 4206 17100537 87389 HCHG ANTI HIV 1/2 LCC 162.00 $145.80 $64.80 $129.60 $90.72 $113.40 $103.68 $129.60 $126.36 $72.90 $66.42 $68.04 $64.80 $121.50 $105.30
WWH LAB/RAD FEE SCHEDULE - 4206 17100542 87340 HCHG HBSAG LCC 122.00 $109.80 $48.80 $97.60 $68.32 $85.40 $78.08 $97.60 $95.16 $54.90 $50.02 $51.24 $48.80 $91.50 $79.30
WWH LAB/RAD FEE SCHEDULE - 4206 17100546 82746 HCHG FOLIC ACID LCC 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH LAB/RAD FEE SCHEDULE - 4206 17100547 84403 HCHG TESTOSTERONE TOTAL LCC 244.00 $219.60 $97.60 $195.20 $136.64 $170.80 $156.16 $195.20 $190.32 $109.80 $100.04 $102.48 $97.60 $183.00 $158.60
WWH LAB/RAD FEE SCHEDULE - 4206 17100555 84480 HCHG T3 TOTAL LCC 99.00 $89.10 $39.60 $79.20 $55.44 $69.30 $63.36 $79.20 $77.22 $44.55 $40.59 $41.58 $39.60 $74.25 $64.35
WWH LAB/RAD FEE SCHEDULE - 4206 17100556 83001 HCHG FSH LCC 220.00 $198.00 $88.00 $176.00 $123.20 $154.00 $140.80 $176.00 $171.60 $99.00 $90.20 $92.40 $88.00 $165.00 $143.00
WWH LAB/RAD FEE SCHEDULE - 4206 17100560 84146 HCHG PROLACTIN LCC 229.00 $206.10 $91.60 $183.20 $128.24 $160.30 $146.56 $183.20 $178.62 $103.05 $93.89 $96.18 $91.60 $171.75 $148.85
WWH LAB/RAD FEE SCHEDULE - 4206 17100562 87338 HCHG H PYLORI STOOL ANTIGEN LCC 143.00 $128.70 $57.20 $114.40 $80.08 $100.10 $91.52 $114.40 $111.54 $64.35 $58.63 $60.06 $57.20 $107.25 $92.95
WWH LAB/RAD FEE SCHEDULE - 4206 17100564 82670 HCHG ESTRADIOL LCC 264.00 $237.60 $105.60 $211.20 $147.84 $184.80 $168.96 $211.20 $205.92 $118.80 $108.24 $110.88 $105.60 $198.00 $171.60
WWH LAB/RAD FEE SCHEDULE - 4206 17100566 83002 HCHG LUTEINIZING HORMONE LCC 196.00 $176.40 $78.40 $156.80 $109.76 $137.20 $125.44 $156.80 $152.88 $88.20 $80.36 $82.32 $78.40 $147.00 $127.40
WWH LAB/RAD FEE SCHEDULE - 4206 17100567 86704 HCHG GENERAL LAB 8670403 LCC 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH LAB/RAD FEE SCHEDULE - 4206 17100576 84481 "HCHG T3,FREE LCC" 141.00 $126.90 $56.40 $112.80 $78.96 $98.70 $90.24 $112.80 $109.98 $63.45 $57.81 $59.22 $56.40 $105.75 $91.65
WWH LAB/RAD FEE SCHEDULE - 4206 17100578 84144 HCHG PROGESTERONE LCC 173.00 $155.70 $69.20 $138.40 $96.88 $121.10 $110.72 $138.40 $134.94 $77.85 $70.93 $72.66 $69.20 $129.75 $112.45
WWH LAB/RAD FEE SCHEDULE - 4206 17100605 86317 HCHG GENERAL LAB 8631706 LCC 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 17100609 80074 HCHG GENERAL LAB 8007401 LCC 381.00 $342.90 $152.40 $304.80 $213.36 $266.70 $243.84 $304.80 $297.18 $171.45 $156.21 $160.02 $152.40 $285.75 $247.65
WWH LAB/RAD FEE SCHEDULE - 4206 17100611 82627 HCHG DHEA-SULFATE (DHEA-S) LCC 220.00 $198.00 $88.00 $176.00 $123.20 $154.00 $140.80 $176.00 $171.60 $99.00 $90.20 $92.40 $88.00 $165.00 $143.00
WWH LAB/RAD FEE SCHEDULE - 4206 17100613 86708 HCHG GENERAL LAB 86708 LCC 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH LAB/RAD FEE SCHEDULE - 4206 17100615 86359 HCHG T CELLS LCC 143.00 $128.70 $57.20 $114.40 $80.08 $100.10 $91.52 $114.40 $111.54 $64.35 $58.63 $60.06 $57.20 $107.25 $92.95
WWH LAB/RAD FEE SCHEDULE - 4206 17100616 86360 HCHG CD4/CD8 LCC 157.00 $141.30 $62.80 $125.60 $87.92 $109.90 $100.48 $125.60 $122.46 $70.65 $64.37 $65.94 $62.80 $117.75 $102.05
WWH LAB/RAD FEE SCHEDULE - 4206 17100617 85613 HCHG DRVVT LCC 88.00 $79.20 $35.20 $70.40 $49.28 $61.60 $56.32 $70.40 $68.64 $39.60 $36.08 $36.96 $35.20 $66.00 $57.20
WWH LAB/RAD FEE SCHEDULE - 4206 17100618 85732 HCHG PTT-LA LCC 38.00 $34.20 $15.20 $30.40 $21.28 $26.60 $24.32 $30.40 $29.64 $17.10 $15.58 $15.96 $15.20 $28.50 $24.70
WWH LAB/RAD FEE SCHEDULE - 4206 17100620 87522 HCHG GENERAL LAB 87522 LCC 449.00 $404.10 $179.60 $359.20 $251.44 $314.30 $287.36 $359.20 $350.22 $202.05 $184.09 $188.58 $179.60 $336.75 $291.85
WWH LAB/RAD FEE SCHEDULE - 4206 17100622 84436 HCHG T4 (THYROXINE) LCC 71.00 $63.90 $28.40 $56.80 $39.76 $49.70 $45.44 $56.80 $55.38 $31.95 $29.11 $29.82 $28.40 $53.25 $46.15
WWH LAB/RAD FEE SCHEDULE - 4206 17100623 86141 HCHG HIGH SENSITIVITY-CARD-CRP LCC 158.00 $142.20 $63.20 $126.40 $88.48 $110.60 $101.12 $126.40 $123.24 $71.10 $64.78 $66.36 $63.20 $118.50 $102.70
WWH LAB/RAD FEE SCHEDULE - 4206 17100624 86800 "HCHG THYROGLOBULIN ABY AND THRYOGLOBULIN,IMA OR RIA LCC" 158.00 $142.20 $63.20 $126.40 $88.48 $110.60 $101.12 $126.40 $123.24 $71.10 $64.78 $66.36 $63.20 $118.50 $102.70
WWH LAB/RAD FEE SCHEDULE - 4206 17100625 86705 HCHG GENERAL LAB 86705 LCC 122.00 $109.80 $48.80 $97.60 $68.32 $85.40 $78.08 $97.60 $95.16 $54.90 $50.02 $51.24 $48.80 $91.50 $79.30
WWH LAB/RAD FEE SCHEDULE - 4206 17100632 86800 HCHG THYROGLOBULIN ANTIBODY LCC 158.00 $142.20 $63.20 $126.40 $88.48 $110.60 $101.12 $126.40 $123.24 $71.10 $64.78 $66.36 $63.20 $118.50 $102.70
WWH LAB/RAD FEE SCHEDULE - 4206 17100660 84153 "HCHG PSA,TOTAL LCC" 169.00 $152.10 $67.60 $135.20 $94.64 $118.30 $108.16 $135.20 $131.82 $76.05 $69.29 $70.98 $67.60 $126.75 $109.85
WWH LAB/RAD FEE SCHEDULE - 4206 17100661 84154 "HCHG PSA,FREE LCC" 149.00 $134.10 $59.60 $119.20 $83.44 $104.30 $95.36 $119.20 $116.22 $67.05 $61.09 $62.58 $59.60 $111.75 $96.85
WWH LAB/RAD FEE SCHEDULE - 4206 17100688 83718 HCHG HDL CHOLESTEROL LCC 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH LAB/RAD FEE SCHEDULE - 4206 17100801 80061 HCHG LIPID PANEL LCC 167.00 $150.30 $66.80 $133.60 $93.52 $116.90 $106.88 $133.60 $130.26 $75.15 $68.47 $70.14 $66.80 $125.25 $108.55
WWH LAB/RAD FEE SCHEDULE - 4206 17100804 84443 HCHG TSH LCC 119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
WWH LAB/RAD FEE SCHEDULE - 4206 17100814 84439 "HCHG T4,FREE LCC" 106.00 $95.40 $42.40 $84.80 $59.36 $74.20 $67.84 $84.80 $82.68 $47.70 $43.46 $44.52 $42.40 $79.50 $68.90
WWH LAB/RAD FEE SCHEDULE - 4206 17100854 82465 "HCHG CHOLESTEROL,TOTAL LCC" 42.00 $37.80 $16.80 $33.60 $23.52 $29.40 $26.88 $33.60 $32.76 $18.90 $17.22 $17.64 $16.80 $31.50 $27.30
WWH LAB/RAD FEE SCHEDULE - 4206 17100928 85613 HCHG DRVVT MIX LCC 88.00 $79.20 $35.20 $70.40 $49.28 $61.60 $56.32 $70.40 $68.64 $39.60 $36.08 $36.96 $35.20 $66.00 $57.20
WWH LAB/RAD FEE SCHEDULE - 4206 17100929 85613 HCHG DRVVT CONFIRM LCC 88.00 $79.20 $35.20 $70.40 $49.28 $61.60 $56.32 $70.40 $68.64 $39.60 $36.08 $36.96 $35.20 $66.00 $57.20
WWH LAB/RAD FEE SCHEDULE - 4206 17100930 86701 HCHG GENERAL LAB LCC 8670104 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH LAB/RAD FEE SCHEDULE - 4206 17100931 86702 HCHG GENERAL LAB LCC 8670203 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH LAB/RAD FEE SCHEDULE - 4206 17100932 85732 HCHG PTT LA MIX LCC 38.00 $34.20 $15.20 $30.40 $21.28 $26.60 $24.32 $30.40 $29.64 $17.10 $15.58 $15.96 $15.20 $28.50 $24.70
WWH LAB/RAD FEE SCHEDULE - 4206 17100935 85598 HCHG HEXAGONAL PHASE PHOSPHOLIPID LCC 161.00 $144.90 $64.40 $128.80 $90.16 $112.70 $103.04 $128.80 $125.58 $72.45 $66.01 $67.62 $64.40 $120.75 $104.65
WWH LAB/RAD FEE SCHEDULE - 4206 17500000 80048 HCHG BASIC METABOLIC RTR 107.00 $96.30 $42.80 $85.60 $59.92 $74.90 $68.48 $85.60 $83.46 $48.15 $43.87 $44.94 $42.80 $80.25 $69.55
WWH LAB/RAD FEE SCHEDULE - 4206 17500009 81001 HCHG UA COMPLETE RTR 13.00 $11.70 $5.20 $10.40 $7.28 $9.10 $8.32 $10.40 $10.14 $5.85 $5.33 $5.46 $5.20 $9.75 $8.45
WWH LAB/RAD FEE SCHEDULE - 4206 303641500 36415 PB VENIPUNCTURE 26.00 $23.40 $10.40 $20.80 $14.56 $18.20 $16.64 $20.80 $20.28 $11.70 $10.66 $10.92 $10.40 $19.50 $16.90
WWH LAB/RAD FEE SCHEDULE - 4206 308004800 80048 PB BASIC METABOLIC PANEL 105.00 $94.50 $42.00 $84.00 $58.80 $73.50 $67.20 $84.00 $81.90 $47.25 $43.05 $44.10 $42.00 $78.75 $68.25
WWH LAB/RAD FEE SCHEDULE - 4206 308005100 80051 PB ELECTROLYTE PANEL 70.00 $63.00 $28.00 $56.00 $39.20 $49.00 $44.80 $56.00 $54.60 $31.50 $28.70 $29.40 $28.00 $52.50 $45.50
WWH LAB/RAD FEE SCHEDULE - 4206 308005300 80053 PB COMPREHENSIVE METABOLIC PANE 68.00 $61.20 $27.20 $54.40 $38.08 $47.60 $43.52 $54.40 $53.04 $30.60 $27.88 $28.56 $27.20 $51.00 $44.20
WWH LAB/RAD FEE SCHEDULE - 4206 308006100 80061 PB LIPID PANEL 167.00 $150.30 $66.80 $133.60 $93.52 $116.90 $106.88 $133.60 $130.26 $75.15 $68.47 $70.14 $66.80 $125.25 $108.55
WWH LAB/RAD FEE SCHEDULE - 4206 308006900 80069 PB RENAL FUNCTION PANEL 56.00 $50.40 $22.40 $44.80 $31.36 $39.20 $35.84 $44.80 $43.68 $25.20 $22.96 $23.52 $22.40 $42.00 $36.40
WWH LAB/RAD FEE SCHEDULE - 4206 308007400 80074 PB GENERAL LAB 8007400 381.00 $342.90 $152.40 $304.80 $213.36 $266.70 $243.84 $304.80 $297.18 $171.45 $156.21 $160.02 $152.40 $285.75 $247.65
WWH LAB/RAD FEE SCHEDULE - 4206 308007600 80076 PB HEPATIC FUNCTION PANEL 94.00 $84.60 $37.60 $75.20 $52.64 $65.80 $60.16 $75.20 $73.32 $42.30 $38.54 $39.48 $37.60 $70.50 $61.10
WWH LAB/RAD FEE SCHEDULE - 4206 308015600 80156 PB CARBAMAZEPINE 145.00 $130.50 $58.00 $116.00 $81.20 $101.50 $92.80 $116.00 $113.10 $65.25 $59.45 $60.90 $58.00 $108.75 $94.25
WWH LAB/RAD FEE SCHEDULE - 4206 308016200 80162 PB DIGOXIN 134.00 $120.60 $53.60 $107.20 $75.04 $93.80 $85.76 $107.20 $104.52 $60.30 $54.94 $56.28 $53.60 $100.50 $87.10
WWH LAB/RAD FEE SCHEDULE - 4206 308016400 80164 PB VALPROIC ACID TOTAL 141.00 $126.90 $56.40 $112.80 $78.96 $98.70 $90.24 $112.80 $109.98 $63.45 $57.81 $59.22 $56.40 $105.75 $91.65
WWH LAB/RAD FEE SCHEDULE - 4206 308016800 80168 PB ETHOSUXIMIDE 165.00 $148.50 $66.00 $132.00 $92.40 $115.50 $105.60 $132.00 $128.70 $74.25 $67.65 $69.30 $66.00 $123.75 $107.25
WWH LAB/RAD FEE SCHEDULE - 4206 308017000 80170 PB GENTAMICIN 161.00 $144.90 $64.40 $128.80 $90.16 $112.70 $103.04 $128.80 $125.58 $72.45 $66.01 $67.62 $64.40 $120.75 $104.65
WWH LAB/RAD FEE SCHEDULE - 4206 308017001 80170 PB GENTAMICIN RANDOM 161.00 $144.90 $64.40 $128.80 $90.16 $112.70 $103.04 $128.80 $125.58 $72.45 $66.01 $67.62 $64.40 $120.75 $104.65
WWH LAB/RAD FEE SCHEDULE - 4206 308017500 80175 PB LAMOTRIGINE 137.00 $123.30 $54.80 $109.60 $76.72 $95.90 $87.68 $109.60 $106.86 $61.65 $56.17 $57.54 $54.80 $102.75 $89.05
WWH LAB/RAD FEE SCHEDULE - 4206 308017700 80177 PB LEVETIRACETAM 57.00 $51.30 $22.80 $45.60 $31.92 $39.90 $36.48 $45.60 $44.46 $25.65 $23.37 $23.94 $22.80 $42.75 $37.05
WWH LAB/RAD FEE SCHEDULE - 4206 308017800 80178 PB LITHIUM 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH LAB/RAD FEE SCHEDULE - 4206 308018301 80183 PB OXCARBAZEPINE MEDTOX 137.00 $123.30 $54.80 $109.60 $76.72 $95.90 $87.68 $109.60 $106.86 $61.65 $56.17 $57.54 $54.80 $102.75 $89.05
WWH LAB/RAD FEE SCHEDULE - 4206 308018400 80184 PB PHENOBARBITAL 114.00 $102.60 $45.60 $91.20 $63.84 $79.80 $72.96 $91.20 $88.92 $51.30 $46.74 $47.88 $45.60 $85.50 $74.10
WWH LAB/RAD FEE SCHEDULE - 4206 308018500 80185 PB PHENYTOIN 129.00 $116.10 $51.60 $103.20 $72.24 $90.30 $82.56 $103.20 $100.62 $58.05 $52.89 $54.18 $51.60 $96.75 $83.85
WWH LAB/RAD FEE SCHEDULE - 4206 308018600 80186 PB PHENYTOIN FREE 137.00 $123.30 $54.80 $109.60 $76.72 $95.90 $87.68 $109.60 $106.86 $61.65 $56.17 $57.54 $54.80 $102.75 $89.05
WWH LAB/RAD FEE SCHEDULE - 4206 308019500 80195 PB RAPAMYCIN 224.00 $201.60 $89.60 $179.20 $125.44 $156.80 $143.36 $179.20 $174.72 $100.80 $91.84 $94.08 $89.60 $168.00 $145.60
WWH LAB/RAD FEE SCHEDULE - 4206 308020001 80200 PB TOBRAMICIN KINETICS 161.00 $144.90 $64.40 $128.80 $90.16 $112.70 $103.04 $128.80 $125.58 $72.45 $66.01 $67.62 $64.40 $120.75 $104.65
WWH LAB/RAD FEE SCHEDULE - 4206 308020101 80201 PB TOPIRAMATE TMX 142.00 $127.80 $56.80 $113.60 $79.52 $99.40 $90.88 $113.60 $110.76 $63.90 $58.22 $59.64 $56.80 $106.50 $92.30
WWH LAB/RAD FEE SCHEDULE - 4206 308020200 80202 PB VANCOMYCIN TROUGH 142.00 $127.80 $56.80 $113.60 $79.52 $99.40 $90.88 $113.60 $110.76 $63.90 $58.22 $59.64 $56.80 $106.50 $92.30
WWH LAB/RAD FEE SCHEDULE - 4206 308020201 80202 PB VANCOMYCIN KINETICS 142.00 $127.80 $56.80 $113.60 $79.52 $99.40 $90.88 $113.60 $110.76 $63.90 $58.22 $59.64 $56.80 $106.50 $92.30
WWH LAB/RAD FEE SCHEDULE - 4206 308020202 80202 PB VANCOMYCIN PEAK 142.00 $127.80 $56.80 $113.60 $79.52 $99.40 $90.88 $113.60 $110.76 $63.90 $58.22 $59.64 $56.80 $106.50 $92.30
WWH LAB/RAD FEE SCHEDULE - 4206 308020300 80203 PB ZONISAMIDE 164.00 $147.60 $65.60 $131.20 $91.84 $114.80 $104.96 $131.20 $127.92 $73.80 $67.24 $68.88 $65.60 $123.00 $106.60
WWH LAB/RAD FEE SCHEDULE - 4206 308030701 80307 PB COMPLIANCE DRUG ANALYSIS CDS 259.00 $233.10 $103.60 $207.20 $145.04 $181.30 $165.76 $207.20 $202.02 $116.55 $106.19 $108.78 $103.60 $194.25 $168.35
WWH LAB/RAD FEE SCHEDULE - 4206 308030705 80307 PB FLUNITRAZEPAM SCREEN URINE FLT 259.00 $233.10 $103.60 $207.20 $145.04 $181.30 $165.76 $207.20 $202.02 $116.55 $106.19 $108.78 $103.60 $194.25 $168.35
WWH LAB/RAD FEE SCHEDULE - 4206 308030708 80307 PB LIMITED COMPLIANCE DRUG SCREEN 259.00 $233.10 $103.60 $207.20 $145.04 $181.30 $165.76 $207.20 $202.02 $116.55 $106.19 $108.78 $103.60 $194.25 $168.35
WWH LAB/RAD FEE SCHEDULE - 4206 308030709 80307 PB MECONIUM DRUG SCR HCMC 259.00 $233.10 $103.60 $207.20 $145.04 $181.30 $165.76 $207.20 $202.02 $116.55 $106.19 $108.78 $103.60 $194.25 $168.35
WWH LAB/RAD FEE SCHEDULE - 4206 308100100 81001 PB URINALYSIS COMPLETE 38.00 $34.20 $15.20 $30.40 $21.28 $26.60 $24.32 $30.40 $29.64 $17.10 $15.58 $15.96 $15.20 $28.50 $24.70
WWH LAB/RAD FEE SCHEDULE - 4206 308100300 81003 PB PH URINE 28.00 $25.20 $11.20 $22.40 $15.68 $19.60 $17.92 $22.40 $21.84 $12.60 $11.48 $11.76 $11.20 $21.00 $18.20
WWH LAB/RAD FEE SCHEDULE - 4206 308100301 81003 PB URINALYSIS 28.00 $25.20 $11.20 $22.40 $15.68 $19.60 $17.92 $22.40 $21.84 $12.60 $11.48 $11.76 $11.20 $21.00 $18.20
WWH LAB/RAD FEE SCHEDULE - 4206 308100302 81003 PB SPECIFIC GRAVITY URINE 28.00 $25.20 $11.20 $22.40 $15.68 $19.60 $17.92 $22.40 $21.84 $12.60 $11.48 $11.76 $11.20 $21.00 $18.20
WWH LAB/RAD FEE SCHEDULE - 4206 308100303 81003 PB OCCULT BLOOD URINE 28.00 $25.20 $11.20 $22.40 $15.68 $19.60 $17.92 $22.40 $21.84 $12.60 $11.48 $11.76 $11.20 $21.00 $18.20
WWH LAB/RAD FEE SCHEDULE - 4206 308100304 81003 PB KETONES URINE 28.00 $25.20 $11.20 $22.40 $15.68 $19.60 $17.92 $22.40 $21.84 $12.60 $11.48 $11.76 $11.20 $21.00 $18.20
WWH LAB/RAD FEE SCHEDULE - 4206 308100305 81003 PB GLUCOSE QUAL URINE 28.00 $25.20 $11.20 $22.40 $15.68 $19.60 $17.92 $22.40 $21.84 $12.60 $11.48 $11.76 $11.20 $21.00 $18.20
WWH LAB/RAD FEE SCHEDULE - 4206 308100306 81003 PB PROTEIN QUAL URINE 28.00 $25.20 $11.20 $22.40 $15.68 $19.60 $17.92 $22.40 $21.84 $12.60 $11.48 $11.76 $11.20 $21.00 $18.20
WWH LAB/RAD FEE SCHEDULE - 4206 308100311 81003 OCH DOT UA 11.00 $9.90 $4.40 $8.80 $6.16 $7.70 $7.04 $8.80 $8.58 $4.95 $4.51 $4.62 $4.40 $8.25 $7.15
WWH LAB/RAD FEE SCHEDULE - 4206 308101501 81015 PB MICROSCOPIC URINE 30.00 $27.00 $12.00 $24.00 $16.80 $21.00 $19.20 $24.00 $23.40 $13.50 $12.30 $12.60 $12.00 $22.50 $19.50
WWH LAB/RAD FEE SCHEDULE - 4206 308102500 81025 PB GENERAL LAB 8102500 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH LAB/RAD FEE SCHEDULE - 4206 308102501 81025 PB GENERAL LAB 8102501 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH LAB/RAD FEE SCHEDULE - 4206 308109900 81099 PB EOSINOPHIL SMEAR 10.00 $9.00 $4.00 $8.00 $5.60 $7.00 $6.40 $8.00 $7.80 $4.50 $4.10 $4.20 $4.00 $7.50 $6.50
WWH LAB/RAD FEE SCHEDULE - 4206 308121900 81219 PB CALRETICULIN EXON 9 587.00 $528.30 $234.80 $469.60 $328.72 $410.90 $375.68 $469.60 $457.86 $264.15 $240.67 $246.54 $234.80 $440.25 $381.55
WWH LAB/RAD FEE SCHEDULE - 4206 308122001 81220 (IA) PB CYSTIC FIBROSIS MUTATION "1,033.00" $929.70 $413.20 $826.40 $578.48 $723.10 $661.12 $826.40 $805.74 $464.85 $423.53 $433.86 $413.20 $774.75 $671.45
WWH LAB/RAD FEE SCHEDULE - 4206 308124000 81240 PB FACTOR 2 GENE MUTATION 217.00 $195.30 $86.80 $173.60 $121.52 $151.90 $138.88 $173.60 $169.26 $97.65 $88.97 $91.14 $86.80 $162.75 $141.05
WWH LAB/RAD FEE SCHEDULE - 4206 308124100 81241 PB FACTOR V LEIDEN MUTATION 396.00 $356.40 $158.40 $316.80 $221.76 $277.20 $253.44 $316.80 $308.88 $178.20 $162.36 $166.32 $158.40 $297.00 $257.40
WWH LAB/RAD FEE SCHEDULE - 4206 308125600 81256 PB H HEMACHROMATOSIS 644.00 $579.60 $257.60 $515.20 $360.64 $450.80 $412.16 $515.20 $502.32 $289.80 $264.04 $270.48 $257.60 $483.00 $418.60
WWH LAB/RAD FEE SCHEDULE - 4206 308129100 81291 PB MTHFR MUTATION 309.00 $278.10 $123.60 $247.20 $173.04 $216.30 $197.76 $247.20 $241.02 $139.05 $126.69 $129.78 $123.60 $231.75 $200.85
WWH LAB/RAD FEE SCHEDULE - 4206 308137500 81375 PB HLA DR AND DQ 769.00 $692.10 $307.60 $615.20 $430.64 $538.30 $492.16 $615.20 $599.82 $346.05 $315.29 $322.98 $307.60 $576.75 $499.85
WWH LAB/RAD FEE SCHEDULE - 4206 308200900 82009 PB KETONE BLOOD 23.00 $20.70 $9.20 $18.40 $12.88 $16.10 $14.72 $18.40 $17.94 $10.35 $9.43 $9.66 $9.20 $17.25 $14.95
WWH LAB/RAD FEE SCHEDULE - 4206 308201701 82017 PB FATTY ACID OXIDATION - WISC NEWBORN 74.00 $66.60 $29.60 $59.20 $41.44 $51.80 $47.36 $59.20 $57.72 $33.30 $30.34 $31.08 $29.60 $55.50 $48.10
WWH LAB/RAD FEE SCHEDULE - 4206 308204001 82040 PB ALBUMIN 32.00 $28.80 $12.80 $25.60 $17.92 $22.40 $20.48 $25.60 $24.96 $14.40 $13.12 $13.44 $12.80 $24.00 $20.80
WWH LAB/RAD FEE SCHEDULE - 4206 308204301 82043 "PB URINE ALBUMIN TO CREATININE RATIO, RANDOM" 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 308204400 82044 PB MICROALBUMIN SEMIQUANT CLINIC ONLY 44.00 $39.60 $17.60 $35.20 $24.64 $30.80 $28.16 $35.20 $34.32 $19.80 $18.04 $18.48 $17.60 $33.00 $28.60
WWH LAB/RAD FEE SCHEDULE - 4206 308208501 82085 PB ALDOLASE LC 74.00 $66.60 $29.60 $59.20 $41.44 $51.80 $47.36 $59.20 $57.72 $33.30 $30.34 $31.08 $29.60 $55.50 $48.10
WWH LAB/RAD FEE SCHEDULE - 4206 308208802 82088 "PB ALDOSTERONE, SERUM LC" 168.00 $151.20 $67.20 $134.40 $94.08 $117.60 $107.52 $134.40 $131.04 $75.60 $68.88 $70.56 $67.20 $126.00 $109.20
WWH LAB/RAD FEE SCHEDULE - 4206 308210500 82105 PB AFP TUMOR MARKER SERUM 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH LAB/RAD FEE SCHEDULE - 4206 308210501 82105 PB AFP BLOOD OPEN SPINA BIFIDA LC 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH LAB/RAD FEE SCHEDULE - 4206 308210502 82105 PB INTEGRATED SCREEN AFP 145.00 $130.50 $58.00 $116.00 $81.20 $101.50 $92.80 $116.00 $113.10 $65.25 $59.45 $60.90 $58.00 $108.75 $94.25
WWH LAB/RAD FEE SCHEDULE - 4206 308210503 82105 PB AFP-PRENATAL 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH LAB/RAD FEE SCHEDULE - 4206 308214000 82140 PB AMMONIA 149.00 $134.10 $59.60 $119.20 $83.44 $104.30 $95.36 $119.20 $116.22 $67.05 $61.09 $62.58 $59.60 $111.75 $96.85
WWH LAB/RAD FEE SCHEDULE - 4206 308215000 82150 PB AMYLASE 73.00 $65.70 $29.20 $58.40 $40.88 $51.10 $46.72 $58.40 $56.94 $32.85 $29.93 $30.66 $29.20 $54.75 $47.45
WWH LAB/RAD FEE SCHEDULE - 4206 308217500 82175 "PB ARSENIC,BLOOD" 160.00 $144.00 $64.00 $128.00 $89.60 $112.00 $102.40 $128.00 $124.80 $72.00 $65.60 $67.20 $64.00 $120.00 $104.00
WWH LAB/RAD FEE SCHEDULE - 4206 308217507 82175 (IA) PB ARSENIC HEAVY METAL SCR URINE 83.00 $74.70 $33.20 $66.40 $46.48 $58.10 $53.12 $66.40 $64.74 $37.35 $34.03 $34.86 $33.20 $62.25 $53.95
WWH LAB/RAD FEE SCHEDULE - 4206 308217511 82175 "PB ARSENIC HEAVY METALS PROFILE II, BLOOD LC" 83.00 $74.70 $33.20 $66.40 $46.48 $58.10 $53.12 $66.40 $64.74 $37.35 $34.03 $34.86 $33.20 $62.25 $53.95
WWH LAB/RAD FEE SCHEDULE - 4206 308218001 82180 PB VITAMIN C LC 103.00 $92.70 $41.20 $82.40 $57.68 $72.10 $65.92 $82.40 $80.34 $46.35 $42.23 $43.26 $41.20 $77.25 $66.95
WWH LAB/RAD FEE SCHEDULE - 4206 308223201 82232 PB BETA-2 MICROGLOBULIN 165.00 $148.50 $66.00 $132.00 $92.40 $115.50 $105.60 $132.00 $128.70 $74.25 $67.65 $69.30 $66.00 $123.75 $107.25
WWH LAB/RAD FEE SCHEDULE - 4206 308224700 82247 "PB BILIRUBIN, TOTAL" 49.00 $44.10 $19.60 $39.20 $27.44 $34.30 $31.36 $39.20 $38.22 $22.05 $20.09 $20.58 $19.60 $36.75 $31.85
WWH LAB/RAD FEE SCHEDULE - 4206 308224800 82248 "PB BILIRUBIN,DIRECT" 33.00 $29.70 $13.20 $26.40 $18.48 $23.10 $21.12 $26.40 $25.74 $14.85 $13.53 $13.86 $13.20 $24.75 $21.45
WWH LAB/RAD FEE SCHEDULE - 4206 308226101 82261 PB BIOTINIDASE NSW 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 308227000 82270 PB OCCULT BLOOD -3 DAY 32.00 $28.80 $12.80 $25.60 $17.92 $22.40 $20.48 $25.60 $24.96 $14.40 $13.12 $13.44 $12.80 $24.00 $20.80
WWH LAB/RAD FEE SCHEDULE - 4206 308227201 82272 PB OCCULT BLOOD STOOL 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH LAB/RAD FEE SCHEDULE - 4206 308230000 82300 PB CADMIUM BLOOD 126.00 $113.40 $50.40 $100.80 $70.56 $88.20 $80.64 $100.80 $98.28 $56.70 $51.66 $52.92 $50.40 $94.50 $81.90
WWH LAB/RAD FEE SCHEDULE - 4206 308230005 82300 "PB CADMIUM HEAVY METALS PROFILE II, BLOOD LC" 126.00 $113.40 $50.40 $100.80 $70.56 $88.20 $80.64 $100.80 $98.28 $56.70 $51.66 $52.92 $50.40 $94.50 $81.90
WWH LAB/RAD FEE SCHEDULE - 4206 308230600 82306 PB VITAMIN D TOTAL 210.00 $189.00 $84.00 $168.00 $117.60 $147.00 $134.40 $168.00 $163.80 $94.50 $86.10 $88.20 $84.00 $157.50 $136.50
WWH LAB/RAD FEE SCHEDULE - 4206 308231000 82310 PB CALCIUM 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 308233000 82330 "PB CALCIUM, IONIZED" 137.00 $123.30 $54.80 $109.60 $76.72 $95.90 $87.68 $109.60 $106.86 $61.65 $56.17 $57.54 $54.80 $102.75 $89.05
WWH LAB/RAD FEE SCHEDULE - 4206 308234000 82340 "PB CALCIUM, TIMED URINE" 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH LAB/RAD FEE SCHEDULE - 4206 308237400 82374 PB CO2 TOTAL 49.00 $44.10 $19.60 $39.20 $27.44 $34.30 $31.36 $39.20 $38.22 $22.05 $20.09 $20.58 $19.60 $36.75 $31.85
WWH LAB/RAD FEE SCHEDULE - 4206 308237401 82374 PB HCO3 49.00 $44.10 $19.60 $39.20 $27.44 $34.30 $31.36 $39.20 $38.22 $22.05 $20.09 $20.58 $19.60 $36.75 $31.85
WWH LAB/RAD FEE SCHEDULE - 4206 308237500 82375 PB CARBOXYHEMOGLOBIN 122.00 $109.80 $48.80 $97.60 $68.32 $85.40 $78.08 $97.60 $95.16 $54.90 $50.02 $51.24 $48.80 $91.50 $79.30
WWH LAB/RAD FEE SCHEDULE - 4206 308237800 82378 PB CEA 172.00 $154.80 $68.80 $137.60 $96.32 $120.40 $110.08 $137.60 $134.16 $77.40 $70.52 $72.24 $68.80 $129.00 $111.80
WWH LAB/RAD FEE SCHEDULE - 4206 308239000 82390 PB CERULOPLASMIN 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 308243500 82435 PB CHLORIDE 45.00 $40.50 $18.00 $36.00 $25.20 $31.50 $28.80 $36.00 $35.10 $20.25 $18.45 $18.90 $18.00 $33.75 $29.25
WWH LAB/RAD FEE SCHEDULE - 4206 308246500 82465 PB CHOLESTEROL 30.00 $27.00 $12.00 $24.00 $16.80 $21.00 $19.20 $24.00 $23.40 $13.50 $12.30 $12.60 $12.00 $22.50 $19.50
WWH LAB/RAD FEE SCHEDULE - 4206 308249500 82495 PB CHROMIUM SERUM MEDTOX 114.00 $102.60 $45.60 $91.20 $63.84 $79.80 $72.96 $91.20 $88.92 $51.30 $46.74 $47.88 $45.60 $85.50 $74.10
WWH LAB/RAD FEE SCHEDULE - 4206 308249501 82495 PB CHROMIUM BLOOD 148.00 $133.20 $59.20 $118.40 $82.88 $103.60 $94.72 $118.40 $115.44 $66.60 $60.68 $62.16 $59.20 $111.00 $96.20
WWH LAB/RAD FEE SCHEDULE - 4206 308252303 82523 "PB N-TELOPEPTIDE, URINE LC" 157.00 $141.30 $62.80 $125.60 $87.92 $109.90 $100.48 $125.60 $122.46 $70.65 $64.37 $65.94 $62.80 $117.75 $102.05
WWH LAB/RAD FEE SCHEDULE - 4206 308252504 82525 "PB COPPER, SERUM LC" 132.00 $118.80 $52.80 $105.60 $73.92 $92.40 $84.48 $105.60 $102.96 $59.40 $54.12 $55.44 $52.80 $99.00 $85.80
WWH LAB/RAD FEE SCHEDULE - 4206 308253300 82533 PB DEXAMETHASONE SUPP 180.00 $162.00 $72.00 $144.00 $100.80 $126.00 $115.20 $144.00 $140.40 $81.00 $73.80 $75.60 $72.00 $135.00 $117.00
WWH LAB/RAD FEE SCHEDULE - 4206 308253301 82533 PB CORTISOL 288.00 $259.20 $115.20 $230.40 $161.28 $201.60 $184.32 $230.40 $224.64 $129.60 $118.08 $120.96 $115.20 $216.00 $187.20
WWH LAB/RAD FEE SCHEDULE - 4206 308254268 82542 PB N METHYLHISTAMINE UR 153.00 $137.70 $61.20 $122.40 $85.68 $107.10 $97.92 $122.40 $119.34 $68.85 $62.73 $64.26 $61.20 $114.75 $99.45
WWH LAB/RAD FEE SCHEDULE - 4206 308255000 82550 PB CK TOTAL 44.00 $39.60 $17.60 $35.20 $24.64 $30.80 $28.16 $35.20 $34.32 $19.80 $18.04 $18.48 $17.60 $33.00 $28.60
WWH LAB/RAD FEE SCHEDULE - 4206 308255300 82553 PB CK-MB 114.00 $102.60 $45.60 $91.20 $63.84 $79.80 $72.96 $91.20 $88.92 $51.30 $46.74 $47.88 $45.60 $85.50 $74.10
WWH LAB/RAD FEE SCHEDULE - 4206 308256500 82565 PB CREATININE 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH LAB/RAD FEE SCHEDULE - 4206 308257001 82570 "PB CREATININE,TIMED URINE" 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH LAB/RAD FEE SCHEDULE - 4206 308257002 82570 "PB CREATININE,RANDOM URINE" 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH LAB/RAD FEE SCHEDULE - 4206 308257500 82575 PB CREATININE CLEARANCE 94.00 $84.60 $37.60 $75.20 $52.64 $65.80 $60.16 $75.20 $73.32 $42.30 $38.54 $39.48 $37.60 $70.50 $61.10
WWH LAB/RAD FEE SCHEDULE - 4206 308260001 82600 PB CYANIDE MTX 137.00 $123.30 $54.80 $109.60 $76.72 $95.90 $87.68 $109.60 $106.86 $61.65 $56.17 $57.54 $54.80 $102.75 $89.05
WWH LAB/RAD FEE SCHEDULE - 4206 308260700 82607 PB VITAMIN B-12 169.00 $152.10 $67.60 $135.20 $94.64 $118.30 $108.16 $135.20 $131.82 $76.05 $69.29 $70.98 $67.60 $126.75 $109.85
WWH LAB/RAD FEE SCHEDULE - 4206 308261000 82610 PB CYSTATIN C LC 66.00 $59.40 $26.40 $52.80 $36.96 $46.20 $42.24 $52.80 $51.48 $29.70 $27.06 $27.72 $26.40 $49.50 $42.90
WWH LAB/RAD FEE SCHEDULE - 4206 308262601 82626 "PB DHEA, SERUM LC" 266.00 $239.40 $106.40 $212.80 $148.96 $186.20 $170.24 $212.80 $207.48 $119.70 $109.06 $111.72 $106.40 $199.50 $172.90
WWH LAB/RAD FEE SCHEDULE - 4206 308262700 82627 PB DHEA-SULFATE 220.00 $198.00 $88.00 $176.00 $123.20 $154.00 $140.80 $176.00 $171.60 $99.00 $90.20 $92.40 $88.00 $165.00 $143.00
WWH LAB/RAD FEE SCHEDULE - 4206 308265201 82652 "PB CALCITRIOL(1,25 DI-OH VIT D) LC" 333.00 $299.70 $133.20 $266.40 $186.48 $233.10 $213.12 $266.40 $259.74 $149.85 $136.53 $139.86 $133.20 $249.75 $216.45
WWH LAB/RAD FEE SCHEDULE - 4206 308267000 82670 PB ESTRADIOL SERUM 264.00 $237.60 $105.60 $211.20 $147.84 $184.80 $168.96 $211.20 $205.92 $118.80 $108.24 $110.88 $105.60 $198.00 $171.60
WWH LAB/RAD FEE SCHEDULE - 4206 308267700 82677 PB INTEGRATED SCREEN ESTRIOL 179.00 $161.10 $71.60 $143.20 $100.24 $125.30 $114.56 $143.20 $139.62 $80.55 $73.39 $75.18 $71.60 $134.25 $116.35
WWH LAB/RAD FEE SCHEDULE - 4206 308267701 82677 PB ESTRIOL-PRENATAL 168.00 $151.20 $67.20 $134.40 $94.08 $117.60 $107.52 $134.40 $131.04 $75.60 $68.88 $70.56 $67.20 $126.00 $109.20
WWH LAB/RAD FEE SCHEDULE - 4206 308267902 82679 "PB ESTRONE, SERUM LC" 249.00 $224.10 $99.60 $199.20 $139.44 $174.30 $159.36 $199.20 $194.22 $112.05 $102.09 $104.58 $99.60 $186.75 $161.85
WWH LAB/RAD FEE SCHEDULE - 4206 308272800 82728 PB FERRITIN 158.00 $142.20 $63.20 $126.40 $88.48 $110.60 $101.12 $126.40 $123.24 $71.10 $64.78 $66.36 $63.20 $118.50 $102.70
WWH LAB/RAD FEE SCHEDULE - 4206 308273100 82731 PB FETAL FIBRONECTIN 518.00 $466.20 $207.20 $414.40 $290.08 $362.60 $331.52 $414.40 $404.04 $233.10 $212.38 $217.56 $207.20 $388.50 $336.70
WWH LAB/RAD FEE SCHEDULE - 4206 308274600 82746 PB FOLIC ACID 145.00 $130.50 $58.00 $116.00 $81.20 $101.50 $92.80 $116.00 $113.10 $65.25 $59.45 $60.90 $58.00 $108.75 $94.25
WWH LAB/RAD FEE SCHEDULE - 4206 308277500 82775 PB GALACTOSEMIA NSW 76.00 $68.40 $30.40 $60.80 $42.56 $53.20 $48.64 $60.80 $59.28 $34.20 $31.16 $31.92 $30.40 $57.00 $49.40
WWH LAB/RAD FEE SCHEDULE - 4206 308278400 82784 PB IGG (SERUM) 98.00 $88.20 $39.20 $78.40 $54.88 $68.60 $62.72 $78.40 $76.44 $44.10 $40.18 $41.16 $39.20 $73.50 $63.70
WWH LAB/RAD FEE SCHEDULE - 4206 308278402 82784 PB IGM 98.00 $88.20 $39.20 $78.40 $54.88 $68.60 $62.72 $78.40 $76.44 $44.10 $40.18 $41.16 $39.20 $73.50 $63.70
WWH LAB/RAD FEE SCHEDULE - 4206 308278403 82784 PB IGA 98.00 $88.20 $39.20 $78.40 $54.88 $68.60 $62.72 $78.40 $76.44 $44.10 $40.18 $41.16 $39.20 $73.50 $63.70
WWH LAB/RAD FEE SCHEDULE - 4206 308278409 82784 PB IGG LC 98.00 $88.20 $39.20 $78.40 $54.88 $68.60 $62.72 $78.40 $76.44 $44.10 $40.18 $41.16 $39.20 $73.50 $63.70
WWH LAB/RAD FEE SCHEDULE - 4206 308278500 82785 PB IGE 148.00 $133.20 $59.20 $118.40 $82.88 $103.60 $94.72 $118.40 $115.44 $66.60 $60.68 $62.16 $59.20 $111.00 $96.20
WWH LAB/RAD FEE SCHEDULE - 4206 308278706 82787 "PB IGG, SUBCLASSES (1-4) LC" 95.00 $85.50 $38.00 $76.00 $53.20 $66.50 $60.80 $76.00 $74.10 $42.75 $38.95 $39.90 $38.00 $71.25 $61.75
WWH LAB/RAD FEE SCHEDULE - 4206 308280000 82800 "PB PH, BLOOD GAS" 40.00 $36.00 $16.00 $32.00 $22.40 $28.00 $25.60 $32.00 $31.20 $18.00 $16.40 $16.80 $16.00 $30.00 $26.00
WWH LAB/RAD FEE SCHEDULE - 4206 308280300 82803 PB BLOOD GAS CORD ARTERIAL 75.00 $67.50 $30.00 $60.00 $42.00 $52.50 $48.00 $60.00 $58.50 $33.75 $30.75 $31.50 $30.00 $56.25 $48.75
WWH LAB/RAD FEE SCHEDULE - 4206 308280301 82803 PB BLOOD GAS 75.00 $67.50 $30.00 $60.00 $42.00 $52.50 $48.00 $60.00 $58.50 $33.75 $30.75 $31.50 $30.00 $56.25 $48.75
WWH LAB/RAD FEE SCHEDULE - 4206 308280303 82803 PB BLOOD GAS CORD VENOUS 75.00 $67.50 $30.00 $60.00 $42.00 $52.50 $48.00 $60.00 $58.50 $33.75 $30.75 $31.50 $30.00 $56.25 $48.75
WWH LAB/RAD FEE SCHEDULE - 4206 308281000 82810 PB O2 SAT MEASURED 44.00 $39.60 $17.60 $35.20 $24.64 $30.80 $28.16 $35.20 $34.32 $19.80 $18.04 $18.48 $17.60 $33.00 $28.60
WWH LAB/RAD FEE SCHEDULE - 4206 308294101 82941 "PB GASTRIN, SERUM LC" 178.00 $160.20 $71.20 $142.40 $99.68 $124.60 $113.92 $142.40 $138.84 $80.10 $72.98 $74.76 $71.20 $133.50 $115.70
WWH LAB/RAD FEE SCHEDULE - 4206 308294502 82945 "PB GLUCOSE, BODY FLUID" 54.00 $48.60 $21.60 $43.20 $30.24 $37.80 $34.56 $43.20 $42.12 $24.30 $22.14 $22.68 $21.60 $40.50 $35.10
WWH LAB/RAD FEE SCHEDULE - 4206 308294700 82947 PB GLUCOSE 49.00 $44.10 $19.60 $39.20 $27.44 $34.30 $31.36 $39.20 $38.22 $22.05 $20.09 $20.58 $19.60 $36.75 $31.85
WWH LAB/RAD FEE SCHEDULE - 4206 308294701 82947 PB GLUCOSE POCT 49.00 $44.10 $19.60 $39.20 $27.44 $34.30 $31.36 $39.20 $38.22 $22.05 $20.09 $20.58 $19.60 $36.75 $31.85
WWH LAB/RAD FEE SCHEDULE - 4206 308294702 82947 PB FASTING GLUCOSE 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 308294703 82947 PB GLUCOSE TOLERANCE FASTING 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 308295000 82950 "PB GLUCOSE, GESTATIONAL" 48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
WWH LAB/RAD FEE SCHEDULE - 4206 308295001 82950 PB GLUCOSE 2HPP 48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
WWH LAB/RAD FEE SCHEDULE - 4206 308295002 82950 PB GLUCOSE 2 HOUR 48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
WWH LAB/RAD FEE SCHEDULE - 4206 308296200 82962 PB GLUCOSE METER TIMED 29.00 $26.10 $11.60 $23.20 $16.24 $20.30 $18.56 $23.20 $22.62 $13.05 $11.89 $12.18 $11.60 $21.75 $18.85
WWH LAB/RAD FEE SCHEDULE - 4206 308297700 82977 PB GAMMA GT 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH LAB/RAD FEE SCHEDULE - 4206 308300100 83001 PB FSH-SERUM 220.00 $198.00 $88.00 $176.00 $123.20 $154.00 $140.80 $176.00 $171.60 $99.00 $90.20 $92.40 $88.00 $165.00 $143.00
WWH LAB/RAD FEE SCHEDULE - 4206 308300201 83002 PB LUTEINIZING HORMONE 196.00 $176.40 $78.40 $156.80 $109.76 $137.20 $125.44 $156.80 $152.88 $88.20 $80.36 $82.32 $78.40 $147.00 $127.40
WWH LAB/RAD FEE SCHEDULE - 4206 308301000 83010 PB HAPTOGLOBIN 126.00 $113.40 $50.40 $100.80 $70.56 $88.20 $80.64 $100.80 $98.28 $56.70 $51.66 $52.92 $50.40 $94.50 $81.90
WWH LAB/RAD FEE SCHEDULE - 4206 308301300 83013 PB H PYLORI BREATH 298.00 $268.20 $119.20 $238.40 $166.88 $208.60 $190.72 $238.40 $232.44 $134.10 $122.18 $125.16 $119.20 $223.50 $193.70
WWH LAB/RAD FEE SCHEDULE - 4206 308301400 83014 PB H PYLORI DRUG ADMINISTRATION 35.00 $31.50 $14.00 $28.00 $19.60 $24.50 $22.40 $28.00 $27.30 $15.75 $14.35 $14.70 $14.00 $26.25 $22.75
WWH LAB/RAD FEE SCHEDULE - 4206 308301800 83018 "PB COBALT,SERUM" 139.00 $125.10 $55.60 $111.20 $77.84 $97.30 $88.96 $111.20 $108.42 $62.55 $56.99 $58.38 $55.60 $104.25 $90.35
WWH LAB/RAD FEE SCHEDULE - 4206 308301813 83018 PB BARIUM SERUM 191.00 $171.90 $76.40 $152.80 $106.96 $133.70 $122.24 $152.80 $148.98 $85.95 $78.31 $80.22 $76.40 $143.25 $124.15
WWH LAB/RAD FEE SCHEDULE - 4206 308302001 83020 PB HEMOGLOBINOPATHIES NSW 148.00 $133.20 $59.20 $118.40 $82.88 $103.60 $94.72 $118.40 $115.44 $66.60 $60.68 $62.16 $59.20 $111.00 $96.20
WWH LAB/RAD FEE SCHEDULE - 4206 308303600 83036 PB HEMOGLOBIN A1C 93.00 $83.70 $37.20 $74.40 $52.08 $65.10 $59.52 $74.40 $72.54 $41.85 $38.13 $39.06 $37.20 $69.75 $60.45
WWH LAB/RAD FEE SCHEDULE - 4206 3083088XX 83088 PB MISC LAB CHARGE 83088 294.00 $264.60 $117.60 $235.20 $164.64 $205.80 $188.16 $235.20 $229.32 $132.30 $120.54 $123.48 $117.60 $220.50 $191.10
WWH LAB/RAD FEE SCHEDULE - 4206 308309000 83090 "PB HOMOCYSTEINE, CARDIAC" 190.00 $171.00 $76.00 $152.00 $106.40 $133.00 $121.60 $152.00 $148.20 $85.50 $77.90 $79.80 $76.00 $142.50 $123.50
WWH LAB/RAD FEE SCHEDULE - 4206 308349801 83498 PB CONGENITAL ADRENAL HYPERPLAS NSW 272.00 $244.80 $108.80 $217.60 $152.32 $190.40 $174.08 $217.60 $212.16 $122.40 $111.52 $114.24 $108.80 $204.00 $176.80
WWH LAB/RAD FEE SCHEDULE - 4206 308351606 83516 PB CYSTIC FIBROSIS WISC 131.00 $117.90 $52.40 $104.80 $73.36 $91.70 $83.84 $104.80 $102.18 $58.95 $53.71 $55.02 $52.40 $98.25 $85.15
WWH LAB/RAD FEE SCHEDULE - 4206 308351609 83516 (IA) PB TISSUE TRANSGLUT IGA 137.00 $123.30 $54.80 $109.60 $76.72 $95.90 $87.68 $109.60 $106.86 $61.65 $56.17 $57.54 $54.80 $102.75 $89.05
WWH LAB/RAD FEE SCHEDULE - 4206 308351610 83516 (IA) PB TISSUE TRANSGLUTAMINASE IGG 137.00 $123.30 $54.80 $109.60 $76.72 $95.90 $87.68 $109.60 $106.86 $61.65 $56.17 $57.54 $54.80 $102.75 $89.05
WWH LAB/RAD FEE SCHEDULE - 4206 308351611 83516 (IA) PB GLIADIN ABY IGA 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 308351618 83516 PB PROTEINASE 3 AB 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 308351621 83516 PB ANTIPARIETAL CELL ANTIBODY LC 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 308351900 83519 PB ACETYLCHOLINE RECEP BIND 171.00 $153.90 $68.40 $136.80 $95.76 $119.70 $109.44 $136.80 $133.38 $76.95 $70.11 $71.82 $68.40 $128.25 $111.15
WWH LAB/RAD FEE SCHEDULE - 4206 308351904 83519 PB NEURONAL (V-G) K+ CHANNEL ABY 171.00 $153.90 $68.40 $136.80 $95.76 $119.70 $109.44 $136.80 $133.38 $76.95 $70.11 $71.82 $68.40 $128.25 $111.15
WWH LAB/RAD FEE SCHEDULE - 4206 308352033 83520 (IA) PB INTERLEUKIN 6 IL 6 SERUM 160.00 $144.00 $64.00 $128.00 $89.60 $112.00 $102.40 $128.00 $124.80 $72.00 $65.60 $67.20 $64.00 $120.00 $104.00
WWH LAB/RAD FEE SCHEDULE - 4206 308352044 83520 "PB THYROTROPIN RECEPTOR AB, SERUM LC" 118.00 $106.20 $47.20 $94.40 $66.08 $82.60 $75.52 $94.40 $92.04 $53.10 $48.38 $49.56 $47.20 $88.50 $76.70
WWH LAB/RAD FEE SCHEDULE - 4206 308352045 83520 PB TRYPTASE LC 117.00 $105.30 $46.80 $93.60 $65.52 $81.90 $74.88 $93.60 $91.26 $52.65 $47.97 $49.14 $46.80 $87.75 $76.05
WWH LAB/RAD FEE SCHEDULE - 4206 308352500 83525 PB INSULIN 146.00 $131.40 $58.40 $116.80 $81.76 $102.20 $93.44 $116.80 $113.88 $65.70 $59.86 $61.32 $58.40 $109.50 $94.90
WWH LAB/RAD FEE SCHEDULE - 4206 308354000 83540 PB IRON 63.00 $56.70 $25.20 $50.40 $35.28 $44.10 $40.32 $50.40 $49.14 $28.35 $25.83 $26.46 $25.20 $47.25 $40.95
WWH LAB/RAD FEE SCHEDULE - 4206 308355000 83550 PB IRON BINDING CAPACITY (IBC) 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH LAB/RAD FEE SCHEDULE - 4206 308360500 83605 PB LACTATE BLOOD 98.00 $88.20 $39.20 $78.40 $54.88 $68.60 $62.72 $78.40 $76.44 $44.10 $40.18 $41.16 $39.20 $73.50 $63.70
WWH LAB/RAD FEE SCHEDULE - 4206 308361500 83615 "PB LD, TOTAL" 42.00 $37.80 $16.80 $33.60 $23.52 $29.40 $26.88 $33.60 $32.76 $18.90 $17.22 $17.64 $16.80 $31.50 $27.30
WWH LAB/RAD FEE SCHEDULE - 4206 308365504 83655 (IA) PB LEAD TEST 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH LAB/RAD FEE SCHEDULE - 4206 308365506 83655 (IA) PB LEAD HEAVY METAL SCR URINE 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH LAB/RAD FEE SCHEDULE - 4206 308365510 83655 "PB LEAD, BLOOD LC" 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH LAB/RAD FEE SCHEDULE - 4206 308365511 83655 "PB LEAD HEAVY METALS PROFILE II, BLOOD LC" 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH LAB/RAD FEE SCHEDULE - 4206 308365513 83655 "PB LEAD, CAPILLARY, BLOOD LC" 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH LAB/RAD FEE SCHEDULE - 4206 308369000 83690 PB LIPASE 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH LAB/RAD FEE SCHEDULE - 4206 308369500 83695 PB LIPOPROTEIN LPA 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH LAB/RAD FEE SCHEDULE - 4206 308369501 83695 PB LIPOPROTEIN LPA LC 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH LAB/RAD FEE SCHEDULE - 4206 308371800 83718 PB HDL CHOLESTEROL 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH LAB/RAD FEE SCHEDULE - 4206 308372100 83721 PB LDL DIRECT CHOLESTEROL 96.00 $86.40 $38.40 $76.80 $53.76 $67.20 $61.44 $76.80 $74.88 $43.20 $39.36 $40.32 $38.40 $72.00 $62.40
WWH LAB/RAD FEE SCHEDULE - 4206 308373500 83735 PB MAGNESIUM BLOOD 45.00 $40.50 $18.00 $36.00 $25.20 $31.50 $28.80 $36.00 $35.10 $20.25 $18.45 $18.90 $18.00 $33.75 $29.25
WWH LAB/RAD FEE SCHEDULE - 4206 308378907 83789 PB MASS SPEC WISC 87.00 $78.30 $34.80 $69.60 $48.72 $60.90 $55.68 $69.60 $67.86 $39.15 $35.67 $36.54 $34.80 $65.25 $56.55
WWH LAB/RAD FEE SCHEDULE - 4206 308378912 83789 "PB IODINE, RANDOM URINE LC" 87.00 $78.30 $34.80 $69.60 $48.72 $60.90 $55.68 $69.60 $67.86 $39.15 $35.67 $36.54 $34.80 $65.25 $56.55
WWH LAB/RAD FEE SCHEDULE - 4206 308382503 83825 (IA) PB MERCURY HEAVY METAL SCR URINE 76.00 $68.40 $30.40 $60.80 $42.56 $53.20 $48.64 $60.80 $59.28 $34.20 $31.16 $31.92 $30.40 $57.00 $49.40
WWH LAB/RAD FEE SCHEDULE - 4206 308382506 83825 "PB MERCURY, BLOOD LC" 76.00 $68.40 $30.40 $60.80 $42.56 $53.20 $48.64 $60.80 $59.28 $34.20 $31.16 $31.92 $30.40 $57.00 $49.40
WWH LAB/RAD FEE SCHEDULE - 4206 308382507 83825 "PB MERCURY HEAVY METALS PROFILE II, BLOOD LC" 76.00 $68.40 $30.40 $60.80 $42.56 $53.20 $48.64 $60.80 $59.28 $34.20 $31.16 $31.92 $30.40 $57.00 $49.40
WWH LAB/RAD FEE SCHEDULE - 4206 308387400 83874 "PB MYOGLOBIN, SERUM" 68.00 $61.20 $27.20 $54.40 $38.08 $47.60 $43.52 $54.40 $53.04 $30.60 $27.88 $28.56 $27.20 $51.00 $44.20
WWH LAB/RAD FEE SCHEDULE - 4206 308387602 83876 PB MYELOPEROXIDASE AB 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH LAB/RAD FEE SCHEDULE - 4206 308388001 83880 PB BRAIN NATRIURETIC PEPTIDE 217.00 $195.30 $86.80 $173.60 $121.52 $151.90 $138.88 $173.60 $169.26 $97.65 $88.97 $91.14 $86.80 $162.75 $141.05
WWH LAB/RAD FEE SCHEDULE - 4206 308392103 83921 "PB METHYLMALONIC ACID, SERUM LC" 133.00 $119.70 $53.20 $106.40 $74.48 $93.10 $85.12 $106.40 $103.74 $59.85 $54.53 $55.86 $53.20 $99.75 $86.45
WWH LAB/RAD FEE SCHEDULE - 4206 308393000 83930 "PB OSMOLALITY,SERUM" 63.00 $56.70 $25.20 $50.40 $35.28 $44.10 $40.32 $50.40 $49.14 $28.35 $25.83 $26.46 $25.20 $47.25 $40.95
WWH LAB/RAD FEE SCHEDULE - 4206 308393500 83935 "PB OSMOLALITY,URINE" 71.00 $63.90 $28.40 $56.80 $39.76 $49.70 $45.44 $56.80 $55.38 $31.95 $29.11 $29.82 $28.40 $53.25 $46.15
WWH LAB/RAD FEE SCHEDULE - 4206 308397000 83970 PB PTH INTACT 384.00 $345.60 $153.60 $307.20 $215.04 $268.80 $245.76 $307.20 $299.52 $172.80 $157.44 $161.28 $153.60 $288.00 $249.60
WWH LAB/RAD FEE SCHEDULE - 4206 308403000 84030 PB PHENYLKETONURIA NEWBORN SCR WISC 48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
WWH LAB/RAD FEE SCHEDULE - 4206 308407500 84075 PB ALK PHOSPHATASE 55.00 $49.50 $22.00 $44.00 $30.80 $38.50 $35.20 $44.00 $42.90 $24.75 $22.55 $23.10 $22.00 $41.25 $35.75
WWH LAB/RAD FEE SCHEDULE - 4206 308407501 84075 PB ALK PHOS TOTAL LC 55.00 $49.50 $22.00 $44.00 $30.80 $38.50 $35.20 $44.00 $42.90 $24.75 $22.55 $23.10 $22.00 $41.25 $35.75
WWH LAB/RAD FEE SCHEDULE - 4206 308408002 84080 PB ALK PHOS ISOENZYME LC 164.00 $147.60 $65.60 $131.20 $91.84 $114.80 $104.96 $131.20 $127.92 $73.80 $67.24 $68.88 $65.60 $123.00 $106.60
WWH LAB/RAD FEE SCHEDULE - 4206 308410000 84100 PB PHOSPHORUS 45.00 $40.50 $18.00 $36.00 $25.20 $31.50 $28.80 $36.00 $35.10 $20.25 $18.45 $18.90 $18.00 $33.75 $29.25
WWH LAB/RAD FEE SCHEDULE - 4206 308411200 84112 PB AMNISURE 235.00 $211.50 $94.00 $188.00 $131.60 $164.50 $150.40 $188.00 $183.30 $105.75 $96.35 $98.70 $94.00 $176.25 $152.75
WWH LAB/RAD FEE SCHEDULE - 4206 308413200 84132 PB POTASSIUM 59.00 $53.10 $23.60 $47.20 $33.04 $41.30 $37.76 $47.20 $46.02 $26.55 $24.19 $24.78 $23.60 $44.25 $38.35
WWH LAB/RAD FEE SCHEDULE - 4206 308413201 84132 PB POTASSIUM POCT 59.00 $53.10 $23.60 $47.20 $33.04 $41.30 $37.76 $47.20 $46.02 $26.55 $24.19 $24.78 $23.60 $44.25 $38.35
WWH LAB/RAD FEE SCHEDULE - 4206 308413400 84134 PB PREALBUMIN 144.00 $129.60 $57.60 $115.20 $80.64 $100.80 $92.16 $115.20 $112.32 $64.80 $59.04 $60.48 $57.60 $108.00 $93.60
WWH LAB/RAD FEE SCHEDULE - 4206 308414400 84144 PB PROGESTERONE BLOOD 173.00 $155.70 $69.20 $138.40 $96.88 $121.10 $110.72 $138.40 $134.94 $77.85 $70.93 $72.66 $69.20 $129.75 $112.45
WWH LAB/RAD FEE SCHEDULE - 4206 308414500 84145 PB PROCALCITONIN 243.00 $218.70 $97.20 $194.40 $136.08 $170.10 $155.52 $194.40 $189.54 $109.35 $99.63 $102.06 $97.20 $182.25 $157.95
WWH LAB/RAD FEE SCHEDULE - 4206 308414600 84146 PB PROLACTIN 229.00 $206.10 $91.60 $183.20 $128.24 $160.30 $146.56 $183.20 $178.62 $103.05 $93.89 $96.18 $91.60 $171.75 $148.85
WWH LAB/RAD FEE SCHEDULE - 4206 308415300 84153 PB PSA-DIAGNOSTIC 169.00 $152.10 $67.60 $135.20 $94.64 $118.30 $108.16 $135.20 $131.82 $76.05 $69.29 $70.98 $67.60 $126.75 $109.85
WWH LAB/RAD FEE SCHEDULE - 4206 308415500 84155 PB PROTEIN TOTAL 38.00 $34.20 $15.20 $30.40 $21.28 $26.60 $24.32 $30.40 $29.64 $17.10 $15.58 $15.96 $15.20 $28.50 $24.70
WWH LAB/RAD FEE SCHEDULE - 4206 308415600 84156 "PB PROTEIN, TIMED UR" 38.00 $34.20 $15.20 $30.40 $21.28 $26.60 $24.32 $30.40 $29.64 $17.10 $15.58 $15.96 $15.20 $28.50 $24.70
WWH LAB/RAD FEE SCHEDULE - 4206 308415601 84156 PB PROTEIN ELP URINE RANDOM 38.00 $34.20 $15.20 $30.40 $21.28 $26.60 $24.32 $30.40 $29.64 $17.10 $15.58 $15.96 $15.20 $28.50 $24.70
WWH LAB/RAD FEE SCHEDULE - 4206 308415701 84157 "PB PROTEIN,BODY FLUID" 47.00 $42.30 $18.80 $37.60 $26.32 $32.90 $30.08 $37.60 $36.66 $21.15 $19.27 $19.74 $18.80 $35.25 $30.55
WWH LAB/RAD FEE SCHEDULE - 4206 308416301 84163 PB INTEGRATED SCREEN PAPPA 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH LAB/RAD FEE SCHEDULE - 4206 308416500 84165 "PB PROTEIN ELP,SERUM" 104.00 $93.60 $41.60 $83.20 $58.24 $72.80 $66.56 $83.20 $81.12 $46.80 $42.64 $43.68 $41.60 $78.00 $67.60
WWH LAB/RAD FEE SCHEDULE - 4206 308416600 84166 PB PROTEIN ELP URINE 99.00 $89.10 $39.60 $79.20 $55.44 $69.30 $63.36 $79.20 $77.22 $44.55 $40.59 $41.58 $39.60 $74.25 $64.35
WWH LAB/RAD FEE SCHEDULE - 4206 308420701 84207 "PB VITAMIN B6, PLASMA LC" 293.00 $263.70 $117.20 $234.40 $164.08 $205.10 $187.52 $234.40 $228.54 $131.85 $120.13 $123.06 $117.20 $219.75 $190.45
WWH LAB/RAD FEE SCHEDULE - 4206 308424401 84244 "PB RENIN ACTIVITY, PLASMA LC" 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 308425501 84255 "PB SELENIUM, SERUM/PLASMA LC" 224.00 $201.60 $89.60 $179.20 $125.44 $156.80 $143.36 $179.20 $174.72 $100.80 $91.84 $94.08 $89.60 $168.00 $145.60
WWH LAB/RAD FEE SCHEDULE - 4206 308427001 84270 "PB SEX HORM BINDING GLOB, SERUM LC" 216.00 $194.40 $86.40 $172.80 $120.96 $151.20 $138.24 $172.80 $168.48 $97.20 $88.56 $90.72 $86.40 $162.00 $140.40
WWH LAB/RAD FEE SCHEDULE - 4206 308429500 84295 PB SODIUM 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 308430000 84300 "PB SODIUM, TIMED URINE" 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 308430001 84300 "PB SODIUM, URINE, RANDOM" 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 308430502 84305 PB IGF-1 LC 202.00 $181.80 $80.80 $161.60 $113.12 $141.40 $129.28 $161.60 $157.56 $90.90 $82.82 $84.84 $80.80 $151.50 $131.30
WWH LAB/RAD FEE SCHEDULE - 4206 308440203 84402 "PB TESTOSTERONE, FREE, EQUILIBRIUM ULTRAFILTRATION LC" 264.00 $237.60 $105.60 $211.20 $147.84 $184.80 $168.96 $211.20 $205.92 $118.80 $108.24 $110.88 $105.60 $198.00 $171.60
WWH LAB/RAD FEE SCHEDULE - 4206 308440204 84402 PB TESTOSTERONE FREE LC 264.00 $237.60 $105.60 $211.20 $147.84 $184.80 $168.96 $211.20 $205.92 $118.80 $108.24 $110.88 $105.60 $198.00 $171.60
WWH LAB/RAD FEE SCHEDULE - 4206 308440300 84403 "PB TESTOSTERONE,TOTAL" 244.00 $219.60 $97.60 $195.20 $136.64 $170.80 $156.16 $195.20 $190.32 $109.80 $100.04 $102.48 $97.60 $183.00 $158.60
WWH LAB/RAD FEE SCHEDULE - 4206 308440303 84403 "PB TOTAL TESTOSTERONE, LC" 244.00 $219.60 $97.60 $195.20 $136.64 $170.80 $156.16 $195.20 $190.32 $109.80 $100.04 $102.48 $97.60 $183.00 $158.60
WWH LAB/RAD FEE SCHEDULE - 4206 308441002 84410 PB TESTOSTERONE BIOAVAIL LC 368.00 $331.20 $147.20 $294.40 $206.08 $257.60 $235.52 $294.40 $287.04 $165.60 $150.88 $154.56 $147.20 $276.00 $239.20
WWH LAB/RAD FEE SCHEDULE - 4206 308442501 84425 "PB VITAMIN B1 (THIAMINE), BLOOD LC" 222.00 $199.80 $88.80 $177.60 $124.32 $155.40 $142.08 $177.60 $173.16 $99.90 $91.02 $93.24 $88.80 $166.50 $144.30
WWH LAB/RAD FEE SCHEDULE - 4206 308443600 84436 PB T4 (THYROXINE) 70.00 $63.00 $28.00 $56.00 $39.20 $49.00 $44.80 $56.00 $54.60 $31.50 $28.70 $29.40 $28.00 $52.50 $45.50
WWH LAB/RAD FEE SCHEDULE - 4206 308443900 84439 "PB T4, FREE" 101.00 $90.90 $40.40 $80.80 $56.56 $70.70 $64.64 $80.80 $78.78 $45.45 $41.41 $42.42 $40.40 $75.75 $65.65
WWH LAB/RAD FEE SCHEDULE - 4206 308444300 84443 PB TSH 119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
WWH LAB/RAD FEE SCHEDULE - 4206 308444302 84443 PB HYPOTHYROIDISM WISC (TSH) 119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
WWH LAB/RAD FEE SCHEDULE - 4206 308445000 84450 PB AST (SGOT) 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH LAB/RAD FEE SCHEDULE - 4206 308446000 84460 PB ALT (SGPT) 42.00 $37.80 $16.80 $33.60 $23.52 $29.40 $26.88 $33.60 $32.76 $18.90 $17.22 $17.64 $16.80 $31.50 $27.30
WWH LAB/RAD FEE SCHEDULE - 4206 308446600 84466 PB TRANSFERRIN (IBC) 135.00 $121.50 $54.00 $108.00 $75.60 $94.50 $86.40 $108.00 $105.30 $60.75 $55.35 $56.70 $54.00 $101.25 $87.75
WWH LAB/RAD FEE SCHEDULE - 4206 308447800 84478 PB TRIGLYCERIDES 46.00 $41.40 $18.40 $36.80 $25.76 $32.20 $29.44 $36.80 $35.88 $20.70 $18.86 $19.32 $18.40 $34.50 $29.90
WWH LAB/RAD FEE SCHEDULE - 4206 308448000 84480 PB T3 TOTAL 99.00 $89.10 $39.60 $79.20 $55.44 $69.30 $63.36 $79.20 $77.22 $44.55 $40.59 $41.58 $39.60 $74.25 $64.35
WWH LAB/RAD FEE SCHEDULE - 4206 308448100 84481 "PB T3, FREE" 178.00 $160.20 $71.20 $142.40 $99.68 $124.60 $113.92 $142.40 $138.84 $80.10 $72.98 $74.76 $71.20 $133.50 $115.70
WWH LAB/RAD FEE SCHEDULE - 4206 308448201 84482 "PB REVERSE T3, SERUM LC" 166.00 $149.40 $66.40 $132.80 $92.96 $116.20 $106.24 $132.80 $129.48 $74.70 $68.06 $69.72 $66.40 $124.50 $107.90
WWH LAB/RAD FEE SCHEDULE - 4206 308448402 84484 PB TROPONIN I 161.00 $144.90 $64.40 $128.80 $90.16 $112.70 $103.04 $128.80 $125.58 $72.45 $66.01 $67.62 $64.40 $120.75 $104.65
WWH LAB/RAD FEE SCHEDULE - 4206 308451000 84510 PB TYROSINEMIA NEWBORN SCR WISC 77.00 $69.30 $30.80 $61.60 $43.12 $53.90 $49.28 $61.60 $60.06 $34.65 $31.57 $32.34 $30.80 $57.75 $50.05
WWH LAB/RAD FEE SCHEDULE - 4206 308452000 84520 PB BUN 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 308454000 84540 PB UREA NITROGEN-URINE 26.00 $23.40 $10.40 $20.80 $14.56 $18.20 $16.64 $20.80 $20.28 $11.70 $10.66 $10.92 $10.40 $19.50 $16.90
WWH LAB/RAD FEE SCHEDULE - 4206 308455000 84550 PB URIC ACID 48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
WWH LAB/RAD FEE SCHEDULE - 4206 308456001 84560 PB URIC ACID BODY FLUID 45.00 $40.50 $18.00 $36.00 $25.20 $31.50 $28.80 $36.00 $35.10 $20.25 $18.45 $18.90 $18.00 $33.75 $29.25
WWH LAB/RAD FEE SCHEDULE - 4206 308457800 84578 "PB UROBILINOGEN QUAL,UR" 13.00 $11.70 $5.20 $10.40 $7.28 $9.10 $8.32 $10.40 $10.14 $5.85 $5.33 $5.46 $5.20 $9.75 $8.45
WWH LAB/RAD FEE SCHEDULE - 4206 308458600 84586 (IA) PB VASO INTEST POLYPEPT 363.00 $326.70 $145.20 $290.40 $203.28 $254.10 $232.32 $290.40 $283.14 $163.35 $148.83 $152.46 $145.20 $272.25 $235.95
WWH LAB/RAD FEE SCHEDULE - 4206 308458800 84588 PB ARGININE VASOPRESSIN (ADH) 357.00 $321.30 $142.80 $285.60 $199.92 $249.90 $228.48 $285.60 $278.46 $160.65 $146.37 $149.94 $142.80 $267.75 $232.05
WWH LAB/RAD FEE SCHEDULE - 4206 308459001 84590 "PB VITAMIN A, SERUM LC" 122.00 $109.80 $48.80 $97.60 $68.32 $85.40 $78.08 $97.60 $95.16 $54.90 $50.02 $51.24 $48.80 $91.50 $79.30
WWH LAB/RAD FEE SCHEDULE - 4206 308463002 84630 "PB ZINC, PLASMA OR SERUM LC" 119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
WWH LAB/RAD FEE SCHEDULE - 4206 308468100 84681 PB C-PEPTIDE SERUM 206.00 $185.40 $82.40 $164.80 $115.36 $144.20 $131.84 $164.80 $160.68 $92.70 $84.46 $86.52 $82.40 $154.50 $133.90
WWH LAB/RAD FEE SCHEDULE - 4206 308470201 84702 PB GENERAL LAB 8470201 132.00 $118.80 $52.80 $105.60 $73.92 $92.40 $84.48 $105.60 $102.96 $59.40 $54.12 $55.44 $52.80 $99.00 $85.80
WWH LAB/RAD FEE SCHEDULE - 4206 308470202 84702 PB GENERAL LAB 8470202 132.00 $118.80 $52.80 $105.60 $73.92 $92.40 $84.48 $105.60 $102.96 $59.40 $54.12 $55.44 $52.80 $99.00 $85.80
WWH LAB/RAD FEE SCHEDULE - 4206 308470204 84702 PB GENERAL LAB 8470204 132.00 $118.80 $52.80 $105.60 $73.92 $92.40 $84.48 $105.60 $102.96 $59.40 $54.12 $55.44 $52.80 $99.00 $85.80
WWH LAB/RAD FEE SCHEDULE - 4206 308470208 84702 PB GENERAL LAB 8470208 132.00 $118.80 $52.80 $105.60 $73.92 $92.40 $84.48 $105.60 $102.96 $59.40 $54.12 $55.44 $52.80 $99.00 $85.80
WWH LAB/RAD FEE SCHEDULE - 4206 308470300 84703 PB GENERAL LAB 8470300 73.00 $65.70 $29.20 $58.40 $40.88 $51.10 $46.72 $58.40 $56.94 $32.85 $29.93 $30.66 $29.20 $54.75 $47.45
WWH LAB/RAD FEE SCHEDULE - 4206 308500400 85004 PB DIFFERENTIAL 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH LAB/RAD FEE SCHEDULE - 4206 308501402 85014 PB HEMATOCRIT 29.00 $26.10 $11.60 $23.20 $16.24 $20.30 $18.56 $23.20 $22.62 $13.05 $11.89 $12.18 $11.60 $21.75 $18.85
WWH LAB/RAD FEE SCHEDULE - 4206 308501702 82017 PB ORGANIC ACIDEMIA 74.00 $66.60 $29.60 $59.20 $41.44 $51.80 $47.36 $59.20 $57.72 $33.30 $30.34 $31.08 $29.60 $55.50 $48.10
WWH LAB/RAD FEE SCHEDULE - 4206 308501800 85018 "PB HEMOGLOBIN,BLOOD GAS" 32.00 $28.80 $12.80 $25.60 $17.92 $22.40 $20.48 $25.60 $24.96 $14.40 $13.12 $13.44 $12.80 $24.00 $20.80
WWH LAB/RAD FEE SCHEDULE - 4206 308501801 85018 PB HEMOGLOBIN 32.00 $28.80 $12.80 $25.60 $17.92 $22.40 $20.48 $25.60 $24.96 $14.40 $13.12 $13.44 $12.80 $24.00 $20.80
WWH LAB/RAD FEE SCHEDULE - 4206 308502500 85025 PB CBC W/DIFF 96.00 $86.40 $38.40 $76.80 $53.76 $67.20 $61.44 $76.80 $74.88 $43.20 $39.36 $40.32 $38.40 $72.00 $62.40
WWH LAB/RAD FEE SCHEDULE - 4206 308502501 85025 PB CBC 3 PART DIFF 96.00 $86.40 $38.40 $76.80 $53.76 $67.20 $61.44 $76.80 $74.88 $43.20 $39.36 $40.32 $38.40 $72.00 $62.40
WWH LAB/RAD FEE SCHEDULE - 4206 308502700 85027 PB CBC 74.00 $66.60 $29.60 $59.20 $41.44 $51.80 $47.36 $59.20 $57.72 $33.30 $30.34 $31.08 $29.60 $55.50 $48.10
WWH LAB/RAD FEE SCHEDULE - 4206 308504100 85041 PB RBC 30.00 $27.00 $12.00 $24.00 $16.80 $21.00 $19.20 $24.00 $23.40 $13.50 $12.30 $12.60 $12.00 $22.50 $19.50
WWH LAB/RAD FEE SCHEDULE - 4206 308504500 85045 PB RETIC COUNT 47.00 $42.30 $18.80 $37.60 $26.32 $32.90 $30.08 $37.60 $36.66 $21.15 $19.27 $19.74 $18.80 $35.25 $30.55
WWH LAB/RAD FEE SCHEDULE - 4206 308504600 85046 PB RETIC HGB CONC 44.00 $39.60 $17.60 $35.20 $24.64 $30.80 $28.16 $35.20 $34.32 $19.80 $18.04 $18.48 $17.60 $33.00 $28.60
WWH LAB/RAD FEE SCHEDULE - 4206 308504802 85048 PB WBC 28.00 $25.20 $11.20 $22.40 $15.68 $19.60 $17.92 $22.40 $21.84 $12.60 $11.48 $11.76 $11.20 $21.00 $18.20
WWH LAB/RAD FEE SCHEDULE - 4206 308504901 85049 PB PLATELET COUNT 43.00 $38.70 $17.20 $34.40 $24.08 $30.10 $27.52 $34.40 $33.54 $19.35 $17.63 $18.06 $17.20 $32.25 $27.95
WWH LAB/RAD FEE SCHEDULE - 4206 308506000 85060 PB PERIPH BLOOD SMR 130.00 $117.00 $52.00 $104.00 $72.80 $91.00 $83.20 $104.00 $101.40 $58.50 $53.30 $54.60 $52.00 $97.50 $84.50
WWH LAB/RAD FEE SCHEDULE - 4206 308513000 85130 PB FACTOR X CHROMOGENIC 178.00 $160.20 $71.20 $142.40 $99.68 $124.60 $113.92 $142.40 $138.84 $80.10 $72.98 $74.76 $71.20 $133.50 $115.70
WWH LAB/RAD FEE SCHEDULE - 4206 308524000 85240 PB FACTOR 8 ASSAY 182.00 $163.80 $72.80 $145.60 $101.92 $127.40 $116.48 $145.60 $141.96 $81.90 $74.62 $76.44 $72.80 $136.50 $118.30
WWH LAB/RAD FEE SCHEDULE - 4206 308530000 85300 PB ANTITHROMBIN III 146.00 $131.40 $58.40 $116.80 $81.76 $102.20 $93.44 $116.80 $113.88 $65.70 $59.86 $61.32 $58.40 $109.50 $94.90
WWH LAB/RAD FEE SCHEDULE - 4206 308530300 85303 PB PROTEIN C ACTIVITY 201.00 $180.90 $80.40 $160.80 $112.56 $140.70 $128.64 $160.80 $156.78 $90.45 $82.41 $84.42 $80.40 $150.75 $130.65
WWH LAB/RAD FEE SCHEDULE - 4206 308530600 85306 PB PROTEIN S FUNCTIONAL 162.00 $145.80 $64.80 $129.60 $90.72 $113.40 $103.68 $129.60 $126.36 $72.90 $66.42 $68.04 $64.80 $121.50 $105.30
WWH LAB/RAD FEE SCHEDULE - 4206 308530601 85306 PB PROTEIN S FREE 153.00 $137.70 $61.20 $122.40 $85.68 $107.10 $97.92 $122.40 $119.34 $68.85 $62.73 $64.26 $61.20 $114.75 $99.45
WWH LAB/RAD FEE SCHEDULE - 4206 308530700 85307 PB ACT. PROTEIN C RESIST 174.00 $156.60 $69.60 $139.20 $97.44 $121.80 $111.36 $139.20 $135.72 $78.30 $71.34 $73.08 $69.60 $130.50 $113.10
WWH LAB/RAD FEE SCHEDULE - 4206 308537900 85379 PB D-DIMER QUANT 102.00 $91.80 $40.80 $81.60 $57.12 $71.40 $65.28 $81.60 $79.56 $45.90 $41.82 $42.84 $40.80 $76.50 $66.30
WWH LAB/RAD FEE SCHEDULE - 4206 308538400 85384 PB FIBRINOGEN QUANTITATIVE 88.00 $79.20 $35.20 $70.40 $49.28 $61.60 $56.32 $70.40 $68.64 $39.60 $36.08 $36.96 $35.20 $66.00 $57.20
WWH LAB/RAD FEE SCHEDULE - 4206 308544100 85441 PB HEINZ BODIES 23.00 $20.70 $9.20 $18.40 $12.88 $16.10 $14.72 $18.40 $17.94 $10.35 $9.43 $9.66 $9.20 $17.25 $14.95
WWH LAB/RAD FEE SCHEDULE - 4206 308546000 85460 PB KLEIHAUER STAIN 125.00 $112.50 $50.00 $100.00 $70.00 $87.50 $80.00 $100.00 $97.50 $56.25 $51.25 $52.50 $50.00 $93.75 $81.25
WWH LAB/RAD FEE SCHEDULE - 4206 308552001 85520 PB HEPARIN-QUANT 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH LAB/RAD FEE SCHEDULE - 4206 308557600 85576 PB COLLAGEN/EPI 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 308557601 85576 PB COLLAGEN/ADP 173.00 $155.70 $69.20 $138.40 $96.88 $121.10 $110.72 $138.40 $134.94 $77.85 $70.93 $72.66 $69.20 $129.75 $112.45
WWH LAB/RAD FEE SCHEDULE - 4206 308561000 85610 PB PROTHOMBIN TIME 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH LAB/RAD FEE SCHEDULE - 4206 308561001 85610 PB INR POCT 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH LAB/RAD FEE SCHEDULE - 4206 308561300 85613 PB DRVVT SCREEN 83.00 $74.70 $33.20 $66.40 $46.48 $58.10 $53.12 $66.40 $64.74 $37.35 $34.03 $34.86 $33.20 $62.25 $53.95
WWH LAB/RAD FEE SCHEDULE - 4206 308565200 85652 PB SED RATE 28.00 $25.20 $11.20 $22.40 $15.68 $19.60 $17.92 $22.40 $21.84 $12.60 $11.48 $11.76 $11.20 $21.00 $18.20
WWH LAB/RAD FEE SCHEDULE - 4206 308567001 85670 PB THROMBIN TIME 60.00 $54.00 $24.00 $48.00 $33.60 $42.00 $38.40 $48.00 $46.80 $27.00 $24.60 $25.20 $24.00 $45.00 $39.00
WWH LAB/RAD FEE SCHEDULE - 4206 308573000 85730 PB ACTIVATED PTT 62.00 $55.80 $24.80 $49.60 $34.72 $43.40 $39.68 $49.60 $48.36 $27.90 $25.42 $26.04 $24.80 $46.50 $40.30
WWH LAB/RAD FEE SCHEDULE - 4206 308573001 85730 PB PTT-LA SCREEN 62.00 $55.80 $24.80 $49.60 $34.72 $43.40 $39.68 $49.60 $48.36 $27.90 $25.42 $26.04 $24.80 $46.50 $40.30
WWH LAB/RAD FEE SCHEDULE - 4206 308600300 86003 PB RAST IN-HOUSE 42.00 $37.80 $16.80 $33.60 $23.52 $29.40 $26.88 $33.60 $32.76 $18.90 $17.22 $17.64 $16.80 $31.50 $27.30
WWH LAB/RAD FEE SCHEDULE - 4206 308600301 86003 (IA) PB RAST IGE 42.00 $37.80 $16.80 $33.60 $23.52 $29.40 $26.88 $33.60 $32.76 $18.90 $17.22 $17.64 $16.80 $31.50 $27.30
WWH LAB/RAD FEE SCHEDULE - 4206 308603800 86038 PB ANA 141.00 $126.90 $56.40 $112.80 $78.96 $98.70 $90.24 $112.80 $109.98 $63.45 $57.81 $59.22 $56.40 $105.75 $91.65
WWH LAB/RAD FEE SCHEDULE - 4206 308603900 86039 PB FANA TITER 118.00 $106.20 $47.20 $94.40 $66.08 $82.60 $75.52 $94.40 $92.04 $53.10 $48.38 $49.56 $47.20 $88.50 $76.70
WWH LAB/RAD FEE SCHEDULE - 4206 308606002 86060 PB ANTISTREPTOLYSIN O AB LC 63.00 $56.70 $25.20 $50.40 $35.28 $44.10 $40.32 $50.40 $49.14 $28.35 $25.83 $26.46 $25.20 $47.25 $40.95
WWH LAB/RAD FEE SCHEDULE - 4206 308607800 86078 PB TRANSFUSION REACTION 203.00 $182.70 $81.20 $162.40 $113.68 $142.10 $129.92 $162.40 $158.34 $91.35 $83.23 $85.26 $81.20 $152.25 $131.95
WWH LAB/RAD FEE SCHEDULE - 4206 308614000 86140 PB C-REACTIVE PROTEIN 77.00 $69.30 $30.80 $61.60 $43.12 $53.90 $49.28 $61.60 $60.06 $34.65 $31.57 $32.34 $30.80 $57.75 $50.05
WWH LAB/RAD FEE SCHEDULE - 4206 308614100 86141 PB HIGH SENS CRP 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH LAB/RAD FEE SCHEDULE - 4206 308614600 86146 PB BETA 2 GLYCOPROTEIN 1 IGA 139.00 $125.10 $55.60 $111.20 $77.84 $97.30 $88.96 $111.20 $108.42 $62.55 $56.99 $58.38 $55.60 $104.25 $90.35
WWH LAB/RAD FEE SCHEDULE - 4206 308614601 86146 PB BETA 2 GLYCOPROTEIN 1 IGG 139.00 $125.10 $55.60 $111.20 $77.84 $97.30 $88.96 $111.20 $108.42 $62.55 $56.99 $58.38 $55.60 $104.25 $90.35
WWH LAB/RAD FEE SCHEDULE - 4206 308614602 86146 PB BETA 2 GLYCOPROTEIN 1 IGM 139.00 $125.10 $55.60 $111.20 $77.84 $97.30 $88.96 $111.20 $108.42 $62.55 $56.99 $58.38 $55.60 $104.25 $90.35
WWH LAB/RAD FEE SCHEDULE - 4206 308614700 86147 PB CARDIOLIPIN IGA CRD 165.00 $148.50 $66.00 $132.00 $92.40 $115.50 $105.60 $132.00 $128.70 $74.25 $67.65 $69.30 $66.00 $123.75 $107.25
WWH LAB/RAD FEE SCHEDULE - 4206 308614701 86147 PB CARDIOLIPIN IGG CRD 165.00 $148.50 $66.00 $132.00 $92.40 $115.50 $105.60 $132.00 $128.70 $74.25 $67.65 $69.30 $66.00 $123.75 $107.25
WWH LAB/RAD FEE SCHEDULE - 4206 308614702 86147 PB CARDIOLIPIN IGM CRD 165.00 $148.50 $66.00 $132.00 $92.40 $115.50 $105.60 $132.00 $128.70 $74.25 $67.65 $69.30 $66.00 $123.75 $107.25
WWH LAB/RAD FEE SCHEDULE - 4206 308616000 86160 PB C4 COMPLEMENT COMPONENT 125.00 $112.50 $50.00 $100.00 $70.00 $87.50 $80.00 $100.00 $97.50 $56.25 $51.25 $52.50 $50.00 $93.75 $81.25
WWH LAB/RAD FEE SCHEDULE - 4206 308616001 86160 PB C3 COMPLEMENT COMPONENT 125.00 $112.50 $50.00 $100.00 $70.00 $87.50 $80.00 $100.00 $97.50 $56.25 $51.25 $52.50 $50.00 $93.75 $81.25
WWH LAB/RAD FEE SCHEDULE - 4206 308620000 86200 PB CCP ANTIBODY IGG 135.00 $121.50 $54.00 $108.00 $75.60 $94.50 $86.40 $108.00 $105.30 $60.75 $55.35 $56.70 $54.00 $101.25 $87.75
WWH LAB/RAD FEE SCHEDULE - 4206 308622500 86225 PB NATIVE DNA ABY 143.00 $128.70 $57.20 $114.40 $80.08 $100.10 $91.52 $114.40 $111.54 $64.35 $58.63 $60.06 $57.20 $107.25 $92.95
WWH LAB/RAD FEE SCHEDULE - 4206 308623502 86235 PB SM ANTIBODY 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 308623503 86235 PB RNP ANTIBODY 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 308623505 86235 PB SSB ANTIBODY 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 308623507 86235 PB RO52 ANTIBODY 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 308623508 86235 PB RO60 ANTIBODY 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 308625503 86255 (IA) PB SMOOTH MUSCLE ABY 148.00 $133.20 $59.20 $118.40 $82.88 $103.60 $94.72 $118.40 $115.44 $66.60 $60.68 $62.16 $59.20 $111.00 $96.20
WWH LAB/RAD FEE SCHEDULE - 4206 308625510 86255 (IA) PB ANCA 156.00 $140.40 $62.40 $124.80 $87.36 $109.20 $99.84 $124.80 $121.68 $70.20 $63.96 $65.52 $62.40 $117.00 $101.40
WWH LAB/RAD FEE SCHEDULE - 4206 308625603 86256 (IA) PB ANCA TITER 137.00 $123.30 $54.80 $109.60 $76.72 $95.90 $87.68 $109.60 $106.86 $61.65 $56.17 $57.54 $54.80 $102.75 $89.05
WWH LAB/RAD FEE SCHEDULE - 4206 308625623 86256 (IA) PB ATYPICAL P-ANCA LC 137.00 $123.30 $54.80 $109.60 $76.72 $95.90 $87.68 $109.60 $106.86 $61.65 $56.17 $57.54 $54.80 $102.75 $89.05
WWH LAB/RAD FEE SCHEDULE - 4206 308625801 86258 PB GLIADIN DGP ABY IGA 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 308630100 86301 PB CA 19-9 206.00 $185.40 $82.40 $164.80 $115.36 $144.20 $131.84 $164.80 $160.68 $92.70 $84.46 $86.52 $82.40 $154.50 $133.90
WWH LAB/RAD FEE SCHEDULE - 4206 308630400 86304 PB CA 125 212.00 $190.80 $84.80 $169.60 $118.72 $148.40 $135.68 $169.60 $165.36 $95.40 $86.92 $89.04 $84.80 $159.00 $137.80
WWH LAB/RAD FEE SCHEDULE - 4206 308630800 86308 PB HETEROPHILE 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 308631600 86316 PB CHROMOGRANIN A 206.00 $185.40 $82.40 $164.80 $115.36 $144.20 $131.84 $164.80 $160.68 $92.70 $84.46 $86.52 $82.40 $154.50 $133.90
WWH LAB/RAD FEE SCHEDULE - 4206 308631701 86317 PB TETANUS IMM STATUS 118.00 $106.20 $47.20 $94.40 $66.08 $82.60 $75.52 $94.40 $92.04 $53.10 $48.38 $49.56 $47.20 $88.50 $76.70
WWH LAB/RAD FEE SCHEDULE - 4206 308633400 86334 PB IMMUNOFIXATION 168.00 $151.20 $67.20 $134.40 $94.08 $117.60 $107.52 $134.40 $131.04 $75.60 $68.88 $70.56 $67.20 $126.00 $109.20
WWH LAB/RAD FEE SCHEDULE - 4206 308633500 86335 PB IMMUNOFIXATION URINE 294.00 $264.60 $117.60 $235.20 $164.64 $205.80 $188.16 $235.20 $229.32 $132.30 $120.54 $123.48 $117.60 $220.50 $191.10
WWH LAB/RAD FEE SCHEDULE - 4206 308633601 86336 PB INTEGRATED SCREEN INHIBIN 117.00 $105.30 $46.80 $93.60 $65.52 $81.90 $74.88 $93.60 $91.26 $52.65 $47.97 $49.14 $46.80 $87.75 $76.05
WWH LAB/RAD FEE SCHEDULE - 4206 308633603 86336 PB INHIBIN A 153.00 $137.70 $61.20 $122.40 $85.68 $107.10 $97.92 $122.40 $119.34 $68.85 $62.73 $64.26 $61.20 $114.75 $99.45
WWH LAB/RAD FEE SCHEDULE - 4206 308634001 86340 "PB INTRINSIC FACTOR ABS, SERUM LC" 150.00 $135.00 $60.00 $120.00 $84.00 $105.00 $96.00 $120.00 $117.00 $67.50 $61.50 $63.00 $60.00 $112.50 $97.50
WWH LAB/RAD FEE SCHEDULE - 4206 308636400 86364 PB TISSUE TRANSGLUTAMINASE IGA 137.00 $123.30 $54.80 $109.60 $76.72 $95.90 $87.68 $109.60 $106.86 $61.65 $56.17 $57.54 $54.80 $102.75 $89.05
WWH LAB/RAD FEE SCHEDULE - 4206 308636401 86364 PB TISSUE TRANSGLUT IGG 137.00 $123.30 $54.80 $109.60 $76.72 $95.90 $87.68 $109.60 $106.86 $61.65 $56.17 $57.54 $54.80 $102.75 $89.05
WWH LAB/RAD FEE SCHEDULE - 4206 308637600 86376 PB THY PEROXIDASE ABY 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH LAB/RAD FEE SCHEDULE - 4206 308637602 86376 PB LIVER-KIDNEY MICROSOMAL AB LC 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH LAB/RAD FEE SCHEDULE - 4206 308643000 86430 PB RA QUALITATIVE 57.00 $51.30 $22.80 $45.60 $31.92 $39.90 $36.48 $45.60 $44.46 $25.65 $23.37 $23.94 $22.80 $42.75 $37.05
WWH LAB/RAD FEE SCHEDULE - 4206 308643101 86431 PB RA QUANT 59.00 $53.10 $23.60 $47.20 $33.04 $41.30 $37.76 $47.20 $46.02 $26.55 $24.19 $24.78 $23.60 $44.25 $38.35
WWH LAB/RAD FEE SCHEDULE - 4206 308648000 86480 PB QUANTIFERON TB GOLD PLUS 193.00 $173.70 $77.20 $154.40 $108.08 $135.10 $123.52 $154.40 $150.54 $86.85 $79.13 $81.06 $77.20 $144.75 $125.45
WWH LAB/RAD FEE SCHEDULE - 4206 308661105 86611 PB BARTONELLA ANTIBODY LC 48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
WWH LAB/RAD FEE SCHEDULE - 4206 308661702 86617 (IA) PB LYMES WESTERN BLOT 102.00 $91.80 $40.80 $81.60 $57.12 $71.40 $65.28 $81.60 $79.56 $45.90 $41.82 $42.84 $40.80 $76.50 $66.30
WWH LAB/RAD FEE SCHEDULE - 4206 308661705 86617 "PB LYME DISEASE, LINE BLOT EACH LC" 102.00 $91.80 $40.80 $81.60 $57.12 $71.40 $65.28 $81.60 $79.56 $45.90 $41.82 $42.84 $40.80 $76.50 $66.30
WWH LAB/RAD FEE SCHEDULE - 4206 308661801 86618 PB LYME (FIA) POLYVALENT 164.00 $147.60 $65.60 $131.20 $91.84 $114.80 $104.96 $131.20 $127.92 $73.80 $67.24 $68.88 $65.60 $123.00 $106.60
WWH LAB/RAD FEE SCHEDULE - 4206 308663103 86631 PB GENERAL LAB 8663103 LC 88.00 $79.20 $35.20 $70.40 $49.28 $61.60 $56.32 $70.40 $68.64 $39.60 $36.08 $36.96 $35.20 $66.00 $57.20
WWH LAB/RAD FEE SCHEDULE - 4206 308664404 86644 PB CMV IGG ABY 131.00 $117.90 $52.40 $104.80 $73.36 $91.70 $83.84 $104.80 $102.18 $58.95 $53.71 $55.02 $52.40 $98.25 $85.15
WWH LAB/RAD FEE SCHEDULE - 4206 308664501 86645 PB CMV IGM ABY 170.00 $153.00 $68.00 $136.00 $95.20 $119.00 $108.80 $136.00 $132.60 $76.50 $69.70 $71.40 $68.00 $127.50 $110.50
WWH LAB/RAD FEE SCHEDULE - 4206 308666401 86664 PB EBV NA 112.00 $100.80 $44.80 $89.60 $62.72 $78.40 $71.68 $89.60 $87.36 $50.40 $45.92 $47.04 $44.80 $84.00 $72.80
WWH LAB/RAD FEE SCHEDULE - 4206 308666502 86665 PB EBV VCA IGG 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 308666503 86665 PB EBV VCA IGM 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 308666602 86666 PB EHRLICHIA AB LC 103.00 $92.70 $41.20 $82.40 $57.68 $72.10 $65.92 $82.40 $80.34 $46.35 $42.23 $43.26 $41.20 $77.25 $66.95
WWH LAB/RAD FEE SCHEDULE - 4206 308667104 86671 "PB SACCHAROMYCES CEREVISIAE, IGA AND IGG LC" 137.00 $123.30 $54.80 $109.60 $76.72 $95.90 $87.68 $109.60 $106.86 $61.65 $56.17 $57.54 $54.80 $102.75 $89.05
WWH LAB/RAD FEE SCHEDULE - 4206 308667701 86677 PB HELICOBACTER PYLORI IGG AFFILIATE ONLY 160.00 $144.00 $64.00 $128.00 $89.60 $112.00 $102.40 $128.00 $124.80 $72.00 $65.60 $67.20 $64.00 $120.00 $104.00
WWH LAB/RAD FEE SCHEDULE - 4206 308669500 86695 PB GENERAL LAB 8669500 99.00 $89.10 $39.60 $79.20 $55.44 $69.30 $63.36 $79.20 $77.22 $44.55 $40.59 $41.58 $39.60 $74.25 $64.35
WWH LAB/RAD FEE SCHEDULE - 4206 308669600 86696 PB GENERAL LAB 8669600 107.00 $96.30 $42.80 $85.60 $59.92 $74.90 $68.48 $85.60 $83.46 $48.15 $43.87 $44.94 $42.80 $80.25 $69.55
WWH LAB/RAD FEE SCHEDULE - 4206 308670301 86703 PB GENERAL LAB 8670301 153.00 $137.70 $61.20 $122.40 $85.68 $107.10 $97.92 $122.40 $119.34 $68.85 $62.73 $64.26 $61.20 $114.75 $99.45
WWH LAB/RAD FEE SCHEDULE - 4206 308670304 86703 PB GENERAL LAB 8670304 153.00 $137.70 $61.20 $122.40 $85.68 $107.10 $97.92 $122.40 $119.34 $68.85 $62.73 $64.26 $61.20 $114.75 $99.45
WWH LAB/RAD FEE SCHEDULE - 4206 308670400 86704 PB GENERAL LAB 8670400 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH LAB/RAD FEE SCHEDULE - 4206 308670500 86705 PB GENERAL LAB 8670500 122.00 $109.80 $48.80 $97.60 $68.32 $85.40 $78.08 $97.60 $95.16 $54.90 $50.02 $51.24 $48.80 $91.50 $79.30
WWH LAB/RAD FEE SCHEDULE - 4206 308670600 86706 PB GENERAL LAB 8670600 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 308670800 86708 PB GENERAL LAB 8670800 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH LAB/RAD FEE SCHEDULE - 4206 308670900 86709 PB GENERAL LAB 8670900 114.00 $102.60 $45.60 $91.20 $63.84 $79.80 $72.96 $91.20 $88.92 $51.30 $46.74 $47.88 $45.60 $85.50 $74.10
WWH LAB/RAD FEE SCHEDULE - 4206 308673500 86735 PB MUMPS IGG 128.00 $115.20 $51.20 $102.40 $71.68 $89.60 $81.92 $102.40 $99.84 $57.60 $52.48 $53.76 $51.20 $96.00 $83.20
WWH LAB/RAD FEE SCHEDULE - 4206 308673804 86738 PB MYCOPLASMA PNEU IGG/IGM ABS LC 134.00 $120.60 $53.60 $107.20 $75.04 $93.80 $85.76 $107.20 $104.52 $60.30 $54.94 $56.28 $53.60 $100.50 $87.10
WWH LAB/RAD FEE SCHEDULE - 4206 308675303 86753 PB BABESIA MICROTI ANTIBODY LC 102.00 $91.80 $40.80 $81.60 $57.12 $71.40 $65.28 $81.60 $79.56 $45.90 $41.82 $42.84 $40.80 $76.50 $66.30
WWH LAB/RAD FEE SCHEDULE - 4206 308676200 86762 PB RUBELLA IMMUNE STATUS 115.00 $103.50 $46.00 $92.00 $64.40 $80.50 $73.60 $92.00 $89.70 $51.75 $47.15 $48.30 $46.00 $86.25 $74.75
WWH LAB/RAD FEE SCHEDULE - 4206 308676501 86765 PB RUBEOLA IMMUNITY 119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
WWH LAB/RAD FEE SCHEDULE - 4206 308676900 86769 (IA) PB COVID 19 ANTIBODY IGG INHOUSE 216.00 $194.40 $86.40 $172.80 $120.96 $151.20 $138.24 $172.80 $168.48 $97.20 $88.56 $90.72 $86.40 $162.00 $140.40
WWH LAB/RAD FEE SCHEDULE - 4206 308676901 86769 PB SARS COV2 ABY NUCLEOCAPSID LC 216.00 $194.40 $86.40 $172.80 $120.96 $151.20 $138.24 $172.80 $168.48 $97.20 $88.56 $90.72 $86.40 $162.00 $140.40
WWH LAB/RAD FEE SCHEDULE - 4206 308677702 86777 "PB TOXOPLASMA GONDII AB, IGG, QN LC" 118.00 $106.20 $47.20 $94.40 $66.08 $82.60 $75.52 $94.40 $92.04 $53.10 $48.38 $49.56 $47.20 $88.50 $76.70
WWH LAB/RAD FEE SCHEDULE - 4206 308677802 86778 "PB TOXOPLASMA GONDII AB,IGM,QN LC" 125.00 $112.50 $50.00 $100.00 $70.00 $87.50 $80.00 $100.00 $97.50 $56.25 $51.25 $52.50 $50.00 $93.75 $81.25
WWH LAB/RAD FEE SCHEDULE - 4206 308678000 86780 PB GENERAL LAB 8678000 70.00 $63.00 $28.00 $56.00 $39.20 $49.00 $44.80 $56.00 $54.60 $31.50 $28.70 $29.40 $28.00 $52.50 $45.50
WWH LAB/RAD FEE SCHEDULE - 4206 308678700 86787 PB VARICELLA ZOSTER IMMUNE ASSAY 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH LAB/RAD FEE SCHEDULE - 4206 308680002 86800 (IA) PB THYROGLOB ABY SCREEN 104.00 $93.60 $41.60 $83.20 $58.24 $72.80 $66.56 $83.20 $81.12 $46.80 $42.64 $43.68 $41.60 $78.00 $67.60
WWH LAB/RAD FEE SCHEDULE - 4206 308680300 86803 PB GENERAL LAB 8680300 148.00 $133.20 $59.20 $118.40 $82.88 $103.60 $94.72 $118.40 $115.44 $66.60 $60.68 $62.16 $59.20 $111.00 $96.20
WWH LAB/RAD FEE SCHEDULE - 4206 308685001 86850 PB ABY SCREEN 94.00 $84.60 $37.60 $75.20 $52.64 $65.80 $60.16 $75.20 $73.32 $42.30 $38.54 $39.48 $37.60 $70.50 $61.10
WWH LAB/RAD FEE SCHEDULE - 4206 308688001 86880 PB CORD DAT 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 308688003 86880 PB FETAL DIRECT COOMBS 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 308688004 86880 PB IGG ANTIHUMAN GLOBULIN 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 308688005 86880 PB DIRECT ANTIGLOBULIN TEST 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 308690000 86900 PB ABO GROUP 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH LAB/RAD FEE SCHEDULE - 4206 308690001 86900 PB CORD ABO GROUP 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH LAB/RAD FEE SCHEDULE - 4206 308690003 86900 PB FETAL ABO 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH LAB/RAD FEE SCHEDULE - 4206 308690100 86901 PB RH (D) TYPE 70.00 $63.00 $28.00 $56.00 $39.20 $49.00 $44.80 $56.00 $54.60 $31.50 $28.70 $29.40 $28.00 $52.50 $45.50
WWH LAB/RAD FEE SCHEDULE - 4206 308690101 86901 PB CORD RH TYPE 70.00 $63.00 $28.00 $56.00 $39.20 $49.00 $44.80 $56.00 $54.60 $31.50 $28.70 $29.40 $28.00 $52.50 $45.50
WWH LAB/RAD FEE SCHEDULE - 4206 308690103 86901 PB WEAK DU 70.00 $63.00 $28.00 $56.00 $39.20 $49.00 $44.80 $56.00 $54.60 $31.50 $28.70 $29.40 $28.00 $52.50 $45.50
WWH LAB/RAD FEE SCHEDULE - 4206 308690106 86901 PB FETAL RH TYPE 70.00 $63.00 $28.00 $56.00 $39.20 $49.00 $44.80 $56.00 $54.60 $31.50 $28.70 $29.40 $28.00 $52.50 $45.50
WWH LAB/RAD FEE SCHEDULE - 4206 308690107 86901 PB FETAL WEAK D 70.00 $63.00 $28.00 $56.00 $39.20 $49.00 $44.80 $56.00 $54.60 $31.50 $28.70 $29.40 $28.00 $52.50 $45.50
WWH LAB/RAD FEE SCHEDULE - 4206 308690553 86905 PB ARC PATIENT PHENOTYPE 200.00 $180.00 $80.00 $160.00 $112.00 $140.00 $128.00 $160.00 $156.00 $90.00 $82.00 $84.00 $80.00 $150.00 $130.00
WWH LAB/RAD FEE SCHEDULE - 4206 308701500 87015 PB MALIARIAL/PARASITE THICK SMEAR 21.00 $18.90 $8.40 $16.80 $11.76 $14.70 $13.44 $16.80 $16.38 $9.45 $8.61 $8.82 $8.40 $15.75 $13.65
WWH LAB/RAD FEE SCHEDULE - 4206 308704001 87040 PB BLOOD CULTURE-BACTEC 102.00 $91.80 $40.80 $81.60 $57.12 $71.40 $65.28 $81.60 $79.56 $45.90 $41.82 $42.84 $40.80 $76.50 $66.30
WWH LAB/RAD FEE SCHEDULE - 4206 308704500 87045 PB STOOL CULT 88.00 $79.20 $35.20 $70.40 $49.28 $61.60 $56.32 $70.40 $68.64 $39.60 $36.08 $36.96 $35.20 $66.00 $57.20
WWH LAB/RAD FEE SCHEDULE - 4206 308704602 87046 PB AEROMONAS PLATE STOOL 35.00 $31.50 $14.00 $28.00 $19.60 $24.50 $22.40 $28.00 $27.30 $15.75 $14.35 $14.70 $14.00 $26.25 $22.75
WWH LAB/RAD FEE SCHEDULE - 4206 308704603 87046 PB E COLI 0157 PLATE STL 35.00 $31.50 $14.00 $28.00 $19.60 $24.50 $22.40 $28.00 $27.30 $15.75 $14.35 $14.70 $14.00 $26.25 $22.75
WWH LAB/RAD FEE SCHEDULE - 4206 308707001 87070 PB IV CATHETER CULTURE 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH LAB/RAD FEE SCHEDULE - 4206 308707005 87070 PB THROAT CULTURE 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH LAB/RAD FEE SCHEDULE - 4206 308707007 87070 PB TISSUE CULTURE 81.00 $72.90 $32.40 $64.80 $45.36 $56.70 $51.84 $64.80 $63.18 $36.45 $33.21 $34.02 $32.40 $60.75 $52.65
WWH LAB/RAD FEE SCHEDULE - 4206 308707008 87070 PB VAG CERV CULTURE 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH LAB/RAD FEE SCHEDULE - 4206 308707009 87070 PB BODY FLUID CULTURE 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH LAB/RAD FEE SCHEDULE - 4206 308707010 87070 PB SPINAL FLUID CULTURE 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH LAB/RAD FEE SCHEDULE - 4206 308707011 87070 PB SPUTUM CULTURE 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH LAB/RAD FEE SCHEDULE - 4206 308707014 87070 PB WOUND CULTURE 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH LAB/RAD FEE SCHEDULE - 4206 308707015 87070 PB MISCELLANEOUS BACTERIAL CULT 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH LAB/RAD FEE SCHEDULE - 4206 308707500 87075 PB ANAEROBIC CULTURE 94.00 $84.60 $37.60 $75.20 $52.64 $65.80 $60.16 $75.20 $73.32 $42.30 $38.54 $39.48 $37.60 $70.50 $61.10
WWH LAB/RAD FEE SCHEDULE - 4206 308707700 87077 "PB ID AEROBE, EACH" 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH LAB/RAD FEE SCHEDULE - 4206 308707702 87077TRACK "PB REFERRAL ID/SUSC, URINE" 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH LAB/RAD FEE SCHEDULE - 4206 308708100 87081 PB GENERAL LAB 8708100 28.00 $25.20 $11.20 $22.40 $15.68 $19.60 $17.92 $22.40 $21.84 $12.60 $11.48 $11.76 $11.20 $21.00 $18.20
WWH LAB/RAD FEE SCHEDULE - 4206 308708102 87081 PB METH RES STAPH CULTURE 45.00 $40.50 $18.00 $36.00 $25.20 $31.50 $28.80 $36.00 $35.10 $20.25 $18.45 $18.90 $18.00 $33.75 $29.25
WWH LAB/RAD FEE SCHEDULE - 4206 308708104 87081 PB THROAT STREP A CULT CONF 68.00 $61.20 $27.20 $54.40 $38.08 $47.60 $43.52 $54.40 $53.04 $30.60 $27.88 $28.56 $27.20 $51.00 $44.20
WWH LAB/RAD FEE SCHEDULE - 4206 308708106 87081 PB CLOTEST 45.00 $40.50 $18.00 $36.00 $25.20 $31.50 $28.80 $36.00 $35.10 $20.25 $18.45 $18.90 $18.00 $33.75 $29.25
WWH LAB/RAD FEE SCHEDULE - 4206 308708601 87086 PB URINE CULTURE 81.00 $72.90 $32.40 $64.80 $45.36 $56.70 $51.84 $64.80 $63.18 $36.45 $33.21 $34.02 $32.40 $60.75 $52.65
WWH LAB/RAD FEE SCHEDULE - 4206 308708800 87088 PB URINE PRESUMPTIVE ID 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH LAB/RAD FEE SCHEDULE - 4206 308710100 87101 "PB FUNGUS CUL-SKIN, HAIR, NAIL" 75.00 $67.50 $30.00 $60.00 $42.00 $52.50 $48.00 $60.00 $58.50 $33.75 $30.75 $31.50 $30.00 $56.25 $48.75
WWH LAB/RAD FEE SCHEDULE - 4206 308710201 87102 PB FUNGUS CULTURE 61.00 $54.90 $24.40 $48.80 $34.16 $42.70 $39.04 $48.80 $47.58 $27.45 $25.01 $25.62 $24.40 $45.75 $39.65
WWH LAB/RAD FEE SCHEDULE - 4206 308710700 87107 PB MOLD IDENT 72.00 $64.80 $28.80 $57.60 $40.32 $50.40 $46.08 $57.60 $56.16 $32.40 $29.52 $30.24 $28.80 $54.00 $46.80
WWH LAB/RAD FEE SCHEDULE - 4206 308711000 87110 PB GENERAL LAB 8711000 78.00 $70.20 $31.20 $62.40 $43.68 $54.60 $49.92 $62.40 $60.84 $35.10 $31.98 $32.76 $31.20 $58.50 $50.70
WWH LAB/RAD FEE SCHEDULE - 4206 308717200 87172 PB PINWORM PREP 43.00 $38.70 $17.20 $34.40 $24.08 $30.10 $27.52 $34.40 $33.54 $19.35 $17.63 $18.06 $17.20 $32.25 $27.95
WWH LAB/RAD FEE SCHEDULE - 4206 308717600 87176 PB TISSUE HOMOGENIZATION 49.00 $44.10 $19.60 $39.20 $27.44 $34.30 $31.36 $39.20 $38.22 $22.05 $20.09 $20.58 $19.60 $36.75 $31.85
WWH LAB/RAD FEE SCHEDULE - 4206 308717700 87177 (IA) PB O&P CONCENTRATE 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 308717701 87177 PB O&P EXAM LC 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 308718600 87186 PB MIC VITEK 93.00 $83.70 $37.20 $74.40 $52.08 $65.10 $59.52 $74.40 $72.54 $41.85 $38.13 $39.06 $37.20 $69.75 $60.45
WWH LAB/RAD FEE SCHEDULE - 4206 308720500 87205 PB GRAM STAIN 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH LAB/RAD FEE SCHEDULE - 4206 308720702 87207 PB MALARIAL/PARASITE SMEAR 49.00 $44.10 $19.60 $39.20 $27.44 $34.30 $31.36 $39.20 $38.22 $22.05 $20.09 $20.58 $19.60 $36.75 $31.85
WWH LAB/RAD FEE SCHEDULE - 4206 308720900 87209 (IA) PB O & P STAIN 73.00 $65.70 $29.20 $58.40 $40.88 $51.10 $46.72 $58.40 $56.94 $32.85 $29.93 $30.66 $29.20 $54.75 $47.45
WWH LAB/RAD FEE SCHEDULE - 4206 308720901 87209 PB O&P STAIN LC 73.00 $65.70 $29.20 $58.40 $40.88 $51.10 $46.72 $58.40 $56.94 $32.85 $29.93 $30.66 $29.20 $54.75 $47.45
WWH LAB/RAD FEE SCHEDULE - 4206 308721002 87210 PB TRICH/YEAST/CLUE 42.00 $37.80 $16.80 $33.60 $23.52 $29.40 $26.88 $33.60 $32.76 $18.90 $17.22 $17.64 $16.80 $31.50 $27.30
WWH LAB/RAD FEE SCHEDULE - 4206 308722001 87220 "PB KOH-SKIN, HAIR, NAILS" 45.00 $40.50 $18.00 $36.00 $25.20 $31.50 $28.80 $36.00 $35.10 $20.25 $18.45 $18.90 $18.00 $33.75 $29.25
WWH LAB/RAD FEE SCHEDULE - 4206 308732400 87324 PB C DIFF TOXIN 119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
WWH LAB/RAD FEE SCHEDULE - 4206 308732800 87328 (IA) PB CRYPTOSPORIDIUM TEST 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH LAB/RAD FEE SCHEDULE - 4206 308732900 87329 (IA) PB GIARDIA ANTIGEN 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH LAB/RAD FEE SCHEDULE - 4206 308733800 87338 "PB H. PYLORI ANTIGEN, STOOL" 143.00 $128.70 $57.20 $114.40 $80.08 $100.10 $91.52 $114.40 $111.54 $64.35 $58.63 $60.06 $57.20 $107.25 $92.95
WWH LAB/RAD FEE SCHEDULE - 4206 308734000 87340 PB GENERAL LAB 8734000 122.00 $109.80 $48.80 $97.60 $68.32 $85.40 $78.08 $97.60 $95.16 $54.90 $50.02 $51.24 $48.80 $91.50 $79.30
WWH LAB/RAD FEE SCHEDULE - 4206 308738900 87389 PB GENERAL LAB 8738900 162.00 $145.80 $64.80 $129.60 $90.72 $113.40 $103.68 $129.60 $126.36 $72.90 $66.42 $68.04 $64.80 $121.50 $105.30
WWH LAB/RAD FEE SCHEDULE - 4206 308742500 87425 (IA) PB ROTAVIRUS ANTIGEN STOOL 119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
WWH LAB/RAD FEE SCHEDULE - 4206 308742700 87427 PB SHIGA TOXIN 102.00 $91.80 $40.80 $81.60 $57.12 $71.40 $65.28 $81.60 $79.56 $45.90 $41.82 $42.84 $40.80 $76.50 $66.30
WWH LAB/RAD FEE SCHEDULE - 4206 308748000 87480 PB CANDIDA PROBE 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH LAB/RAD FEE SCHEDULE - 4206 308749100 87491 PB GENERAL LAB 8749100 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 308749101 87491 PB GENERAL LAB 8749101 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 308749300 87493 PB CLOSTRIDIUM DIFF TOXIN PCR 339.00 $305.10 $135.60 $271.20 $189.84 $237.30 $216.96 $271.20 $264.42 $152.55 $138.99 $142.38 $135.60 $254.25 $220.35
WWH LAB/RAD FEE SCHEDULE - 4206 308749800 87498 "(IA) PB ENTEROVIRUS BY PCR, CSF" 291.00 $261.90 $116.40 $232.80 $162.96 $203.70 $186.24 $232.80 $226.98 $130.95 $119.31 $122.22 $116.40 $218.25 $189.15
WWH LAB/RAD FEE SCHEDULE - 4206 308750200 87502 PB INFLUENZA A/B PCR 296.00 $266.40 $118.40 $236.80 $165.76 $207.20 $189.44 $236.80 $230.88 $133.20 $121.36 $124.32 $118.40 $222.00 $192.40
WWH LAB/RAD FEE SCHEDULE - 4206 308750300 87503 PB INFLUENZA DNA PROBE ADDL 77.00 $69.30 $30.80 $61.60 $43.12 $53.90 $49.28 $61.60 $60.06 $34.65 $31.57 $32.34 $30.80 $57.75 $50.05
WWH LAB/RAD FEE SCHEDULE - 4206 308750600 87506 PB STOOL PATHOGEN MULTIPLEX PANEL 750.00 $675.00 $300.00 $600.00 $420.00 $525.00 $480.00 $600.00 $585.00 $337.50 $307.50 $315.00 $300.00 $562.50 $487.50
WWH LAB/RAD FEE SCHEDULE - 4206 308751000 87510 PB GARDNERELLA PROBE 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH LAB/RAD FEE SCHEDULE - 4206 308752200 87522 PB GENERAL LAB 8752200 427.00 $384.30 $170.80 $341.60 $239.12 $298.90 $273.28 $341.60 $333.06 $192.15 $175.07 $179.34 $170.80 $320.25 $277.55
WWH LAB/RAD FEE SCHEDULE - 4206 308752902 87529 PB GENERAL LAB 8752902 LC 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH LAB/RAD FEE SCHEDULE - 4206 308759100 87591 PB GENERAL LAB 8759100 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 308759102 87591 PB GENERAL LAB 8759102 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 308762400 87624 PB GENERAL LAB 8762400 198.00 $178.20 $79.20 $158.40 $110.88 $138.60 $126.72 $158.40 $154.44 $89.10 $81.18 $83.16 $79.20 $148.50 $128.70
WWH LAB/RAD FEE SCHEDULE - 4206 308765100 87651 PB STREP A PCR 78.00 $70.20 $31.20 $62.40 $43.68 $54.60 $49.92 $62.40 $60.84 $35.10 $31.98 $32.76 $31.20 $58.50 $50.70
WWH LAB/RAD FEE SCHEDULE - 4206 308766000 87660 PB TRICHOMONAS PROBE 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH LAB/RAD FEE SCHEDULE - 4206 308766100 87661 PB GENERAL LAB 8766100 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH LAB/RAD FEE SCHEDULE - 4206 308779825 87798 (IA) PB EHRLICHIA DETECTION PCR LC 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH LAB/RAD FEE SCHEDULE - 4206 308779832 87798 "(IA) PB BABESIA MICROTI, PCR LC" 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH LAB/RAD FEE SCHEDULE - 4206 308780400 87804 PB INFLUENZA ANTIGEN A OR B IN HOUSE ONLY 95.00 $85.50 $38.00 $76.00 $53.20 $66.50 $60.80 $76.00 $74.10 $42.75 $38.95 $39.90 $38.00 $71.25 $61.75
WWH LAB/RAD FEE SCHEDULE - 4206 308780700 87807 PB RSV RAPID ANTIGEN 119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
WWH LAB/RAD FEE SCHEDULE - 4206 308788000 87880 PB RAPID STREP A THROAT-SAT 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH LAB/RAD FEE SCHEDULE - 4206 308817500 88175 PB IMAGED THIN PREP PAP DIAGNOSTIC 101.00 $90.90 $40.40 $80.80 $56.56 $70.70 $64.64 $80.80 $78.78 $45.45 $41.41 $42.42 $40.40 $75.75 $65.65
WWH LAB/RAD FEE SCHEDULE - 4206 308905100 89051 PB CELL COUNT & DIFF B.F. ST 57.00 $51.30 $22.80 $45.60 $31.92 $39.90 $36.48 $45.60 $44.46 $25.65 $23.37 $23.94 $22.80 $42.75 $37.05
WWH LAB/RAD FEE SCHEDULE - 4206 308905500 89055 PB WBC STOOL 45.00 $40.50 $18.00 $36.00 $25.20 $31.50 $28.80 $36.00 $35.10 $20.25 $18.45 $18.90 $18.00 $33.75 $29.25
WWH LAB/RAD FEE SCHEDULE - 4206 308906000 89060 PB CRYSTAL IDENTIFICATION 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH LAB/RAD FEE SCHEDULE - 4206 308919000 89190 PB EOSINOPHIL SMEAR NASAL 45.00 $40.50 $18.00 $36.00 $25.20 $31.50 $28.80 $36.00 $35.10 $20.25 $18.45 $18.90 $18.00 $33.75 $29.25
WWH LAB/RAD FEE SCHEDULE - 4206 308932101 89321 PB POST VAS CHECK IN HOUSE NC 36.00 $32.40 $14.40 $28.80 $20.16 $25.20 $23.04 $28.80 $28.08 $16.20 $14.76 $15.12 $14.40 $27.00 $23.40
WWH LAB/RAD FEE SCHEDULE - 4206 309900000 99000 PB SPECIMEN HANDLING DR OFF >LAB 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 309900100 99001 PB PROCESSING 1 39.00 $35.10 $15.60 $31.20 $21.84 $27.30 $24.96 $31.20 $30.42 $17.55 $15.99 $16.38 $15.60 $29.25 $25.35
WWH LAB/RAD FEE SCHEDULE - 4206 309900101 99001 PB PROCESSING 39.00 $35.10 $15.60 $31.20 $21.84 $27.30 $24.96 $31.20 $30.42 $17.55 $15.99 $16.38 $15.60 $29.25 $25.35
WWH LAB/RAD FEE SCHEDULE - 4206 309900102 99001 PB PROCESSING 2 39.00 $35.10 $15.60 $31.20 $21.84 $27.30 $24.96 $31.20 $30.42 $17.55 $15.99 $16.38 $15.60 $29.25 $25.35
WWH LAB/RAD FEE SCHEDULE - 4206 30G010300 G0103 PB PSA-SCREEN 67.00 $60.30 $26.80 $53.60 $37.52 $46.90 $42.88 $53.60 $52.26 $30.15 $27.47 $28.14 $26.80 $50.25 $43.55
WWH LAB/RAD FEE SCHEDULE - 4206 30G014500 G0145 PB IMAGED THIN PREP PAP SCREEN 96.00 $86.40 $38.40 $76.80 $53.76 $67.20 $61.44 $76.80 $74.88 $43.20 $39.36 $40.32 $38.40 $72.00 $62.40
WWH LAB/RAD FEE SCHEDULE - 4206 30G048098 G0480 PB THC MARIJUANA QUANT UR TCQ 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 30J279000 J2790 PB RHO D IMMUNE GLOB 179.00 $161.10 $71.60 $143.20 $100.24 $125.30 $114.56 $143.20 $139.62 $80.55 $73.39 $75.18 $71.60 $134.25 $116.35
WWH LAB/RAD FEE SCHEDULE - 4206 30Q011401 Q0114 PB FERN TESTING PROVIDER PERFORMED 21.00 $18.90 $8.40 $16.80 $11.76 $14.70 $13.44 $16.80 $16.38 $9.45 $8.61 $8.82 $8.40 $15.75 $13.65
WWH LAB/RAD FEE SCHEDULE - 4206 30U000301 U0003 (IA) PB COVID 19 HIGH THROUGHPUT MAYO 216.00 $194.40 $86.40 $172.80 $120.96 $151.20 $138.24 $172.80 $168.48 $97.20 $88.56 $90.72 $86.40 $162.00 $140.40
WWH LAB/RAD FEE SCHEDULE - 4206 30U000306 U0003 (IA) PB COVID 19 SEEGENE INHOUSE 216.00 $194.40 $86.40 $172.80 $120.96 $151.20 $138.24 $172.80 $168.48 $97.20 $88.56 $90.72 $86.40 $162.00 $140.40
WWH LAB/RAD FEE SCHEDULE - 4206 512693 A9502 NM DOSE TETROFOSMIN OR MYOVIEW 178.00 $160.20 $71.20 $142.40 $99.68 $124.60 $113.92 $142.40 $138.84 $80.10 $72.98 $74.76 $71.20 $133.50 $115.70
WWH LAB/RAD FEE SCHEDULE - 4206 512694 A9503 NM DOSE TECH 99M MDP UP TO 30 MCI 283.00 $254.70 $113.20 $226.40 $158.48 $198.10 $181.12 $226.40 $220.74 $127.35 $116.03 $118.86 $113.20 $212.25 $183.95
WWH LAB/RAD FEE SCHEDULE - 4206 512697 A9510 NM DOSE TECH 99M HEPATOLITE/DISOFENIN 15 MCI 117.00 $105.30 $46.80 $93.60 $65.52 $81.90 $74.88 $93.60 $91.26 $52.65 $47.97 $49.14 $46.80 $87.75 $76.05
WWH LAB/RAD FEE SCHEDULE - 4206 512698 A9512 NM DOSE TECH 99M PERTECHNETATE PER MCI 241.00 $216.90 $96.40 $192.80 $134.96 $168.70 $154.24 $192.80 $187.98 $108.45 $98.81 $101.22 $96.40 $180.75 $156.65
WWH LAB/RAD FEE SCHEDULE - 4206 512701 A9516 NM DOSE I 123 DIAG CAP PER 100 UCI UP TO 999 UCI 352.00 $316.80 $140.80 $281.60 $197.12 $246.40 $225.28 $281.60 $274.56 $158.40 $144.32 $147.84 $140.80 $264.00 $228.80
WWH LAB/RAD FEE SCHEDULE - 4206 514708 A9537 NM DOSE TECH 99M MEBROFENIN 15MCI 244.00 $219.60 $97.60 $195.20 $136.64 $170.80 $156.16 $195.20 $190.32 $109.80 $100.04 $102.48 $97.60 $183.00 $158.60
WWH LAB/RAD FEE SCHEDULE - 4206 514709 A9537 NM DOSE TECH CHOLETEC 15MCI 244.00 $219.60 $97.60 $195.20 $136.64 $170.80 $156.16 $195.20 $190.32 $109.80 $100.04 $102.48 $97.60 $183.00 $158.60
WWH LAB/RAD FEE SCHEDULE - 4206 514711 A9539 NM DOSE TECH 99M DTPA 25MCI 112.00 $100.80 $44.80 $89.60 $62.72 $78.40 $71.68 $89.60 $87.36 $50.40 $45.92 $47.04 $44.80 $84.00 $72.80
WWH LAB/RAD FEE SCHEDULE - 4206 514713 A9540 NM DOSE TECH 99M MAA 10MCI 525.00 $472.50 $210.00 $420.00 $294.00 $367.50 $336.00 $420.00 $409.50 $236.25 $215.25 $220.50 $210.00 $393.75 $341.25
WWH LAB/RAD FEE SCHEDULE - 4206 514714 A9541 NM DOSE TECH 99M SULFUR COLLOID 20MCI 751.00 $675.90 $300.40 $600.80 $420.56 $525.70 $480.64 $600.80 $585.78 $337.95 $307.91 $315.42 $300.40 $563.25 $488.15
WWH LAB/RAD FEE SCHEDULE - 4206 514721 A9552 NM DOSE FDG 45MCI 378.00 $340.20 $151.20 $302.40 $211.68 $264.60 $241.92 $302.40 $294.84 $170.10 $154.98 $158.76 $151.20 $283.50 $245.70
WWH LAB/RAD FEE SCHEDULE - 4206 514725 A9560 NM DOSE TECH 99M RBC 30MCI 589.00 $530.10 $235.60 $471.20 $329.84 $412.30 $376.96 $471.20 $459.42 $265.05 $241.49 $247.38 $235.60 $441.75 $382.85
WWH LAB/RAD FEE SCHEDULE - 4206 514726 A9561 NM DOSE TECH 99M HDP 30MCI 246.00 $221.40 $98.40 $196.80 $137.76 $172.20 $157.44 $196.80 $191.88 $110.70 $100.86 $103.32 $98.40 $184.50 $159.90
WWH LAB/RAD FEE SCHEDULE - 4206 514729 A9562 NM DOSE TECH 99M MAG 3 15MCI 606.00 $545.40 $242.40 $484.80 $339.36 $424.20 $387.84 $484.80 $472.68 $272.70 $248.46 $254.52 $242.40 $454.50 $393.90
WWH LAB/RAD FEE SCHEDULE - 4206 514763 Q9957 HCHG DEFINITY PER ML 128.00 $115.20 $51.20 $102.40 $71.68 $89.60 $81.92 $102.40 $99.84 $57.60 $52.48 $53.76 $51.20 $96.00 $83.20
WWH LAB/RAD FEE SCHEDULE - 4206 514841 A9500 NM DOSE CARDIOLITE PER STUDY DOSE 502.00 $451.80 $200.80 $401.60 $281.12 $351.40 $321.28 $401.60 $391.56 $225.90 $205.82 $210.84 $200.80 $376.50 $326.30
WWH LAB/RAD FEE SCHEDULE - 4206 514857 A9541 NM DOSE TECH 99M FILTERED SULFUR COLLOID 20MCI 751.00 $675.90 $300.40 $600.80 $420.56 $525.70 $480.64 $600.80 $585.78 $337.95 $307.91 $315.42 $300.40 $563.25 $488.15
WWH LAB/RAD FEE SCHEDULE - 4206 514859 A9569 NM DOSE TECH 99M CERETEC LABEL WBC "4,057.00" " $3,651.30 " " $1,622.80 " " $3,245.60 " " $2,271.92 " " $2,839.90 " " $2,596.48 " " $3,245.60 " " $3,164.46 " " $1,825.65 " " $1,663.37 " " $1,703.94 " " $1,622.80 " " $3,042.75 " " $2,637.05 "
WWH LAB/RAD FEE SCHEDULE - 4206 517065 A9500 NM DOSE SESTAMIBI PER STUDY DOSE 502.00 $451.80 $200.80 $401.60 $281.12 $351.40 $321.28 $401.60 $391.56 $225.90 $205.82 $210.84 $200.80 $376.50 $326.30
WWH LAB/RAD FEE SCHEDULE - 4206 522506 A9567 NM DOSE TECH 99M PENTETATE DX AROSL TO 75 MCI 603.00 $542.70 $241.20 $482.40 $337.68 $422.10 $385.92 $482.40 $470.34 $271.35 $247.23 $253.26 $241.20 $452.25 $391.95
WWH LAB/RAD FEE SCHEDULE - 4206 58340.0 58340 (IA) PR CATH/INJ HYSTEROSALPINGOGRAM 595.00 $535.50 $238.00 $476.00 $333.20 $416.50 $380.80 $476.00 $464.10 $267.75 $243.95 $249.90 $238.00 $446.25 $386.75
WWH LAB/RAD FEE SCHEDULE - 4206 707003000 70030 (IA) RAD XR EYE DETECTION OF FOREIGN BODY 284.00 $255.60 $113.60 $227.20 $159.04 $198.80 $181.76 $227.20 $221.52 $127.80 $116.44 $119.28 $113.60 $213.00 $184.60
WWH LAB/RAD FEE SCHEDULE - 4206 707010000 70100 (IA) RAD XR MANDIBLE THREE VIEWS OR LESS 121.00 $108.90 $48.40 $96.80 $67.76 $84.70 $77.44 $96.80 $94.38 $54.45 $49.61 $50.82 $48.40 $90.75 $78.65
WWH LAB/RAD FEE SCHEDULE - 4206 707011000 70110 (IA) RAD XR MANDIBLE MINIMUM OF FOUR VIEWS 201.00 $180.90 $80.40 $160.80 $112.56 $140.70 $128.64 $160.80 $156.78 $90.45 $82.41 $84.42 $80.40 $150.75 $130.65
WWH LAB/RAD FEE SCHEDULE - 4206 707013000 70130 (IA) RAD XR MASTOIDS MINIMUM OF THREE VIEWS 130.00 $117.00 $52.00 $104.00 $72.80 $91.00 $83.20 $104.00 $101.40 $58.50 $53.30 $54.60 $52.00 $97.50 $84.50
WWH LAB/RAD FEE SCHEDULE - 4206 707014000 70140 (IA) RAD XR FACIAL BONES TWO VIEWS OR LESS 206.00 $185.40 $82.40 $164.80 $115.36 $144.20 $131.84 $164.80 $160.68 $92.70 $84.46 $86.52 $82.40 $154.50 $133.90
WWH LAB/RAD FEE SCHEDULE - 4206 707015000 70150 (IA) RAD XR FACIAL BONES COMPLETE MINIMUM OF THREE VIEWS 308.00 $277.20 $123.20 $246.40 $172.48 $215.60 $197.12 $246.40 $240.24 $138.60 $126.28 $129.36 $123.20 $231.00 $200.20
WWH LAB/RAD FEE SCHEDULE - 4206 707016000 70160 (IA) RAD XR NASAL BONES COMPLETE MINIMUM OF THREE VIEWS 174.00 $156.60 $69.60 $139.20 $97.44 $121.80 $111.36 $139.20 $135.72 $78.30 $71.34 $73.08 $69.60 $130.50 $113.10
WWH LAB/RAD FEE SCHEDULE - 4206 707020000 70200 (IA) RAD XR ORBITS MINIMUM OF FOUR VIEWS 186.00 $167.40 $74.40 $148.80 $104.16 $130.20 $119.04 $148.80 $145.08 $83.70 $76.26 $78.12 $74.40 $139.50 $120.90
WWH LAB/RAD FEE SCHEDULE - 4206 707020052 70200 (IA) RAD XR ORBITS MINIMUM OF FOUR VIEWS LTD 340.00 $306.00 $136.00 $272.00 $190.40 $238.00 $217.60 $272.00 $265.20 $153.00 $139.40 $142.80 $136.00 $255.00 $221.00
WWH LAB/RAD FEE SCHEDULE - 4206 707021000 70210 (IA) RAD XR SINUSES TWO VIEWS OR LESS 125.00 $112.50 $50.00 $100.00 $70.00 $87.50 $80.00 $100.00 $97.50 $56.25 $51.25 $52.50 $50.00 $93.75 $81.25
WWH LAB/RAD FEE SCHEDULE - 4206 707022000 70220 (IA) RAD XR SINUSES COMPLETE MINIMUM OF THREE VIEWS 211.00 $189.90 $84.40 $168.80 $118.16 $147.70 $135.04 $168.80 $164.58 $94.95 $86.51 $88.62 $84.40 $158.25 $137.15
WWH LAB/RAD FEE SCHEDULE - 4206 707025000 70250 (IA) RAD XR SKULL THREE VIEWS OR LESS 276.00 $248.40 $110.40 $220.80 $154.56 $193.20 $176.64 $220.80 $215.28 $124.20 $113.16 $115.92 $110.40 $207.00 $179.40
WWH LAB/RAD FEE SCHEDULE - 4206 707025010 70250 (IA) RAD XR SKULL THREE VIEWS OR LESS PORTABLE 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH LAB/RAD FEE SCHEDULE - 4206 707026000 70260 (IA) RAD XR SKULL COMPLETE MINIMUM OF FOUR VIEWS 382.00 $343.80 $152.80 $305.60 $213.92 $267.40 $244.48 $305.60 $297.96 $171.90 $156.62 $160.44 $152.80 $286.50 $248.30
WWH LAB/RAD FEE SCHEDULE - 4206 707032800 70328 (IA) RAD XR TEMPROMANDIBULAR JOINTS UNILATERAL 105.00 $94.50 $42.00 $84.00 $58.80 $73.50 $67.20 $84.00 $81.90 $47.25 $43.05 $44.10 $42.00 $78.75 $68.25
WWH LAB/RAD FEE SCHEDULE - 4206 707033000 70330 (IA) RAD XR TEMPROMANDIBULAR JOINTS BILATERAL 219.00 $197.10 $87.60 $175.20 $122.64 $153.30 $140.16 $175.20 $170.82 $98.55 $89.79 $91.98 $87.60 $164.25 $142.35
WWH LAB/RAD FEE SCHEDULE - 4206 707033600 70336 (IA) RAD MR TEMPOROMANDIBULAR JOINT "3,345.00" " $3,010.50 " " $1,338.00 " " $2,676.00 " " $1,873.20 " " $2,341.50 " " $2,140.80 " " $2,676.00 " " $2,609.10 " " $1,505.25 " " $1,371.45 " " $1,404.90 " " $1,338.00 " " $2,508.75 " " $2,174.25 "
WWH LAB/RAD FEE SCHEDULE - 4206 707036000 70360 (IA) RAD XR NECK SOFT TISSUE 164.00 $147.60 $65.60 $131.20 $91.84 $114.80 $104.96 $131.20 $127.92 $73.80 $67.24 $68.88 $65.60 $123.00 $106.60
WWH LAB/RAD FEE SCHEDULE - 4206 707036010 70360 (IA) RAD XR NECK SOFT TISSUE PORTABLE 182.00 $163.80 $72.80 $145.60 $101.92 $127.40 $116.48 $145.60 $141.96 $81.90 $74.62 $76.44 $72.80 $136.50 $118.30
WWH LAB/RAD FEE SCHEDULE - 4206 707039005 70390 (IA) RAD XR SIALOGRAM 468.00 $421.20 $187.20 $374.40 $262.08 $327.60 $299.52 $374.40 $365.04 $210.60 $191.88 $196.56 $187.20 $351.00 $304.20
WWH LAB/RAD FEE SCHEDULE - 4206 707045000 70450 (IA) RAD CT HEAD BRAIN WO "1,991.00" " $1,791.90 " $796.40 " $1,592.80 " " $1,114.96 " " $1,393.70 " " $1,274.24 " " $1,592.80 " " $1,552.98 " $895.95 $816.31 $836.22 $796.40 " $1,493.25 " " $1,294.15 "
WWH LAB/RAD FEE SCHEDULE - 4206 707046000 70460 (IA) RAD CT HEAD BRAIN W "1,254.00" " $1,128.60 " $501.60 " $1,003.20 " $702.24 $877.80 $802.56 " $1,003.20 " $978.12 $564.30 $514.14 $526.68 $501.60 $940.50 $815.10
WWH LAB/RAD FEE SCHEDULE - 4206 707047000 70470 (IA) RAD CT HEAD BRAIN WWO "1,627.00" " $1,464.30 " $650.80 " $1,301.60 " $911.12 " $1,138.90 " " $1,041.28 " " $1,301.60 " " $1,269.06 " $732.15 $667.07 $683.34 $650.80 " $1,220.25 " " $1,057.55 "
WWH LAB/RAD FEE SCHEDULE - 4206 707048000 70480 (IA) RAD CT ORBITS OR TEMPORAL BONES WO "1,383.00" " $1,244.70 " $553.20 " $1,106.40 " $774.48 $968.10 $885.12 " $1,106.40 " " $1,078.74 " $622.35 $567.03 $580.86 $553.20 " $1,037.25 " $898.95
WWH LAB/RAD FEE SCHEDULE - 4206 707048100 70481 (IA) RAD CT ORBITS OR TEMPORAL BONES W "1,627.00" " $1,464.30 " $650.80 " $1,301.60 " $911.12 " $1,138.90 " " $1,041.28 " " $1,301.60 " " $1,269.06 " $732.15 $667.07 $683.34 $650.80 " $1,220.25 " " $1,057.55 "
WWH LAB/RAD FEE SCHEDULE - 4206 707048200 70482 (IA) RAD CT ORBITS OR TEMPORAL BONES WWO "1,489.00" " $1,340.10 " $595.60 " $1,191.20 " $833.84 " $1,042.30 " $952.96 " $1,191.20 " " $1,161.42 " $670.05 $610.49 $625.38 $595.60 " $1,116.75 " $967.85
WWH LAB/RAD FEE SCHEDULE - 4206 707048600 70486 (IA) RAD CT FACIAL BONES AND SINUS WO 974.00 $876.60 $389.60 $779.20 $545.44 $681.80 $623.36 $779.20 $759.72 $438.30 $399.34 $409.08 $389.60 $730.50 $633.10
WWH LAB/RAD FEE SCHEDULE - 4206 707048700 70487 (IA) RAD CT FACIAL BONES AND SINUS W "1,627.00" " $1,464.30 " $650.80 " $1,301.60 " $911.12 " $1,138.90 " " $1,041.28 " " $1,301.60 " " $1,269.06 " $732.15 $667.07 $683.34 $650.80 " $1,220.25 " " $1,057.55 "
WWH LAB/RAD FEE SCHEDULE - 4206 707048800 70488 (IA) RAD CT FACIAL BONES AND SINUS WWO "1,371.00" " $1,233.90 " $548.40 " $1,096.80 " $767.76 $959.70 $877.44 " $1,096.80 " " $1,069.38 " $616.95 $562.11 $575.82 $548.40 " $1,028.25 " $891.15
WWH LAB/RAD FEE SCHEDULE - 4206 707049000 70490 (IA) RAD CT NECK SOFT TISSUE WO "1,771.00" " $1,593.90 " $708.40 " $1,416.80 " $991.76 " $1,239.70 " " $1,133.44 " " $1,416.80 " " $1,381.38 " $796.95 $726.11 $743.82 $708.40 " $1,328.25 " " $1,151.15 "
WWH LAB/RAD FEE SCHEDULE - 4206 707049100 70491 (IA) RAD CT NECK SOFT TISSUE W "2,730.00" " $2,457.00 " " $1,092.00 " " $2,184.00 " " $1,528.80 " " $1,911.00 " " $1,747.20 " " $2,184.00 " " $2,129.40 " " $1,228.50 " " $1,119.30 " " $1,146.60 " " $1,092.00 " " $2,047.50 " " $1,774.50 "
WWH LAB/RAD FEE SCHEDULE - 4206 707049200 70492 (IA) RAD CT NECK SOFT TISSUE WWO "1,452.00" " $1,306.80 " $580.80 " $1,161.60 " $813.12 " $1,016.40 " $929.28 " $1,161.60 " " $1,132.56 " $653.40 $595.32 $609.84 $580.80 " $1,089.00 " $943.80
WWH LAB/RAD FEE SCHEDULE - 4206 707049600 70496 (IA) RAD CT ANGIO HEAD "3,408.00" " $3,067.20 " " $1,363.20 " " $2,726.40 " " $1,908.48 " " $2,385.60 " " $2,181.12 " " $2,726.40 " " $2,658.24 " " $1,533.60 " " $1,397.28 " " $1,431.36 " " $1,363.20 " " $2,556.00 " " $2,215.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 707049800 70498 (IA) RAD CT ANGIO NECK "3,516.00" " $3,164.40 " " $1,406.40 " " $2,812.80 " " $1,968.96 " " $2,461.20 " " $2,250.24 " " $2,812.80 " " $2,742.48 " " $1,582.20 " " $1,441.56 " " $1,476.72 " " $1,406.40 " " $2,637.00 " " $2,285.40 "
WWH LAB/RAD FEE SCHEDULE - 4206 707054000 70540 (IA) RAD MR NECK SOFT TISSUE ORBIT FACE WO "2,759.00" " $2,483.10 " " $1,103.60 " " $2,207.20 " " $1,545.04 " " $1,931.30 " " $1,765.76 " " $2,207.20 " " $2,152.02 " " $1,241.55 " " $1,131.19 " " $1,158.78 " " $1,103.60 " " $2,069.25 " " $1,793.35 "
WWH LAB/RAD FEE SCHEDULE - 4206 707054200 70542 (IA) RAD MR NECK SOFT TISSUE ORBIT FACE W "4,043.00" " $3,638.70 " " $1,617.20 " " $3,234.40 " " $2,264.08 " " $2,830.10 " " $2,587.52 " " $3,234.40 " " $3,153.54 " " $1,819.35 " " $1,657.63 " " $1,698.06 " " $1,617.20 " " $3,032.25 " " $2,627.95 "
WWH LAB/RAD FEE SCHEDULE - 4206 707054300 70543 (IA) RAD MR NECK SOFT TISSUE ORBIT FACE WWO "5,088.00" " $4,579.20 " " $2,035.20 " " $4,070.40 " " $2,849.28 " " $3,561.60 " " $3,256.32 " " $4,070.40 " " $3,968.64 " " $2,289.60 " " $2,086.08 " " $2,136.96 " " $2,035.20 " " $3,816.00 " " $3,307.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 707054400 70544 (IA) RAD MR ANGIO HEAD WO "3,688.00" " $3,319.20 " " $1,475.20 " " $2,950.40 " " $2,065.28 " " $2,581.60 " " $2,360.32 " " $2,950.40 " " $2,876.64 " " $1,659.60 " " $1,512.08 " " $1,548.96 " " $1,475.20 " " $2,766.00 " " $2,397.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 707054500 70545 (IA) RAD MR ANGIO HEAD W "2,188.00" " $1,969.20 " $875.20 " $1,750.40 " " $1,225.28 " " $1,531.60 " " $1,400.32 " " $1,750.40 " " $1,706.64 " $984.60 $897.08 $918.96 $875.20 " $1,641.00 " " $1,422.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 707054600 70546 (IA) RAD MR ANGIO HEAD BRAIN WWO "6,160.00" " $5,544.00 " " $2,464.00 " " $4,928.00 " " $3,449.60 " " $4,312.00 " " $3,942.40 " " $4,928.00 " " $4,804.80 " " $2,772.00 " " $2,525.60 " " $2,587.20 " " $2,464.00 " " $4,620.00 " " $4,004.00 "
WWH LAB/RAD FEE SCHEDULE - 4206 707054700 70547 (IA) RAD MR ANGIO NECK WO "3,309.00" " $2,978.10 " " $1,323.60 " " $2,647.20 " " $1,853.04 " " $2,316.30 " " $2,117.76 " " $2,647.20 " " $2,581.02 " " $1,489.05 " " $1,356.69 " " $1,389.78 " " $1,323.60 " " $2,481.75 " " $2,150.85 "
WWH LAB/RAD FEE SCHEDULE - 4206 707054800 70548 (IA) RAD MR ANGIO NECK W "2,061.00" " $1,854.90 " $824.40 " $1,648.80 " " $1,154.16 " " $1,442.70 " " $1,319.04 " " $1,648.80 " " $1,607.58 " $927.45 $845.01 $865.62 $824.40 " $1,545.75 " " $1,339.65 "
WWH LAB/RAD FEE SCHEDULE - 4206 707054900 70549 (IA) RAD MR ANGIO NECK WWO "5,832.00" " $5,248.80 " " $2,332.80 " " $4,665.60 " " $3,265.92 " " $4,082.40 " " $3,732.48 " " $4,665.60 " " $4,548.96 " " $2,624.40 " " $2,391.12 " " $2,449.44 " " $2,332.80 " " $4,374.00 " " $3,790.80 "
WWH LAB/RAD FEE SCHEDULE - 4206 707055150 70551 (IA) RAD MR HEAD BRAIN WO "2,922.00" " $2,629.80 " " $1,168.80 " " $2,337.60 " " $1,636.32 " " $2,045.40 " " $1,870.08 " " $2,337.60 " " $2,279.16 " " $1,314.90 " " $1,198.02 " " $1,227.24 " " $1,168.80 " " $2,191.50 " " $1,899.30 "
WWH LAB/RAD FEE SCHEDULE - 4206 707055152 70551 (IA) RAD MR HEAD BRAIN WO LTD "1,849.00" " $1,664.10 " $739.60 " $1,479.20 " " $1,035.44 " " $1,294.30 " " $1,183.36 " " $1,479.20 " " $1,442.22 " $832.05 $758.09 $776.58 $739.60 " $1,386.75 " " $1,201.85 "
WWH LAB/RAD FEE SCHEDULE - 4206 707055200 70552 (IA) RAD MR HEAD BRAIN W "4,237.00" " $3,813.30 " " $1,694.80 " " $3,389.60 " " $2,372.72 " " $2,965.90 " " $2,711.68 " " $3,389.60 " " $3,304.86 " " $1,906.65 " " $1,737.17 " " $1,779.54 " " $1,694.80 " " $3,177.75 " " $2,754.05 "
WWH LAB/RAD FEE SCHEDULE - 4206 707055252 70552 (IA) RAD MR HEAD BRAIN W LTD "4,237.00" " $3,813.30 " " $1,694.80 " " $3,389.60 " " $2,372.72 " " $2,965.90 " " $2,711.68 " " $3,389.60 " " $3,304.86 " " $1,906.65 " " $1,737.17 " " $1,779.54 " " $1,694.80 " " $3,177.75 " " $2,754.05 "
WWH LAB/RAD FEE SCHEDULE - 4206 707055300 70553 (IA) RAD MR HEAD BRAIN WWO "4,860.00" " $4,374.00 " " $1,944.00 " " $3,888.00 " " $2,721.60 " " $3,402.00 " " $3,110.40 " " $3,888.00 " " $3,790.80 " " $2,187.00 " " $1,992.60 " " $2,041.20 " " $1,944.00 " " $3,645.00 " " $3,159.00 "
WWH LAB/RAD FEE SCHEDULE - 4206 707104500 71045 (IA) RAD XR CHEST FRONTAL 1 VIEW 200.00 $180.00 $80.00 $160.00 $112.00 $140.00 $128.00 $160.00 $156.00 $90.00 $82.00 $84.00 $80.00 $150.00 $130.00
WWH LAB/RAD FEE SCHEDULE - 4206 707104510 71045 (IA) RAD XR CHEST FRONTAL 1 VIEW PORTABLE 200.00 $180.00 $80.00 $160.00 $112.00 $140.00 $128.00 $160.00 $156.00 $90.00 $82.00 $84.00 $80.00 $150.00 $130.00
WWH LAB/RAD FEE SCHEDULE - 4206 707104600 71046 (IA) RAD XR CHEST 2 VIEWS PA AND LATERAL 286.00 $257.40 $114.40 $228.80 $160.16 $200.20 $183.04 $228.80 $223.08 $128.70 $117.26 $120.12 $114.40 $214.50 $185.90
WWH LAB/RAD FEE SCHEDULE - 4206 707104610 71046 (IA) RAD XR CHEST 2 VIEWS PA AND LAT PORTABLE 264.00 $237.60 $105.60 $211.20 $147.84 $184.80 $168.96 $211.20 $205.92 $118.80 $108.24 $110.88 $105.60 $198.00 $171.60
WWH LAB/RAD FEE SCHEDULE - 4206 707104700 71047 (IA) RAD XR CHEST 2 VIEWS APICAL LORDOTIC 298.00 $268.20 $119.20 $238.40 $166.88 $208.60 $190.72 $238.40 $232.44 $134.10 $122.18 $125.16 $119.20 $223.50 $193.70
WWH LAB/RAD FEE SCHEDULE - 4206 707104800 71048 (IA) RAD XR CHEST 4 VIEWS OR MORE 308.00 $277.20 $123.20 $246.40 $172.48 $215.60 $197.12 $246.40 $240.24 $138.60 $126.28 $129.36 $123.20 $231.00 $200.20
WWH LAB/RAD FEE SCHEDULE - 4206 707110000 71100 (IA) RAD XR RIBS 2 VIEWS UNILATERAL 273.00 $245.70 $109.20 $218.40 $152.88 $191.10 $174.72 $218.40 $212.94 $122.85 $111.93 $114.66 $109.20 $204.75 $177.45
WWH LAB/RAD FEE SCHEDULE - 4206 707110100 71101 (IA) RAD XR RIBS UNI INCLUDING PA CHEST MINIMUM OF 3 VIEWS 319.00 $287.10 $127.60 $255.20 $178.64 $223.30 $204.16 $255.20 $248.82 $143.55 $130.79 $133.98 $127.60 $239.25 $207.35
WWH LAB/RAD FEE SCHEDULE - 4206 707111000 71110 (IA) RAD XR RIBS 3 VIEWS BILATERAL 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 707111100 71111 (IA) RAD XR RIBS BILATERAL AND CHEST MINIMUM 4 VIEWS 386.00 $347.40 $154.40 $308.80 $216.16 $270.20 $247.04 $308.80 $301.08 $173.70 $158.26 $162.12 $154.40 $289.50 $250.90
WWH LAB/RAD FEE SCHEDULE - 4206 707112000 71120 (IA) RAD XR STERNUM MINIMUM 2 VIEWS 174.00 $156.60 $69.60 $139.20 $97.44 $121.80 $111.36 $139.20 $135.72 $78.30 $71.34 $73.08 $69.60 $130.50 $113.10
WWH LAB/RAD FEE SCHEDULE - 4206 707113000 71130 (IA) RAD XR STERNOCLAVICULAR JOINT(S) MIN 3 VIEWS 224.00 $201.60 $89.60 $179.20 $125.44 $156.80 $143.36 $179.20 $174.72 $100.80 $91.84 $94.08 $89.60 $168.00 $145.60
WWH LAB/RAD FEE SCHEDULE - 4206 707125000 71250 (IA) RAD CT CHEST WO CONTRAST DIAGNOSTIC "2,828.00" " $2,545.20 " " $1,131.20 " " $2,262.40 " " $1,583.68 " " $1,979.60 " " $1,809.92 " " $2,262.40 " " $2,205.84 " " $1,272.60 " " $1,159.48 " " $1,187.76 " " $1,131.20 " " $2,121.00 " " $1,838.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 707125001 71250 (IA) RAD CT CHEST WO CONTRAST ADD ON DIAGNOSTIC "2,828.00" " $2,545.20 " " $1,131.20 " " $2,262.40 " " $1,583.68 " " $1,979.60 " " $1,809.92 " " $2,262.40 " " $2,205.84 " " $1,272.60 " " $1,159.48 " " $1,187.76 " " $1,131.20 " " $2,121.00 " " $1,838.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 707125002 71250 (IA) RAD CT CHEST WO CONTRAST LOW DOSE DIAGNOSTIC "2,828.00" " $2,545.20 " " $1,131.20 " " $2,262.40 " " $1,583.68 " " $1,979.60 " " $1,809.92 " " $2,262.40 " " $2,205.84 " " $1,272.60 " " $1,159.48 " " $1,187.76 " " $1,131.20 " " $2,121.00 " " $1,838.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 707126000 71260 (IA) RAD CT CHEST W CONTRAST DIAGNOSTIC "2,951.00" " $2,655.90 " " $1,180.40 " " $2,360.80 " " $1,652.56 " " $2,065.70 " " $1,888.64 " " $2,360.80 " " $2,301.78 " " $1,327.95 " " $1,209.91 " " $1,239.42 " " $1,180.40 " " $2,213.25 " " $1,918.15 "
WWH LAB/RAD FEE SCHEDULE - 4206 707126001 71260 (IA) RAD CT CHEST W CONTRAST ADD ON DIAGNOSTIC "2,951.00" " $2,655.90 " " $1,180.40 " " $2,360.80 " " $1,652.56 " " $2,065.70 " " $1,888.64 " " $2,360.80 " " $2,301.78 " " $1,327.95 " " $1,209.91 " " $1,239.42 " " $1,180.40 " " $2,213.25 " " $1,918.15 "
WWH LAB/RAD FEE SCHEDULE - 4206 707127000 71270 (IA) RAD CT CHEST WWO CONTRAST DIAGNOSTIC "1,947.00" " $1,752.30 " $778.80 " $1,557.60 " " $1,090.32 " " $1,362.90 " " $1,246.08 " " $1,557.60 " " $1,518.66 " $876.15 $798.27 $817.74 $778.80 " $1,460.25 " " $1,265.55 "
WWH LAB/RAD FEE SCHEDULE - 4206 707127001 71270 (IA) RAD CT CHEST WWO CONTRAST ADD ON DIAGNOSTIC "2,791.00" " $2,511.90 " " $1,116.40 " " $2,232.80 " " $1,562.96 " " $1,953.70 " " $1,786.24 " " $2,232.80 " " $2,176.98 " " $1,255.95 " " $1,144.31 " " $1,172.22 " " $1,116.40 " " $2,093.25 " " $1,814.15 "
WWH LAB/RAD FEE SCHEDULE - 4206 707127100 71271 (IA) RAD CT THORAX LOW DOSE LUNG CANCER SCREEN 241.00 $216.90 $96.40 $192.80 $134.96 $168.70 $154.24 $192.80 $187.98 $108.45 $98.81 $101.22 $96.40 $180.75 $156.65
WWH LAB/RAD FEE SCHEDULE - 4206 707127500 71275 (IA) RAD CT ANGIO CHEST "3,299.00" " $2,969.10 " " $1,319.60 " " $2,639.20 " " $1,847.44 " " $2,309.30 " " $2,111.36 " " $2,639.20 " " $2,573.22 " " $1,484.55 " " $1,352.59 " " $1,385.58 " " $1,319.60 " " $2,474.25 " " $2,144.35 "
WWH LAB/RAD FEE SCHEDULE - 4206 707155000 71550 (IA) RAD MR CHEST WO "2,048.00" " $1,843.20 " $819.20 " $1,638.40 " " $1,146.88 " " $1,433.60 " " $1,310.72 " " $1,638.40 " " $1,597.44 " $921.60 $839.68 $860.16 $819.20 " $1,536.00 " " $1,331.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 707155100 71551 (IA) RAD MR CHEST W "1,997.00" " $1,797.30 " $798.80 " $1,597.60 " " $1,118.32 " " $1,397.90 " " $1,278.08 " " $1,597.60 " " $1,557.66 " $898.65 $818.77 $838.74 $798.80 " $1,497.75 " " $1,298.05 "
WWH LAB/RAD FEE SCHEDULE - 4206 707155200 71552 (IA) RAD MR CHEST WWO "5,954.00" " $5,358.60 " " $2,381.60 " " $4,763.20 " " $3,334.24 " " $4,167.80 " " $3,810.56 " " $4,763.20 " " $4,644.12 " " $2,679.30 " " $2,441.14 " " $2,500.68 " " $2,381.60 " " $4,465.50 " " $3,870.10 "
WWH LAB/RAD FEE SCHEDULE - 4206 707202000 72020 (IA) RAD XR SPINE 1 VIEW 83.00 $74.70 $33.20 $66.40 $46.48 $58.10 $53.12 $66.40 $64.74 $37.35 $34.03 $34.86 $33.20 $62.25 $53.95
WWH LAB/RAD FEE SCHEDULE - 4206 707202010 72020 (IA) RAD XR SPINE 1 VIEW PORTABLE 61.00 $54.90 $24.40 $48.80 $34.16 $42.70 $39.04 $48.80 $47.58 $27.45 $25.01 $25.62 $24.40 $45.75 $39.65
WWH LAB/RAD FEE SCHEDULE - 4206 707204000 72040 (IA) RAD XR SPINE CERVICAL 2 OR 3 VIEWS 184.00 $165.60 $73.60 $147.20 $103.04 $128.80 $117.76 $147.20 $143.52 $82.80 $75.44 $77.28 $73.60 $138.00 $119.60
WWH LAB/RAD FEE SCHEDULE - 4206 707204010 72040 (IA) RAD XR SPINE CERVICAL 2 OR 3 VIEWS PORTABLE 138.00 $124.20 $55.20 $110.40 $77.28 $96.60 $88.32 $110.40 $107.64 $62.10 $56.58 $57.96 $55.20 $103.50 $89.70
WWH LAB/RAD FEE SCHEDULE - 4206 707205000 72050 (IA) RAD XR SPINE CERVICAL FOUR OR FIVE VIEWS 261.00 $234.90 $104.40 $208.80 $146.16 $182.70 $167.04 $208.80 $203.58 $117.45 $107.01 $109.62 $104.40 $195.75 $169.65
WWH LAB/RAD FEE SCHEDULE - 4206 707205200 72052 (IA) RAD XR CERVICAL SPINE SIX OR MORE VIEWS 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH LAB/RAD FEE SCHEDULE - 4206 707207000 72070 (IA) RAD XR SPINE THORACIC 2 VIEWS 141.00 $126.90 $56.40 $112.80 $78.96 $98.70 $90.24 $112.80 $109.98 $63.45 $57.81 $59.22 $56.40 $105.75 $91.65
WWH LAB/RAD FEE SCHEDULE - 4206 707207010 72070 (IA) RAD XR SPINE THORACIC 2 VIEWS PORTABLE 138.00 $124.20 $55.20 $110.40 $77.28 $96.60 $88.32 $110.40 $107.64 $62.10 $56.58 $57.96 $55.20 $103.50 $89.70
WWH LAB/RAD FEE SCHEDULE - 4206 707207200 72072 (IA) RAD XR SPINE THORACIC 3 VIEWS 314.00 $282.60 $125.60 $251.20 $175.84 $219.80 $200.96 $251.20 $244.92 $141.30 $128.74 $131.88 $125.60 $235.50 $204.10
WWH LAB/RAD FEE SCHEDULE - 4206 707207400 72074 (IA) RAD XR SPINE THORACIC MINIMUM 4 VIEWS 197.00 $177.30 $78.80 $157.60 $110.32 $137.90 $126.08 $157.60 $153.66 $88.65 $80.77 $82.74 $78.80 $147.75 $128.05
WWH LAB/RAD FEE SCHEDULE - 4206 707208000 72080 (IA) RAD XR SPINE THORACOLUMBAR JUNCTION MINIMUM OF 2 VIEWS 308.00 $277.20 $123.20 $246.40 $172.48 $215.60 $197.12 $246.40 $240.24 $138.60 $126.28 $129.36 $123.20 $231.00 $200.20
WWH LAB/RAD FEE SCHEDULE - 4206 707208010 72080 (IA) RAD XR SPINE THORACOLUMBAR JUNCTION MINIMUM OF 2 VIEWS PORTABLE 209.00 $188.10 $83.60 $167.20 $117.04 $146.30 $133.76 $167.20 $163.02 $94.05 $85.69 $87.78 $83.60 $156.75 $135.85
WWH LAB/RAD FEE SCHEDULE - 4206 707208101 72081 (IA) RAD XR SPINE THORACOLUMBAR STANDING SCOLIOSIS 1 VIEW 211.00 $189.90 $84.40 $168.80 $118.16 $147.70 $135.04 $168.80 $164.58 $94.95 $86.51 $88.62 $84.40 $158.25 $137.15
WWH LAB/RAD FEE SCHEDULE - 4206 707208200 72082 (IA) RAD XR SPINE ENTIRE 2 TO 3 VIEWS 237.00 $213.30 $94.80 $189.60 $132.72 $165.90 $151.68 $189.60 $184.86 $106.65 $97.17 $99.54 $94.80 $177.75 $154.05
WWH LAB/RAD FEE SCHEDULE - 4206 707208201 72082 (IA) RAD XR SPINE THORACOLUMBAR STANDING SCOLIOSIS 2 TO 3 VIEW 209.00 $188.10 $83.60 $167.20 $117.04 $146.30 $133.76 $167.20 $163.02 $94.05 $85.69 $87.78 $83.60 $156.75 $135.85
WWH LAB/RAD FEE SCHEDULE - 4206 707208210 72082 (IA) RAD XR SPINE ENTIRE 2 TO 3 VIEWS PORTABLE 165.00 $148.50 $66.00 $132.00 $92.40 $115.50 $105.60 $132.00 $128.70 $74.25 $67.65 $69.30 $66.00 $123.75 $107.25
WWH LAB/RAD FEE SCHEDULE - 4206 707208300 72083 (IA) RAD XR SPINE ENTIRE 4 TO 5 VIEWS 298.00 $268.20 $119.20 $238.40 $166.88 $208.60 $190.72 $238.40 $232.44 $134.10 $122.18 $125.16 $119.20 $223.50 $193.70
WWH LAB/RAD FEE SCHEDULE - 4206 707208400 72084 (IA) RAD XR SPINE ENTIRE MINIMUM OF 6 VIEWS 277.00 $249.30 $110.80 $221.60 $155.12 $193.90 $177.28 $221.60 $216.06 $124.65 $113.57 $116.34 $110.80 $207.75 $180.05
WWH LAB/RAD FEE SCHEDULE - 4206 707210000 72100 (IA) RAD XR LUMBOSACRAL SPINE 2 OR 3 VIEWS 193.00 $173.70 $77.20 $154.40 $108.08 $135.10 $123.52 $154.40 $150.54 $86.85 $79.13 $81.06 $77.20 $144.75 $125.45
WWH LAB/RAD FEE SCHEDULE - 4206 707210010 72100 (IA) RAD XR LUMBOSACRAL SPINE 2 OR 3 VIEWS PORTABLE 153.00 $137.70 $61.20 $122.40 $85.68 $107.10 $97.92 $122.40 $119.34 $68.85 $62.73 $64.26 $61.20 $114.75 $99.45
WWH LAB/RAD FEE SCHEDULE - 4206 707211000 72110 (IA) RAD XR LUMBOSACRAL MINIMUM OF 4 VIEWS 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH LAB/RAD FEE SCHEDULE - 4206 707211400 72114 (IA) RAD XR SPINE LUMBAR INC BENDING MINIMUM 6 VIEWS 380.00 $342.00 $152.00 $304.00 $212.80 $266.00 $243.20 $304.00 $296.40 $171.00 $155.80 $159.60 $152.00 $285.00 $247.00
WWH LAB/RAD FEE SCHEDULE - 4206 707212000 72120 (IA) RAD XR BENDING LUMBOSACRAL SPINE 2 OR 3 VIEWS 255.00 $229.50 $102.00 $204.00 $142.80 $178.50 $163.20 $204.00 $198.90 $114.75 $104.55 $107.10 $102.00 $191.25 $165.75
WWH LAB/RAD FEE SCHEDULE - 4206 707212500 72125 (IA) RAD CT SPINE CERVICAL WO "1,868.00" " $1,681.20 " $747.20 " $1,494.40 " " $1,046.08 " " $1,307.60 " " $1,195.52 " " $1,494.40 " " $1,457.04 " $840.60 $765.88 $784.56 $747.20 " $1,401.00 " " $1,214.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 707212600 72126 (IA) RAD CT SPINE CERVICAL W "1,893.00" " $1,703.70 " $757.20 " $1,514.40 " " $1,060.08 " " $1,325.10 " " $1,211.52 " " $1,514.40 " " $1,476.54 " $851.85 $776.13 $795.06 $757.20 " $1,419.75 " " $1,230.45 "
WWH LAB/RAD FEE SCHEDULE - 4206 707212800 72128 (IA) RAD CT SPINE THORACIC WO "1,866.00" " $1,679.40 " $746.40 " $1,492.80 " " $1,044.96 " " $1,306.20 " " $1,194.24 " " $1,492.80 " " $1,455.48 " $839.70 $765.06 $783.72 $746.40 " $1,399.50 " " $1,212.90 "
WWH LAB/RAD FEE SCHEDULE - 4206 707212900 72129 (IA) RAD CT SPINE THORACIC W "2,130.00" " $1,917.00 " $852.00 " $1,704.00 " " $1,192.80 " " $1,491.00 " " $1,363.20 " " $1,704.00 " " $1,661.40 " $958.50 $873.30 $894.60 $852.00 " $1,597.50 " " $1,384.50 "
WWH LAB/RAD FEE SCHEDULE - 4206 707213100 72131 (IA) RAD CT SPINE LUMBAR OR SACRUM WO "1,866.00" " $1,679.40 " $746.40 " $1,492.80 " " $1,044.96 " " $1,306.20 " " $1,194.24 " " $1,492.80 " " $1,455.48 " $839.70 $765.06 $783.72 $746.40 " $1,399.50 " " $1,212.90 "
WWH LAB/RAD FEE SCHEDULE - 4206 707213200 72132 (IA) RAD CT SPINE LUMBAR OR SACRUM W "2,247.00" " $2,022.30 " $898.80 " $1,797.60 " " $1,258.32 " " $1,572.90 " " $1,438.08 " " $1,797.60 " " $1,752.66 " " $1,011.15 " $921.27 $943.74 $898.80 " $1,685.25 " " $1,460.55 "
WWH LAB/RAD FEE SCHEDULE - 4206 707213300 72133 (IA) RAD CT SPINE LUMBAR WWO "1,474.00" " $1,326.60 " $589.60 " $1,179.20 " $825.44 " $1,031.80 " $943.36 " $1,179.20 " " $1,149.72 " $663.30 $604.34 $619.08 $589.60 " $1,105.50 " $958.10
WWH LAB/RAD FEE SCHEDULE - 4206 707214100 72141 (IA) RAD MR SPINE CERVICAL WO "2,770.00" " $2,493.00 " " $1,108.00 " " $2,216.00 " " $1,551.20 " " $1,939.00 " " $1,772.80 " " $2,216.00 " " $2,160.60 " " $1,246.50 " " $1,135.70 " " $1,163.40 " " $1,108.00 " " $2,077.50 " " $1,800.50 "
WWH LAB/RAD FEE SCHEDULE - 4206 707214152 72141 (IA) RAD MR SPINE CERVICAL WO LTD "2,012.00" " $1,810.80 " $804.80 " $1,609.60 " " $1,126.72 " " $1,408.40 " " $1,287.68 " " $1,609.60 " " $1,569.36 " $905.40 $824.92 $845.04 $804.80 " $1,509.00 " " $1,307.80 "
WWH LAB/RAD FEE SCHEDULE - 4206 707214200 72142 (IA) RAD MR SPINE CERVICAL W "3,021.00" " $2,718.90 " " $1,208.40 " " $2,416.80 " " $1,691.76 " " $2,114.70 " " $1,933.44 " " $2,416.80 " " $2,356.38 " " $1,359.45 " " $1,238.61 " " $1,268.82 " " $1,208.40 " " $2,265.75 " " $1,963.65 "
WWH LAB/RAD FEE SCHEDULE - 4206 707214252 72142 (IA) RAD MR SPINE CERVICAL W LTD "4,277.00" " $3,849.30 " " $1,710.80 " " $3,421.60 " " $2,395.12 " " $2,993.90 " " $2,737.28 " " $3,421.60 " " $3,336.06 " " $1,924.65 " " $1,753.57 " " $1,796.34 " " $1,710.80 " " $3,207.75 " " $2,780.05 "
WWH LAB/RAD FEE SCHEDULE - 4206 707214600 72146 (IA) RAD MR SPINE THORACIC WO "3,201.00" " $2,880.90 " " $1,280.40 " " $2,560.80 " " $1,792.56 " " $2,240.70 " " $2,048.64 " " $2,560.80 " " $2,496.78 " " $1,440.45 " " $1,312.41 " " $1,344.42 " " $1,280.40 " " $2,400.75 " " $2,080.65 "
WWH LAB/RAD FEE SCHEDULE - 4206 707214652 72146 (IA) RAD MR SPINE THORACIC WO LTD "3,448.00" " $3,103.20 " " $1,379.20 " " $2,758.40 " " $1,930.88 " " $2,413.60 " " $2,206.72 " " $2,758.40 " " $2,689.44 " " $1,551.60 " " $1,413.68 " " $1,448.16 " " $1,379.20 " " $2,586.00 " " $2,241.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 707214700 72147 (IA) RAD MR SPINE THORACIC W "3,799.00" " $3,419.10 " " $1,519.60 " " $3,039.20 " " $2,127.44 " " $2,659.30 " " $2,431.36 " " $3,039.20 " " $2,963.22 " " $1,709.55 " " $1,557.59 " " $1,595.58 " " $1,519.60 " " $2,849.25 " " $2,469.35 "
WWH LAB/RAD FEE SCHEDULE - 4206 707214752 72147 (IA) RAD MR SPINE THORACIC W LTD "3,799.00" " $3,419.10 " " $1,519.60 " " $3,039.20 " " $2,127.44 " " $2,659.30 " " $2,431.36 " " $3,039.20 " " $2,963.22 " " $1,709.55 " " $1,557.59 " " $1,595.58 " " $1,519.60 " " $2,849.25 " " $2,469.35 "
WWH LAB/RAD FEE SCHEDULE - 4206 707214800 72148 (IA) RAD MR SPINE LUMBAR WO "2,870.00" " $2,583.00 " " $1,148.00 " " $2,296.00 " " $1,607.20 " " $2,009.00 " " $1,836.80 " " $2,296.00 " " $2,238.60 " " $1,291.50 " " $1,176.70 " " $1,205.40 " " $1,148.00 " " $2,152.50 " " $1,865.50 "
WWH LAB/RAD FEE SCHEDULE - 4206 707214852 72148 (IA) RAD MR SPINE LUMBAR WO LTD "2,004.00" " $1,803.60 " $801.60 " $1,603.20 " " $1,122.24 " " $1,402.80 " " $1,282.56 " " $1,603.20 " " $1,563.12 " $901.80 $821.64 $841.68 $801.60 " $1,503.00 " " $1,302.60 "
WWH LAB/RAD FEE SCHEDULE - 4206 707214900 72149 (IA) RAD MR SPINE LUMBAR W "4,223.00" " $3,800.70 " " $1,689.20 " " $3,378.40 " " $2,364.88 " " $2,956.10 " " $2,702.72 " " $3,378.40 " " $3,293.94 " " $1,900.35 " " $1,731.43 " " $1,773.66 " " $1,689.20 " " $3,167.25 " " $2,744.95 "
WWH LAB/RAD FEE SCHEDULE - 4206 707214952 72149 (IA) RAD MR SPINE LUMBAR W LTD "4,223.00" " $3,800.70 " " $1,689.20 " " $3,378.40 " " $2,364.88 " " $2,956.10 " " $2,702.72 " " $3,378.40 " " $3,293.94 " " $1,900.35 " " $1,731.43 " " $1,773.66 " " $1,689.20 " " $3,167.25 " " $2,744.95 "
WWH LAB/RAD FEE SCHEDULE - 4206 707215600 72156 (IA) RAD MR SPINE CERVICAL WWO "4,209.00" " $3,788.10 " " $1,683.60 " " $3,367.20 " " $2,357.04 " " $2,946.30 " " $2,693.76 " " $3,367.20 " " $3,283.02 " " $1,894.05 " " $1,725.69 " " $1,767.78 " " $1,683.60 " " $3,156.75 " " $2,735.85 "
WWH LAB/RAD FEE SCHEDULE - 4206 707215652 72156 (IA) RAD MR SPINE CERVICAL WWO LTD "5,079.00" " $4,571.10 " " $2,031.60 " " $4,063.20 " " $2,844.24 " " $3,555.30 " " $3,250.56 " " $4,063.20 " " $3,961.62 " " $2,285.55 " " $2,082.39 " " $2,133.18 " " $2,031.60 " " $3,809.25 " " $3,301.35 "
WWH LAB/RAD FEE SCHEDULE - 4206 707215700 72157 (IA) RAD MR SPINE THORACIC WWO "4,209.00" " $3,788.10 " " $1,683.60 " " $3,367.20 " " $2,357.04 " " $2,946.30 " " $2,693.76 " " $3,367.20 " " $3,283.02 " " $1,894.05 " " $1,725.69 " " $1,767.78 " " $1,683.60 " " $3,156.75 " " $2,735.85 "
WWH LAB/RAD FEE SCHEDULE - 4206 707215752 72157 (IA) RAD MR SPINE THORACIC WWO LTD "4,714.00" " $4,242.60 " " $1,885.60 " " $3,771.20 " " $2,639.84 " " $3,299.80 " " $3,016.96 " " $3,771.20 " " $3,676.92 " " $2,121.30 " " $1,932.74 " " $1,979.88 " " $1,885.60 " " $3,535.50 " " $3,064.10 "
WWH LAB/RAD FEE SCHEDULE - 4206 707215800 72158 (IA) RAD MR SPINE LUMBAR WWO "5,424.00" " $4,881.60 " " $2,169.60 " " $4,339.20 " " $3,037.44 " " $3,796.80 " " $3,471.36 " " $4,339.20 " " $4,230.72 " " $2,440.80 " " $2,223.84 " " $2,278.08 " " $2,169.60 " " $4,068.00 " " $3,525.60 "
WWH LAB/RAD FEE SCHEDULE - 4206 707215852 72158 (IA) RAD MR SPINE LUMBAR WWO LTD "5,006.00" " $4,505.40 " " $2,002.40 " " $4,004.80 " " $2,803.36 " " $3,504.20 " " $3,203.84 " " $4,004.80 " " $3,904.68 " " $2,252.70 " " $2,052.46 " " $2,102.52 " " $2,002.40 " " $3,754.50 " " $3,253.90 "
WWH LAB/RAD FEE SCHEDULE - 4206 707217000 72170 (IA) RAD XR PELVIS 1 OR 2 VIEWS 145.00 $130.50 $58.00 $116.00 $81.20 $101.50 $92.80 $116.00 $113.10 $65.25 $59.45 $60.90 $58.00 $108.75 $94.25
WWH LAB/RAD FEE SCHEDULE - 4206 707217010 72170 (IA) RAD XR PELVIS 1 OR 2 VIEWS PORTABLE 145.00 $130.50 $58.00 $116.00 $81.20 $101.50 $92.80 $116.00 $113.10 $65.25 $59.45 $60.90 $58.00 $108.75 $94.25
WWH LAB/RAD FEE SCHEDULE - 4206 707219000 72190 (IA) RAD XR PELVIS THREE VIEWS OR MORE 308.00 $277.20 $123.20 $246.40 $172.48 $215.60 $197.12 $246.40 $240.24 $138.60 $126.28 $129.36 $123.20 $231.00 $200.20
WWH LAB/RAD FEE SCHEDULE - 4206 707219200 72192 (IA) RAD CT PELVIS WO "1,335.00" " $1,201.50 " $534.00 " $1,068.00 " $747.60 $934.50 $854.40 " $1,068.00 " " $1,041.30 " $600.75 $547.35 $560.70 $534.00 " $1,001.25 " $867.75
WWH LAB/RAD FEE SCHEDULE - 4206 707219300 72193 (IA) RAD CT PELVIS W "1,519.00" " $1,367.10 " $607.60 " $1,215.20 " $850.64 " $1,063.30 " $972.16 " $1,215.20 " " $1,184.82 " $683.55 $622.79 $637.98 $607.60 " $1,139.25 " $987.35
WWH LAB/RAD FEE SCHEDULE - 4206 707219400 72194 (IA) RAD CT PELVIS WWO "2,766.00" " $2,489.40 " " $1,106.40 " " $2,212.80 " " $1,548.96 " " $1,936.20 " " $1,770.24 " " $2,212.80 " " $2,157.48 " " $1,244.70 " " $1,134.06 " " $1,161.72 " " $1,106.40 " " $2,074.50 " " $1,797.90 "
WWH LAB/RAD FEE SCHEDULE - 4206 707219500 72195 (IA) RAD MR PELVIS WO "2,560.00" " $2,304.00 " " $1,024.00 " " $2,048.00 " " $1,433.60 " " $1,792.00 " " $1,638.40 " " $2,048.00 " " $1,996.80 " " $1,152.00 " " $1,049.60 " " $1,075.20 " " $1,024.00 " " $1,920.00 " " $1,664.00 "
WWH LAB/RAD FEE SCHEDULE - 4206 707219600 72196 (IA) RAD MR PELVIS W "4,141.00" " $3,726.90 " " $1,656.40 " " $3,312.80 " " $2,318.96 " " $2,898.70 " " $2,650.24 " " $3,312.80 " " $3,229.98 " " $1,863.45 " " $1,697.81 " " $1,739.22 " " $1,656.40 " " $3,105.75 " " $2,691.65 "
WWH LAB/RAD FEE SCHEDULE - 4206 707219700 72197 (IA) RAD MR PELVIS WWO "4,328.00" " $3,895.20 " " $1,731.20 " " $3,462.40 " " $2,423.68 " " $3,029.60 " " $2,769.92 " " $3,462.40 " " $3,375.84 " " $1,947.60 " " $1,774.48 " " $1,817.76 " " $1,731.20 " " $3,246.00 " " $2,813.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 707220000 72200 (IA) RAD XR SACROILIAC JOINTS TWO VIEWS OR LESS 170.00 $153.00 $68.00 $136.00 $95.20 $119.00 $108.80 $136.00 $132.60 $76.50 $69.70 $71.40 $68.00 $127.50 $110.50
WWH LAB/RAD FEE SCHEDULE - 4206 707220200 72202 (IA) RAD XR SACROILIAC JOINTS THREE VIEWS OR MORE 203.00 $182.70 $81.20 $162.40 $113.68 $142.10 $129.92 $162.40 $158.34 $91.35 $83.23 $85.26 $81.20 $152.25 $131.95
WWH LAB/RAD FEE SCHEDULE - 4206 707222000 72220 (IA) RAD XR SACRUM AND COCCYX TWO VIEWS OR MORE 306.00 $275.40 $122.40 $244.80 $171.36 $214.20 $195.84 $244.80 $238.68 $137.70 $125.46 $128.52 $122.40 $229.50 $198.90
WWH LAB/RAD FEE SCHEDULE - 4206 707300000 73000 (IA) RAD XR CLAVICLE COMPLETE 229.00 $206.10 $91.60 $183.20 $128.24 $160.30 $146.56 $183.20 $178.62 $103.05 $93.89 $96.18 $91.60 $171.75 $148.85
WWH LAB/RAD FEE SCHEDULE - 4206 707300010 73000 (IA) RAD XR CLAVICLE COMPLETE PORTABLE 229.00 $206.10 $91.60 $183.20 $128.24 $160.30 $146.56 $183.20 $178.62 $103.05 $93.89 $96.18 $91.60 $171.75 $148.85
WWH LAB/RAD FEE SCHEDULE - 4206 707301000 73010 (IA) RAD XR SCAPULA COMPLETE 176.00 $158.40 $70.40 $140.80 $98.56 $123.20 $112.64 $140.80 $137.28 $79.20 $72.16 $73.92 $70.40 $132.00 $114.40
WWH LAB/RAD FEE SCHEDULE - 4206 707302000 73020 (IA) RAD XR SHOULDER 1 VIEW 141.00 $126.90 $56.40 $112.80 $78.96 $98.70 $90.24 $112.80 $109.98 $63.45 $57.81 $59.22 $56.40 $105.75 $91.65
WWH LAB/RAD FEE SCHEDULE - 4206 707302010 73020 (IA) RAD XR SHOULDER 1 VIEW PORTABLE 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 707303000 73030 (IA) RAD XR SHOULDER COMPLETE 2 VIEWS OR MORE 272.00 $244.80 $108.80 $217.60 $152.32 $190.40 $174.08 $217.60 $212.16 $122.40 $111.52 $114.24 $108.80 $204.00 $176.80
WWH LAB/RAD FEE SCHEDULE - 4206 707303010 73030 (IA) RAD XR SHOULDER COMPLETE 2 VIEWS OR MORE PORTABLE 282.00 $253.80 $112.80 $225.60 $157.92 $197.40 $180.48 $225.60 $219.96 $126.90 $115.62 $118.44 $112.80 $211.50 $183.30
WWH LAB/RAD FEE SCHEDULE - 4206 707304005 73040 (IA) RAD XR ARTHROGRAM SHOULDER 468.00 $421.20 $187.20 $374.40 $262.08 $327.60 $299.52 $374.40 $365.04 $210.60 $191.88 $196.56 $187.20 $351.00 $304.20
WWH LAB/RAD FEE SCHEDULE - 4206 707305000 73050 (IA) RAD XR ACROMIOCLAVICULAR JOINTS BILATERAL WWO WEIGHTS 196.00 $176.40 $78.40 $156.80 $109.76 $137.20 $125.44 $156.80 $152.88 $88.20 $80.36 $82.32 $78.40 $147.00 $127.40
WWH LAB/RAD FEE SCHEDULE - 4206 707306000 73060 (IA) RAD XR HUMERUS TWO VIEWS OR MORE 273.00 $245.70 $109.20 $218.40 $152.88 $191.10 $174.72 $218.40 $212.94 $122.85 $111.93 $114.66 $109.20 $204.75 $177.45
WWH LAB/RAD FEE SCHEDULE - 4206 707306010 73060 (IA) RAD XR HUMERUS TWO VIEWS OR MORE PORTABLE 240.00 $216.00 $96.00 $192.00 $134.40 $168.00 $153.60 $192.00 $187.20 $108.00 $98.40 $100.80 $96.00 $180.00 $156.00
WWH LAB/RAD FEE SCHEDULE - 4206 707306052 73060 (IA) RAD XR HUMERUS TWO VIEWS OR MORE LTD 240.00 $216.00 $96.00 $192.00 $134.40 $168.00 $153.60 $192.00 $187.20 $108.00 $98.40 $100.80 $96.00 $180.00 $156.00
WWH LAB/RAD FEE SCHEDULE - 4206 707307000 73070 (IA) RAD XR ELBOW 2 VIEWS 133.00 $119.70 $53.20 $106.40 $74.48 $93.10 $85.12 $106.40 $103.74 $59.85 $54.53 $55.86 $53.20 $99.75 $86.45
WWH LAB/RAD FEE SCHEDULE - 4206 707307010 73070 (IA) RAD XR ELBOW 2 VIEWS PORTABLE 112.00 $100.80 $44.80 $89.60 $62.72 $78.40 $71.68 $89.60 $87.36 $50.40 $45.92 $47.04 $44.80 $84.00 $72.80
WWH LAB/RAD FEE SCHEDULE - 4206 707307052 73070 (IA) RAD XR ELBOW 2 VIEWS LTD 133.00 $119.70 $53.20 $106.40 $74.48 $93.10 $85.12 $106.40 $103.74 $59.85 $54.53 $55.86 $53.20 $99.75 $86.45
WWH LAB/RAD FEE SCHEDULE - 4206 707308000 73080 (IA) RAD XR ELBOW COMPLETE THREE VIEWS OR MORE 244.00 $219.60 $97.60 $195.20 $136.64 $170.80 $156.16 $195.20 $190.32 $109.80 $100.04 $102.48 $97.60 $183.00 $158.60
WWH LAB/RAD FEE SCHEDULE - 4206 707309000 73090 (IA) RAD XR FOREARM 2 VIEWS 231.00 $207.90 $92.40 $184.80 $129.36 $161.70 $147.84 $184.80 $180.18 $103.95 $94.71 $97.02 $92.40 $173.25 $150.15
WWH LAB/RAD FEE SCHEDULE - 4206 707309010 73090 (IA) RAD XR FOREARM 2 VIEWS PORTABLE 158.00 $142.20 $63.20 $126.40 $88.48 $110.60 $101.12 $126.40 $123.24 $71.10 $64.78 $66.36 $63.20 $118.50 $102.70
WWH LAB/RAD FEE SCHEDULE - 4206 707309052 73090 (IA) RAD XR FOREARM 2 VIEWS LTD 158.00 $142.20 $63.20 $126.40 $88.48 $110.60 $101.12 $126.40 $123.24 $71.10 $64.78 $66.36 $63.20 $118.50 $102.70
WWH LAB/RAD FEE SCHEDULE - 4206 707309200 73092 (IA) RAD XR UPPER EXTREMITY INFANT TWO VIEWS OR MORE 151.00 $135.90 $60.40 $120.80 $84.56 $105.70 $96.64 $120.80 $117.78 $67.95 $61.91 $63.42 $60.40 $113.25 $98.15
WWH LAB/RAD FEE SCHEDULE - 4206 707310000 73100 (IA) RAD XR WRIST 2 VIEWS 176.00 $158.40 $70.40 $140.80 $98.56 $123.20 $112.64 $140.80 $137.28 $79.20 $72.16 $73.92 $70.40 $132.00 $114.40
WWH LAB/RAD FEE SCHEDULE - 4206 707310010 73100 (IA) RAD XR WRIST 2 VIEWS PORTABLE 176.00 $158.40 $70.40 $140.80 $98.56 $123.20 $112.64 $140.80 $137.28 $79.20 $72.16 $73.92 $70.40 $132.00 $114.40
WWH LAB/RAD FEE SCHEDULE - 4206 707311000 73110 (IA) RAD XR WRIST THREE VIEWS OR MORE 250.00 $225.00 $100.00 $200.00 $140.00 $175.00 $160.00 $200.00 $195.00 $112.50 $102.50 $105.00 $100.00 $187.50 $162.50
WWH LAB/RAD FEE SCHEDULE - 4206 707311010 73110 (IA) RAD XR WRIST THREE VIEWS OR MORE PORTABLE 250.00 $225.00 $100.00 $200.00 $140.00 $175.00 $160.00 $200.00 $195.00 $112.50 $102.50 $105.00 $100.00 $187.50 $162.50
WWH LAB/RAD FEE SCHEDULE - 4206 707311500 73115 (IA) RAD XR ARTHROGRAM WRIST 409.00 $368.10 $163.60 $327.20 $229.04 $286.30 $261.76 $327.20 $319.02 $184.05 $167.69 $171.78 $163.60 $306.75 $265.85
WWH LAB/RAD FEE SCHEDULE - 4206 707312000 73120 (IA) RAD XR HAND 2 VIEWS 136.00 $122.40 $54.40 $108.80 $76.16 $95.20 $87.04 $108.80 $106.08 $61.20 $55.76 $57.12 $54.40 $102.00 $88.40
WWH LAB/RAD FEE SCHEDULE - 4206 707312010 73120 (IA) RAD XR HAND 2 VIEWS PORTABLE 172.00 $154.80 $68.80 $137.60 $96.32 $120.40 $110.08 $137.60 $134.16 $77.40 $70.52 $72.24 $68.80 $129.00 $111.80
WWH LAB/RAD FEE SCHEDULE - 4206 707312052 73120 (IA) RAD XR HAND 2 VIEWS LTD 136.00 $122.40 $54.40 $108.80 $76.16 $95.20 $87.04 $108.80 $106.08 $61.20 $55.76 $57.12 $54.40 $102.00 $88.40
WWH LAB/RAD FEE SCHEDULE - 4206 707313000 73130 (IA) RAD XR HAND 3 VIEWS OR MORE 258.00 $232.20 $103.20 $206.40 $144.48 $180.60 $165.12 $206.40 $201.24 $116.10 $105.78 $108.36 $103.20 $193.50 $167.70
WWH LAB/RAD FEE SCHEDULE - 4206 707314000 73140 (IA) RAD XR FINGER TWO VIEWS OR MORE 202.00 $181.80 $80.80 $161.60 $113.12 $141.40 $129.28 $161.60 $157.56 $90.90 $82.82 $84.84 $80.80 $151.50 $131.30
WWH LAB/RAD FEE SCHEDULE - 4206 707314010 73140 (IA) RAD XR FINGER TWO VIEWS OR MORE PORTABLE 198.00 $178.20 $79.20 $158.40 $110.88 $138.60 $126.72 $158.40 $154.44 $89.10 $81.18 $83.16 $79.20 $148.50 $128.70
WWH LAB/RAD FEE SCHEDULE - 4206 707320000 73200 (IA) RAD CT UPPER EXTREMITY WO "1,355.00" " $1,219.50 " $542.00 " $1,084.00 " $758.80 $948.50 $867.20 " $1,084.00 " " $1,056.90 " $609.75 $555.55 $569.10 $542.00 " $1,016.25 " $880.75
WWH LAB/RAD FEE SCHEDULE - 4206 707320100 73201 (IA) RAD CT UPPER EXTREMITY W "2,137.00" " $1,923.30 " $854.80 " $1,709.60 " " $1,196.72 " " $1,495.90 " " $1,367.68 " " $1,709.60 " " $1,666.86 " $961.65 $876.17 $897.54 $854.80 " $1,602.75 " " $1,389.05 "
WWH LAB/RAD FEE SCHEDULE - 4206 707320200 73202 (IA) RAD CT UPPER EXTREMITY WWO "1,364.00" " $1,227.60 " $545.60 " $1,091.20 " $763.84 $954.80 $872.96 " $1,091.20 " " $1,063.92 " $613.80 $559.24 $572.88 $545.60 " $1,023.00 " $886.60
WWH LAB/RAD FEE SCHEDULE - 4206 707320600 73206 (IA) RAD CT ANGIO UPPER EXTREMITY "2,864.00" " $2,577.60 " " $1,145.60 " " $2,291.20 " " $1,603.84 " " $2,004.80 " " $1,832.96 " " $2,291.20 " " $2,233.92 " " $1,288.80 " " $1,174.24 " " $1,202.88 " " $1,145.60 " " $2,148.00 " " $1,861.60 "
WWH LAB/RAD FEE SCHEDULE - 4206 707321800 73218 (IA) RAD MR NON JOINT UPPER EXTREMITY WO "2,478.00" " $2,230.20 " $991.20 " $1,982.40 " " $1,387.68 " " $1,734.60 " " $1,585.92 " " $1,982.40 " " $1,932.84 " " $1,115.10 " " $1,015.98 " " $1,040.76 " $991.20 " $1,858.50 " " $1,610.70 "
WWH LAB/RAD FEE SCHEDULE - 4206 707322000 73220 (IA) RAD MR NON JOINT UPPER EXTREMITY WWO "5,152.00" " $4,636.80 " " $2,060.80 " " $4,121.60 " " $2,885.12 " " $3,606.40 " " $3,297.28 " " $4,121.60 " " $4,018.56 " " $2,318.40 " " $2,112.32 " " $2,163.84 " " $2,060.80 " " $3,864.00 " " $3,348.80 "
WWH LAB/RAD FEE SCHEDULE - 4206 707322100 73221 (IA) RAD MR JOINT OF UPPER EXTREMITY WO "2,895.00" " $2,605.50 " " $1,158.00 " " $2,316.00 " " $1,621.20 " " $2,026.50 " " $1,852.80 " " $2,316.00 " " $2,258.10 " " $1,302.75 " " $1,186.95 " " $1,215.90 " " $1,158.00 " " $2,171.25 " " $1,881.75 "
WWH LAB/RAD FEE SCHEDULE - 4206 707322200 73222 (IA) RAD MR JOINT OF UPPER EXTREMITY W "3,840.00" " $3,456.00 " " $1,536.00 " " $3,072.00 " " $2,150.40 " " $2,688.00 " " $2,457.60 " " $3,072.00 " " $2,995.20 " " $1,728.00 " " $1,574.40 " " $1,612.80 " " $1,536.00 " " $2,880.00 " " $2,496.00 "
WWH LAB/RAD FEE SCHEDULE - 4206 707322300 73223 (IA) RAD MR JOINT OF UPPER EXTREMITY WWO "4,831.00" " $4,347.90 " " $1,932.40 " " $3,864.80 " " $2,705.36 " " $3,381.70 " " $3,091.84 " " $3,864.80 " " $3,768.18 " " $2,173.95 " " $1,980.71 " " $2,029.02 " " $1,932.40 " " $3,623.25 " " $3,140.15 "
WWH LAB/RAD FEE SCHEDULE - 4206 707350100 73501 (IA) RAD XR HIP UNILATERAL WWO PELVIS 1 VIEW 193.00 $173.70 $77.20 $154.40 $108.08 $135.10 $123.52 $154.40 $150.54 $86.85 $79.13 $81.06 $77.20 $144.75 $125.45
WWH LAB/RAD FEE SCHEDULE - 4206 707350110 73501 (IA) RAD XR HIP UNILATERAL WWO PELVIS1 VIEW PORTABLE 209.00 $188.10 $83.60 $167.20 $117.04 $146.30 $133.76 $167.20 $163.02 $94.05 $85.69 $87.78 $83.60 $156.75 $135.85
WWH LAB/RAD FEE SCHEDULE - 4206 707350200 73502 (IA) RAD XR HIP WWO PELVIS UNILATERAL 2 OR 3 VIEWS 221.00 $198.90 $88.40 $176.80 $123.76 $154.70 $141.44 $176.80 $172.38 $99.45 $90.61 $92.82 $88.40 $165.75 $143.65
WWH LAB/RAD FEE SCHEDULE - 4206 707350201 73502 (IA) RAD XR HIP WWO PELVIS UNILAT 2 OR 3 VIEWS ADD ON 164.00 $147.60 $65.60 $131.20 $91.84 $114.80 $104.96 $131.20 $127.92 $73.80 $67.24 $68.88 $65.60 $123.00 $106.60
WWH LAB/RAD FEE SCHEDULE - 4206 707350210 73502 (IA) RAD XR HIP WWO PELVIS UNILATERAL 2 OR 3 VIEWS PORTABLE 199.00 $179.10 $79.60 $159.20 $111.44 $139.30 $127.36 $159.20 $155.22 $89.55 $81.59 $83.58 $79.60 $149.25 $129.35
WWH LAB/RAD FEE SCHEDULE - 4206 707350300 73503 (IA) RAD XR HIP WWO PELVIS UNILATERAL MINIMUM 4 VIEWS 186.00 $167.40 $74.40 $148.80 $104.16 $130.20 $119.04 $148.80 $145.08 $83.70 $76.26 $78.12 $74.40 $139.50 $120.90
WWH LAB/RAD FEE SCHEDULE - 4206 707352100 73521 (IA) RAD XR HIPS BILATERAL 2V WWO PELVIS 379.00 $341.10 $151.60 $303.20 $212.24 $265.30 $242.56 $303.20 $295.62 $170.55 $155.39 $159.18 $151.60 $284.25 $246.35
WWH LAB/RAD FEE SCHEDULE - 4206 707352101 73521 (IA) RAD XR PELVIS AND HIPS BILAT INFANT/CHILD 2VIEWS 221.00 $198.90 $88.40 $176.80 $123.76 $154.70 $141.44 $176.80 $172.38 $99.45 $90.61 $92.82 $88.40 $165.75 $143.65
WWH LAB/RAD FEE SCHEDULE - 4206 707352110 73521 (IA) RAD XR HIPS BILATERAL 2V WWO PELVIS PORTABLE 338.00 $304.20 $135.20 $270.40 $189.28 $236.60 $216.32 $270.40 $263.64 $152.10 $138.58 $141.96 $135.20 $253.50 $219.70
WWH LAB/RAD FEE SCHEDULE - 4206 707352505 73525 (IA) RAD XR ARTHROGRAM HIP 455.00 $409.50 $182.00 $364.00 $254.80 $318.50 $291.20 $364.00 $354.90 $204.75 $186.55 $191.10 $182.00 $341.25 $295.75
WWH LAB/RAD FEE SCHEDULE - 4206 707355100 73551 (IA) RAD XR FEMUR 1 VIEW UNILATERAL 209.00 $188.10 $83.60 $167.20 $117.04 $146.30 $133.76 $167.20 $163.02 $94.05 $85.69 $87.78 $83.60 $156.75 $135.85
WWH LAB/RAD FEE SCHEDULE - 4206 707355110 73551 (IA) RAD XR FEMUR 1 VIEW UNILATERAL PORTABLE 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 707355200 73552 (IA) RAD XR FEMUR 2 VIEWS 252.00 $226.80 $100.80 $201.60 $141.12 $176.40 $161.28 $201.60 $196.56 $113.40 $103.32 $105.84 $100.80 $189.00 $163.80
WWH LAB/RAD FEE SCHEDULE - 4206 707355210 73552 (IA) RAD XR FEMUR 2 VIEWS PORTABLE 182.00 $163.80 $72.80 $145.60 $101.92 $127.40 $116.48 $145.60 $141.96 $81.90 $74.62 $76.44 $72.80 $136.50 $118.30
WWH LAB/RAD FEE SCHEDULE - 4206 707355252 73552 (IA) RAD XR FEMUR 2 VIEWS LTD 252.00 $226.80 $100.80 $201.60 $141.12 $176.40 $161.28 $201.60 $196.56 $113.40 $103.32 $105.84 $100.80 $189.00 $163.80
WWH LAB/RAD FEE SCHEDULE - 4206 707356000 73560 (IA) RAD XR KNEE 1 OR 2 VIEWS 141.00 $126.90 $56.40 $112.80 $78.96 $98.70 $90.24 $112.80 $109.98 $63.45 $57.81 $59.22 $56.40 $105.75 $91.65
WWH LAB/RAD FEE SCHEDULE - 4206 707356010 73560 (IA) RAD XR KNEE 1 OR 2 VIEWS PORTABLE 119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
WWH LAB/RAD FEE SCHEDULE - 4206 707356200 73562 (IA) RAD XR KNEE 3 VIEWS 258.00 $232.20 $103.20 $206.40 $144.48 $180.60 $165.12 $206.40 $201.24 $116.10 $105.78 $108.36 $103.20 $193.50 $167.70
WWH LAB/RAD FEE SCHEDULE - 4206 707356400 73564 (IA) RAD XR KNEE COMPLETE 4 VIEWS OR MORE 203.00 $182.70 $81.20 $162.40 $113.68 $142.10 $129.92 $162.40 $158.34 $91.35 $83.23 $85.26 $81.20 $152.25 $131.95
WWH LAB/RAD FEE SCHEDULE - 4206 707358000 73580 (IA) RAD XR ARTHROGRAM KNEE 443.00 $398.70 $177.20 $354.40 $248.08 $310.10 $283.52 $354.40 $345.54 $199.35 $181.63 $186.06 $177.20 $332.25 $287.95
WWH LAB/RAD FEE SCHEDULE - 4206 707359000 73590 (IA) RAD XR TIBIA AND FIBULA 2 VIEWS 227.00 $204.30 $90.80 $181.60 $127.12 $158.90 $145.28 $181.60 $177.06 $102.15 $93.07 $95.34 $90.80 $170.25 $147.55
WWH LAB/RAD FEE SCHEDULE - 4206 707359010 73590 (IA) RAD XR TIBIA AND FIBULA 2 VIEWS PORTABLE 160.00 $144.00 $64.00 $128.00 $89.60 $112.00 $102.40 $128.00 $124.80 $72.00 $65.60 $67.20 $64.00 $120.00 $104.00
WWH LAB/RAD FEE SCHEDULE - 4206 707359052 73590 (IA) RAD XR TIBIA AND FIBULA 2 VIEWS LTD 227.00 $204.30 $90.80 $181.60 $127.12 $158.90 $145.28 $181.60 $177.06 $102.15 $93.07 $95.34 $90.80 $170.25 $147.55
WWH LAB/RAD FEE SCHEDULE - 4206 707359200 73592 (IA) RAD XR LOWER EXTREMITY INFANT 2 VIEWS OR MORE 151.00 $135.90 $60.40 $120.80 $84.56 $105.70 $96.64 $120.80 $117.78 $67.95 $61.91 $63.42 $60.40 $113.25 $98.15
WWH LAB/RAD FEE SCHEDULE - 4206 707360000 73600 (IA) RAD XR ANKLE 2 VIEWS 133.00 $119.70 $53.20 $106.40 $74.48 $93.10 $85.12 $106.40 $103.74 $59.85 $54.53 $55.86 $53.20 $99.75 $86.45
WWH LAB/RAD FEE SCHEDULE - 4206 707360010 73600 (IA) RAD XR ANKLE 2 VIEWS PORTABLE 109.00 $98.10 $43.60 $87.20 $61.04 $76.30 $69.76 $87.20 $85.02 $49.05 $44.69 $45.78 $43.60 $81.75 $70.85
WWH LAB/RAD FEE SCHEDULE - 4206 707361000 73610 (IA) RAD XR ANKLE COMPLETE 3 VIEWS OR MORE 258.00 $232.20 $103.20 $206.40 $144.48 $180.60 $165.12 $206.40 $201.24 $116.10 $105.78 $108.36 $103.20 $193.50 $167.70
WWH LAB/RAD FEE SCHEDULE - 4206 707361010 73610 (IA) RAD XR ANKLE COMPLETE 3 VIEWS OR MORE PORTABLE 239.00 $215.10 $95.60 $191.20 $133.84 $167.30 $152.96 $191.20 $186.42 $107.55 $97.99 $100.38 $95.60 $179.25 $155.35
WWH LAB/RAD FEE SCHEDULE - 4206 707362000 73620 (IA) RAD XR FOOT 2 VIEWS 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH LAB/RAD FEE SCHEDULE - 4206 707362010 73620 (IA) RAD XR FOOT 2 VIEWS PORTABLE 100.00 $90.00 $40.00 $80.00 $56.00 $70.00 $64.00 $80.00 $78.00 $45.00 $41.00 $42.00 $40.00 $75.00 $65.00
WWH LAB/RAD FEE SCHEDULE - 4206 707362011 73620 (IA) RAD XR FOOT 2 VIEWS PORTABLE LIMITED 100.00 $90.00 $40.00 $80.00 $56.00 $70.00 $64.00 $80.00 $78.00 $45.00 $41.00 $42.00 $40.00 $75.00 $65.00
WWH LAB/RAD FEE SCHEDULE - 4206 707362052 73620 (IA) RAD XR FOOT 2 VIEWS LTD 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH LAB/RAD FEE SCHEDULE - 4206 707363000 73630 (IA) RAD XR FOOT COMPLETE MINIMUM OF 3 VIEWS 235.00 $211.50 $94.00 $188.00 $131.60 $164.50 $150.40 $188.00 $183.30 $105.75 $96.35 $98.70 $94.00 $176.25 $152.75
WWH LAB/RAD FEE SCHEDULE - 4206 707363010 73630 (IA) RAD XR FOOT COMPLETE MINIMUM OF 3 VIEWS PORTABLE 156.00 $140.40 $62.40 $124.80 $87.36 $109.20 $99.84 $124.80 $121.68 $70.20 $63.96 $65.52 $62.40 $117.00 $101.40
WWH LAB/RAD FEE SCHEDULE - 4206 707365000 73650 (IA) RAD XR CALCANEUS 2 VIEWS 132.00 $118.80 $52.80 $105.60 $73.92 $92.40 $84.48 $105.60 $102.96 $59.40 $54.12 $55.44 $52.80 $99.00 $85.80
WWH LAB/RAD FEE SCHEDULE - 4206 707365052 73650 (IA) RAD XR CALCANEUS 2 VIEWS LTD 111.00 $99.90 $44.40 $88.80 $62.16 $77.70 $71.04 $88.80 $86.58 $49.95 $45.51 $46.62 $44.40 $83.25 $72.15
WWH LAB/RAD FEE SCHEDULE - 4206 707366000 73660 (IA) RAD XR TOE(S) MINIMUM OF 2 VIEWS 193.00 $173.70 $77.20 $154.40 $108.08 $135.10 $123.52 $154.40 $150.54 $86.85 $79.13 $81.06 $77.20 $144.75 $125.45
WWH LAB/RAD FEE SCHEDULE - 4206 707366010 73660 (IA) RAD XR TOE(S) MINIMUM OF 2 VIEWS PORTABLE 144.00 $129.60 $57.60 $115.20 $80.64 $100.80 $92.16 $115.20 $112.32 $64.80 $59.04 $60.48 $57.60 $108.00 $93.60
WWH LAB/RAD FEE SCHEDULE - 4206 707370000 73700 (IA) RAD CT LOWER EXTREMITY WO "1,824.00" " $1,641.60 " $729.60 " $1,459.20 " " $1,021.44 " " $1,276.80 " " $1,167.36 " " $1,459.20 " " $1,422.72 " $820.80 $747.84 $766.08 $729.60 " $1,368.00 " " $1,185.60 "
WWH LAB/RAD FEE SCHEDULE - 4206 707370100 73701 (IA) RAD CT LOWER EXTREMITY W "1,879.00" " $1,691.10 " $751.60 " $1,503.20 " " $1,052.24 " " $1,315.30 " " $1,202.56 " " $1,503.20 " " $1,465.62 " $845.55 $770.39 $789.18 $751.60 " $1,409.25 " " $1,221.35 "
WWH LAB/RAD FEE SCHEDULE - 4206 707370200 73702 (IA) RAD CT LOWER EXTREMITY WWO "2,864.00" " $2,577.60 " " $1,145.60 " " $2,291.20 " " $1,603.84 " " $2,004.80 " " $1,832.96 " " $2,291.20 " " $2,233.92 " " $1,288.80 " " $1,174.24 " " $1,202.88 " " $1,145.60 " " $2,148.00 " " $1,861.60 "
WWH LAB/RAD FEE SCHEDULE - 4206 707370600 73706 (IA) RAD CT ANGIO LOWER EXTREMITY "1,626.00" " $1,463.40 " $650.40 " $1,300.80 " $910.56 " $1,138.20 " " $1,040.64 " " $1,300.80 " " $1,268.28 " $731.70 $666.66 $682.92 $650.40 " $1,219.50 " " $1,056.90 "
WWH LAB/RAD FEE SCHEDULE - 4206 707371800 73718 (IA) RAD MR LOWER EXTREMITY NON JOINT WO "3,650.00" " $3,285.00 " " $1,460.00 " " $2,920.00 " " $2,044.00 " " $2,555.00 " " $2,336.00 " " $2,920.00 " " $2,847.00 " " $1,642.50 " " $1,496.50 " " $1,533.00 " " $1,460.00 " " $2,737.50 " " $2,372.50 "
WWH LAB/RAD FEE SCHEDULE - 4206 707371900 73719 (IA) RAD MR LOWER EXT NON JOINT W CONTRAST "4,046.00" " $3,641.40 " " $1,618.40 " " $3,236.80 " " $2,265.76 " " $2,832.20 " " $2,589.44 " " $3,236.80 " " $3,155.88 " " $1,820.70 " " $1,658.86 " " $1,699.32 " " $1,618.40 " " $3,034.50 " " $2,629.90 "
WWH LAB/RAD FEE SCHEDULE - 4206 707372000 73720 (IA) RAD MR NON JOINT LOWER EXTREMITY WWO "4,036.00" " $3,632.40 " " $1,614.40 " " $3,228.80 " " $2,260.16 " " $2,825.20 " " $2,583.04 " " $3,228.80 " " $3,148.08 " " $1,816.20 " " $1,654.76 " " $1,695.12 " " $1,614.40 " " $3,027.00 " " $2,623.40 "
WWH LAB/RAD FEE SCHEDULE - 4206 707372100 73721 (IA) RAD MR JOINT LOWER EXTREMITY WO "2,651.00" " $2,385.90 " " $1,060.40 " " $2,120.80 " " $1,484.56 " " $1,855.70 " " $1,696.64 " " $2,120.80 " " $2,067.78 " " $1,192.95 " " $1,086.91 " " $1,113.42 " " $1,060.40 " " $1,988.25 " " $1,723.15 "
WWH LAB/RAD FEE SCHEDULE - 4206 707372152 73721 (IA) RAD MR JOINT LOWER EXTREMITY WO LTD "1,992.00" " $1,792.80 " $796.80 " $1,593.60 " " $1,115.52 " " $1,394.40 " " $1,274.88 " " $1,593.60 " " $1,553.76 " $896.40 $816.72 $836.64 $796.80 " $1,494.00 " " $1,294.80 "
WWH LAB/RAD FEE SCHEDULE - 4206 707372200 73722 (IA) RAD MR JOINT OF LOWER EXTREMITY W "3,879.00" " $3,491.10 " " $1,551.60 " " $3,103.20 " " $2,172.24 " " $2,715.30 " " $2,482.56 " " $3,103.20 " " $3,025.62 " " $1,745.55 " " $1,590.39 " " $1,629.18 " " $1,551.60 " " $2,909.25 " " $2,521.35 "
WWH LAB/RAD FEE SCHEDULE - 4206 707372300 73723 (IA) RAD MR JOINT OF LOWER EXTREMITY WWO "4,814.00" " $4,332.60 " " $1,925.60 " " $3,851.20 " " $2,695.84 " " $3,369.80 " " $3,080.96 " " $3,851.20 " " $3,754.92 " " $2,166.30 " " $1,973.74 " " $2,021.88 " " $1,925.60 " " $3,610.50 " " $3,129.10 "
WWH LAB/RAD FEE SCHEDULE - 4206 707401800 74018 (IA) RAD XR ABDOMEN SINGLE AP VIEW 207.00 $186.30 $82.80 $165.60 $115.92 $144.90 $132.48 $165.60 $161.46 $93.15 $84.87 $86.94 $82.80 $155.25 $134.55
WWH LAB/RAD FEE SCHEDULE - 4206 707401810 74018 (IA) RAD XR ABDOMEN SINGLE AP VIEW PORTABLE 207.00 $186.30 $82.80 $165.60 $115.92 $144.90 $132.48 $165.60 $161.46 $93.15 $84.87 $86.94 $82.80 $155.25 $134.55
WWH LAB/RAD FEE SCHEDULE - 4206 707401900 74019 (IA) RAD XR ABDOMEN COMPLETE 244.00 $219.60 $97.60 $195.20 $136.64 $170.80 $156.16 $195.20 $190.32 $109.80 $100.04 $102.48 $97.60 $183.00 $158.60
WWH LAB/RAD FEE SCHEDULE - 4206 707415000 74150 (IA) RAD CT ABDOMEN WO "1,288.00" " $1,159.20 " $515.20 " $1,030.40 " $721.28 $901.60 $824.32 " $1,030.40 " " $1,004.64 " $579.60 $528.08 $540.96 $515.20 $966.00 $837.20
WWH LAB/RAD FEE SCHEDULE - 4206 707416000 74160 (IA) RAD CT ABDOMEN W "1,627.00" " $1,464.30 " $650.80 " $1,301.60 " $911.12 " $1,138.90 " " $1,041.28 " " $1,301.60 " " $1,269.06 " $732.15 $667.07 $683.34 $650.80 " $1,220.25 " " $1,057.55 "
WWH LAB/RAD FEE SCHEDULE - 4206 707417000 74170 (IA) RAD CT ABDOMEN WWO "2,766.00" " $2,489.40 " " $1,106.40 " " $2,212.80 " " $1,548.96 " " $1,936.20 " " $1,770.24 " " $2,212.80 " " $2,157.48 " " $1,244.70 " " $1,134.06 " " $1,161.72 " " $1,106.40 " " $2,074.50 " " $1,797.90 "
WWH LAB/RAD FEE SCHEDULE - 4206 707417400 74174 (IA) RAD CT ANGIO ABDOMEN PELVIS "3,421.00" " $3,078.90 " " $1,368.40 " " $2,736.80 " " $1,915.76 " " $2,394.70 " " $2,189.44 " " $2,736.80 " " $2,668.38 " " $1,539.45 " " $1,402.61 " " $1,436.82 " " $1,368.40 " " $2,565.75 " " $2,223.65 "
WWH LAB/RAD FEE SCHEDULE - 4206 707417500 74175 (IA) RAD CT ANGIO ABDOMEN "3,215.00" " $2,893.50 " " $1,286.00 " " $2,572.00 " " $1,800.40 " " $2,250.50 " " $2,057.60 " " $2,572.00 " " $2,507.70 " " $1,446.75 " " $1,318.15 " " $1,350.30 " " $1,286.00 " " $2,411.25 " " $2,089.75 "
WWH LAB/RAD FEE SCHEDULE - 4206 707417600 74176 (IA) RAD CT ABDOMEN PELVIS WO "2,922.00" " $2,629.80 " " $1,168.80 " " $2,337.60 " " $1,636.32 " " $2,045.40 " " $1,870.08 " " $2,337.60 " " $2,279.16 " " $1,314.90 " " $1,198.02 " " $1,227.24 " " $1,168.80 " " $2,191.50 " " $1,899.30 "
WWH LAB/RAD FEE SCHEDULE - 4206 707417700 74177 (IA) RAD CT ABDOMEN PELVIS W "3,526.00" " $3,173.40 " " $1,410.40 " " $2,820.80 " " $1,974.56 " " $2,468.20 " " $2,256.64 " " $2,820.80 " " $2,750.28 " " $1,586.70 " " $1,445.66 " " $1,480.92 " " $1,410.40 " " $2,644.50 " " $2,291.90 "
WWH LAB/RAD FEE SCHEDULE - 4206 707417800 74178 (IA) RAD CT ABDOMEN PELVIS WWO "4,069.00" " $3,662.10 " " $1,627.60 " " $3,255.20 " " $2,278.64 " " $2,848.30 " " $2,604.16 " " $3,255.20 " " $3,173.82 " " $1,831.05 " " $1,668.29 " " $1,708.98 " " $1,627.60 " " $3,051.75 " " $2,644.85 "
WWH LAB/RAD FEE SCHEDULE - 4206 707418100 74181 (IA) RAD MR ABDOMEN WO "3,363.00" " $3,026.70 " " $1,345.20 " " $2,690.40 " " $1,883.28 " " $2,354.10 " " $2,152.32 " " $2,690.40 " " $2,623.14 " " $1,513.35 " " $1,378.83 " " $1,412.46 " " $1,345.20 " " $2,522.25 " " $2,185.95 "
WWH LAB/RAD FEE SCHEDULE - 4206 707418200 74182 (IA) RAD MR ABDOMEN W "2,250.00" " $2,025.00 " $900.00 " $1,800.00 " " $1,260.00 " " $1,575.00 " " $1,440.00 " " $1,800.00 " " $1,755.00 " " $1,012.50 " $922.50 $945.00 $900.00 " $1,687.50 " " $1,462.50 "
WWH LAB/RAD FEE SCHEDULE - 4206 707418300 74183 (IA) RAD MR ABDOMEN WWO "5,187.00" " $4,668.30 " " $2,074.80 " " $4,149.60 " " $2,904.72 " " $3,630.90 " " $3,319.68 " " $4,149.60 " " $4,045.86 " " $2,334.15 " " $2,126.67 " " $2,178.54 " " $2,074.80 " " $3,890.25 " " $3,371.55 "
WWH LAB/RAD FEE SCHEDULE - 4206 707421000 74210 (IA) RAD XR PHARYNX AND/OR CERVICAL ESOPHAGUS 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH LAB/RAD FEE SCHEDULE - 4206 707422000 74220 (IA) RAD XR ESOPHAGUS 562.00 $505.80 $224.80 $449.60 $314.72 $393.40 $359.68 $449.60 $438.36 $252.90 $230.42 $236.04 $224.80 $421.50 $365.30
WWH LAB/RAD FEE SCHEDULE - 4206 707423000 74230 (IA) RAD XR VIDEO SWALLOW STUDY 613.00 $551.70 $245.20 $490.40 $343.28 $429.10 $392.32 $490.40 $478.14 $275.85 $251.33 $257.46 $245.20 $459.75 $398.45
WWH LAB/RAD FEE SCHEDULE - 4206 707424000 74240 (IA) RAD XR UPPER GI 709.00 $638.10 $283.60 $567.20 $397.04 $496.30 $453.76 $567.20 $553.02 $319.05 $290.69 $297.78 $283.60 $531.75 $460.85
WWH LAB/RAD FEE SCHEDULE - 4206 707424600 74246 (IA) RAD XR UPPER GI AIR CONTRAST 927.00 $834.30 $370.80 $741.60 $519.12 $648.90 $593.28 $741.60 $723.06 $417.15 $380.07 $389.34 $370.80 $695.25 $602.55
WWH LAB/RAD FEE SCHEDULE - 4206 707424800 74248 (IA) RAD XR SMALL BOWEL FOLLOW THROUGH 341.00 $306.90 $136.40 $272.80 $190.96 $238.70 $218.24 $272.80 $265.98 $153.45 $139.81 $143.22 $136.40 $255.75 $221.65
WWH LAB/RAD FEE SCHEDULE - 4206 707425000 74250 (IA) RAD XR SMALL INTESTINE 613.00 $551.70 $245.20 $490.40 $343.28 $429.10 $392.32 $490.40 $478.14 $275.85 $251.33 $257.46 $245.20 $459.75 $398.45
WWH LAB/RAD FEE SCHEDULE - 4206 707426100 74261 (IA) RAD CT ABDOMEN PELVIS COLONOGRAPHY DIAGNOSTIC WO "1,923.00" " $1,730.70 " $769.20 " $1,538.40 " " $1,076.88 " " $1,346.10 " " $1,230.72 " " $1,538.40 " " $1,499.94 " $865.35 $788.43 $807.66 $769.20 " $1,442.25 " " $1,249.95 "
WWH LAB/RAD FEE SCHEDULE - 4206 707426200 74262 (IA) RAD CT ABDOMEN PELVIS COLONOGRAPHY DIAGNOSTIC W "2,636.00" " $2,372.40 " " $1,054.40 " " $2,108.80 " " $1,476.16 " " $1,845.20 " " $1,687.04 " " $2,108.80 " " $2,056.08 " " $1,186.20 " " $1,080.76 " " $1,107.12 " " $1,054.40 " " $1,977.00 " " $1,713.40 "
WWH LAB/RAD FEE SCHEDULE - 4206 707426300 74263 (IA) RAD CT ABDOMEN PELVIS COLONOGRAPHY SCREENING WO "4,328.00" " $3,895.20 " " $1,731.20 " " $3,462.40 " " $2,423.68 " " $3,029.60 " " $2,769.92 " " $3,462.40 " " $3,375.84 " " $1,947.60 " " $1,774.48 " " $1,817.76 " " $1,731.20 " " $3,246.00 " " $2,813.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 707427005 74270 (IA) RAD XR COLON WITH CONTRAST ENEMA 632.00 $568.80 $252.80 $505.60 $353.92 $442.40 $404.48 $505.60 $492.96 $284.40 $259.12 $265.44 $252.80 $474.00 $410.80
WWH LAB/RAD FEE SCHEDULE - 4206 707428000 74280 (IA) RAD XR COLON AIR CONTRAST 762.00 $685.80 $304.80 $609.60 $426.72 $533.40 $487.68 $609.60 $594.36 $342.90 $312.42 $320.04 $304.80 $571.50 $495.30
WWH LAB/RAD FEE SCHEDULE - 4206 707430000 74300 (IA) RAD XR CHOLANGIOGRAM OPERATIVE 339.00 $305.10 $135.60 $271.20 $189.84 $237.30 $216.96 $271.20 $264.42 $152.55 $138.99 $142.38 $135.60 $254.25 $220.35
WWH LAB/RAD FEE SCHEDULE - 4206 707434005 74340 (IA) RAD XR INTRO GI TUBE 565.00 $508.50 $226.00 $452.00 $316.40 $395.50 $361.60 $452.00 $440.70 $254.25 $231.65 $237.30 $226.00 $423.75 $367.25
WWH LAB/RAD FEE SCHEDULE - 4206 707436005 74360 (IA) RAD XR ESOPHAGEAL DILATION 330.00 $297.00 $132.00 $264.00 $184.80 $231.00 $211.20 $264.00 $257.40 $148.50 $135.30 $138.60 $132.00 $247.50 $214.50
WWH LAB/RAD FEE SCHEDULE - 4206 707441000 74410 (IA) RAD XR IVP 344.00 $309.60 $137.60 $275.20 $192.64 $240.80 $220.16 $275.20 $268.32 $154.80 $141.04 $144.48 $137.60 $258.00 $223.60
WWH LAB/RAD FEE SCHEDULE - 4206 707442000 74420 (IA) RAD XR RETROGRADE PYELOGRAM WWO KUB 450.00 $405.00 $180.00 $360.00 $252.00 $315.00 $288.00 $360.00 $351.00 $202.50 $184.50 $189.00 $180.00 $337.50 $292.50
WWH LAB/RAD FEE SCHEDULE - 4206 707442505 74425 (IA) RAD XR UROGRAPHY ANTEGRADE 174.00 $156.60 $69.60 $139.20 $97.44 $121.80 $111.36 $139.20 $135.72 $78.30 $71.34 $73.08 $69.60 $130.50 $113.10
WWH LAB/RAD FEE SCHEDULE - 4206 707443001 74430 (IA) RAD CT PELVIS CYSTOGRAM 487.00 $438.30 $194.80 $389.60 $272.72 $340.90 $311.68 $389.60 $379.86 $219.15 $199.67 $204.54 $194.80 $365.25 $316.55
WWH LAB/RAD FEE SCHEDULE - 4206 707443005 74430 (IA) RAD XR CYSTOGRAM 269.00 $242.10 $107.60 $215.20 $150.64 $188.30 $172.16 $215.20 $209.82 $121.05 $110.29 $112.98 $107.60 $201.75 $174.85
WWH LAB/RAD FEE SCHEDULE - 4206 707445005 74450 (IA) RAD XR URETHROCYSTOGRAM RETROGRADE 487.00 $438.30 $194.80 $389.60 $272.72 $340.90 $311.68 $389.60 $379.86 $219.15 $199.67 $204.54 $194.80 $365.25 $316.55
WWH LAB/RAD FEE SCHEDULE - 4206 707445505 74455 (IA) RAD XR VOIDING CYSTOURETHROGRAM 423.00 $380.70 $169.20 $338.40 $236.88 $296.10 $270.72 $338.40 $329.94 $190.35 $173.43 $177.66 $169.20 $317.25 $274.95
WWH LAB/RAD FEE SCHEDULE - 4206 707474005 74740 (IA) RAD XR HYSTEROSALPINGOGRAM 595.00 $535.50 $238.00 $476.00 $333.20 $416.50 $380.80 $476.00 $464.10 $267.75 $243.95 $249.90 $238.00 $446.25 $386.75
WWH LAB/RAD FEE SCHEDULE - 4206 707557100 75571 (IA) RAD CT CARDIAC CALCIUM SCORING WO 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH LAB/RAD FEE SCHEDULE - 4206 707557400 75574 (IA) RAD CT ANGIO HEART CORONARY ARTERIES "3,408.00" " $3,067.20 " " $1,363.20 " " $2,726.40 " " $1,908.48 " " $2,385.60 " " $2,181.12 " " $2,726.40 " " $2,658.24 " " $1,533.60 " " $1,397.28 " " $1,431.36 " " $1,363.20 " " $2,556.00 " " $2,215.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 707563500 75635 (IA) RAD CT ANGIO ABDOMEN PELVIS LOWER EXTREMITY RUNOFF "3,686.00" " $3,317.40 " " $1,474.40 " " $2,948.80 " " $2,064.16 " " $2,580.20 " " $2,359.04 " " $2,948.80 " " $2,875.08 " " $1,658.70 " " $1,511.26 " " $1,548.12 " " $1,474.40 " " $2,764.50 " " $2,395.90 "
WWH LAB/RAD FEE SCHEDULE - 4206 707582005 75820 (IA) RAD XR VENOGRAM EXTREMITY UNILATERAL 401.00 $360.90 $160.40 $320.80 $224.56 $280.70 $256.64 $320.80 $312.78 $180.45 $164.41 $168.42 $160.40 $300.75 $260.65
WWH LAB/RAD FEE SCHEDULE - 4206 707598405 75984 (IA) RAD XR CATHETER CHANGE NON GASTRO TUBE 402.00 $361.80 $160.80 $321.60 $225.12 $281.40 $257.28 $321.60 $313.56 $180.90 $164.82 $168.84 $160.80 $301.50 $261.30
WWH LAB/RAD FEE SCHEDULE - 4206 707598901 75989 (IA) RAD CT GUIDE PERC DRAIN CATH 868.00 $781.20 $347.20 $694.40 $486.08 $607.60 $555.52 $694.40 $677.04 $390.60 $355.88 $364.56 $347.20 $651.00 $564.20
WWH LAB/RAD FEE SCHEDULE - 4206 707600005 76000 (IA) RAD XR FLUOROSCOPY UP TO 1 HOUR 574.00 $516.60 $229.60 $459.20 $321.44 $401.80 $367.36 $459.20 $447.72 $258.30 $235.34 $241.08 $229.60 $430.50 $373.10
WWH LAB/RAD FEE SCHEDULE - 4206 707601005 76010 (IA) RAD XR NOSE TO RECTUM OF CHILD FOR FOREIGN BODY 216.00 $194.40 $86.40 $172.80 $120.96 $151.20 $138.24 $172.80 $168.48 $97.20 $88.56 $90.72 $86.40 $162.00 $140.40
WWH LAB/RAD FEE SCHEDULE - 4206 707608005 76080 (IA) RAD XR ABSCESS/FISTULA/SINUS TRACT 280.00 $252.00 $112.00 $224.00 $156.80 $196.00 $179.20 $224.00 $218.40 $126.00 $114.80 $117.60 $112.00 $210.00 $182.00
WWH LAB/RAD FEE SCHEDULE - 4206 707609800 76098 (IA) RAD XR SURGICAL SPECIMEN 307.00 $276.30 $122.80 $245.60 $171.92 $214.90 $196.48 $245.60 $239.46 $138.15 $125.87 $128.94 $122.80 $230.25 $199.55
WWH LAB/RAD FEE SCHEDULE - 4206 707637601 76376 (IA) RAD CT 3D RECONSTRUCTION WO POSTPROCESS INDP WKST 401.00 $360.90 $160.40 $320.80 $224.56 $280.70 $256.64 $320.80 $312.78 $180.45 $164.41 $168.42 $160.40 $300.75 $260.65
WWH LAB/RAD FEE SCHEDULE - 4206 707653600 76536 (IA) RAD US NECK OR HEAD SOFT TISSUE 752.00 $676.80 $300.80 $601.60 $421.12 $526.40 $481.28 $601.60 $586.56 $338.40 $308.32 $315.84 $300.80 $564.00 $488.80
WWH LAB/RAD FEE SCHEDULE - 4206 707660400 76604 (IA) RAD US CHEST 461.00 $414.90 $184.40 $368.80 $258.16 $322.70 $295.04 $368.80 $359.58 $207.45 $189.01 $193.62 $184.40 $345.75 $299.65
WWH LAB/RAD FEE SCHEDULE - 4206 707664100 76641 (IA) RAD US BREAST COMPLETE 473.00 $425.70 $189.20 $378.40 $264.88 $331.10 $302.72 $378.40 $368.94 $212.85 $193.93 $198.66 $189.20 $354.75 $307.45
WWH LAB/RAD FEE SCHEDULE - 4206 707664200 76642 (IA) RAD US BREAST LIMITED 552.00 $496.80 $220.80 $441.60 $309.12 $386.40 $353.28 $441.60 $430.56 $248.40 $226.32 $231.84 $220.80 $414.00 $358.80
WWH LAB/RAD FEE SCHEDULE - 4206 707670000 76700 (IA) RAD US ABDOMEN COMPLETE "1,027.00" $924.30 $410.80 $821.60 $575.12 $718.90 $657.28 $821.60 $801.06 $462.15 $421.07 $431.34 $410.80 $770.25 $667.55
WWH LAB/RAD FEE SCHEDULE - 4206 707670500 76705 (IA) RAD US ABDOMEN LIMITED 563.00 $506.70 $225.20 $450.40 $315.28 $394.10 $360.32 $450.40 $439.14 $253.35 $230.83 $236.46 $225.20 $422.25 $365.95
WWH LAB/RAD FEE SCHEDULE - 4206 707670600 76706 (IA) RAD US ABD AORTA SCREENING 492.00 $442.80 $196.80 $393.60 $275.52 $344.40 $314.88 $393.60 $383.76 $221.40 $201.72 $206.64 $196.80 $369.00 $319.80
WWH LAB/RAD FEE SCHEDULE - 4206 707677000 76770 (IA) RAD US RETROPERITONEAL COMPLETE "1,016.00" $914.40 $406.40 $812.80 $568.96 $711.20 $650.24 $812.80 $792.48 $457.20 $416.56 $426.72 $406.40 $762.00 $660.40
WWH LAB/RAD FEE SCHEDULE - 4206 707677500 76775 (IA) RAD US RETROPERITONEAL LIMITED STUDY 764.00 $687.60 $305.60 $611.20 $427.84 $534.80 $488.96 $611.20 $595.92 $343.80 $313.24 $320.88 $305.60 $573.00 $496.60
WWH LAB/RAD FEE SCHEDULE - 4206 707677560 76775 (IA) RAD US RENAL TRANSPLANT 480.00 $432.00 $192.00 $384.00 $268.80 $336.00 $307.20 $384.00 $374.40 $216.00 $196.80 $201.60 $192.00 $360.00 $312.00
WWH LAB/RAD FEE SCHEDULE - 4206 707677600 76776 (IA) RAD US RENAL TRANSPLANT WITH DUPLEX DOPPLER 579.00 $521.10 $231.60 $463.20 $324.24 $405.30 $370.56 $463.20 $451.62 $260.55 $237.39 $243.18 $231.60 $434.25 $376.35
WWH LAB/RAD FEE SCHEDULE - 4206 707680000 76800 (IA) RAD US SPINAL CANAL AND CONTENTS 620.00 $558.00 $248.00 $496.00 $347.20 $434.00 $396.80 $496.00 $483.60 $279.00 $254.20 $260.40 $248.00 $465.00 $403.00
WWH LAB/RAD FEE SCHEDULE - 4206 707680100 76801 (IA) RAD US OB 1ST TRI SINGLE TRANSABD 839.00 $755.10 $335.60 $671.20 $469.84 $587.30 $536.96 $671.20 $654.42 $377.55 $343.99 $352.38 $335.60 $629.25 $545.35
WWH LAB/RAD FEE SCHEDULE - 4206 707680200 76802 (IA) RAD US OB 1ST TRI EACH ADDL GESTATION TRANSABD 625.00 $562.50 $250.00 $500.00 $350.00 $437.50 $400.00 $500.00 $487.50 $281.25 $256.25 $262.50 $250.00 $468.75 $406.25
WWH LAB/RAD FEE SCHEDULE - 4206 707680500 76805 (IA) RAD US OB EQUAL OR GREATER THAN 14 WKS SINGLE GEST 881.00 $792.90 $352.40 $704.80 $493.36 $616.70 $563.84 $704.80 $687.18 $396.45 $361.21 $370.02 $352.40 $660.75 $572.65
WWH LAB/RAD FEE SCHEDULE - 4206 707681000 76810 (IA) RAD US OB EQUAL OR GREATER THAN 14 WKS EA ADDL GEST 826.00 $743.40 $330.40 $660.80 $462.56 $578.20 $528.64 $660.80 $644.28 $371.70 $338.66 $346.92 $330.40 $619.50 $536.90
WWH LAB/RAD FEE SCHEDULE - 4206 707681100 76811 (IA) RAD US OB FETAL ANATOMY SINGLE GESTATION "1,027.00" $924.30 $410.80 $821.60 $575.12 $718.90 $657.28 $821.60 $801.06 $462.15 $421.07 $431.34 $410.80 $770.25 $667.55
WWH LAB/RAD FEE SCHEDULE - 4206 707681200 76812 (IA) RAD US OB DETAIL FETAL ANATOMY EACH ADDL GESTATION 826.00 $743.40 $330.40 $660.80 $462.56 $578.20 $528.64 $660.80 $644.28 $371.70 $338.66 $346.92 $330.40 $619.50 $536.90
WWH LAB/RAD FEE SCHEDULE - 4206 707681300 76813 (IA) RAD US OB NUCHAL TRANSLUCENCY SINGLE GEST 602.00 $541.80 $240.80 $481.60 $337.12 $421.40 $385.28 $481.60 $469.56 $270.90 $246.82 $252.84 $240.80 $451.50 $391.30
WWH LAB/RAD FEE SCHEDULE - 4206 707681400 76814 (IA) RAD US OB NUCHAL TRANSLUCENCY EACH ADDL GESTATION 399.00 $359.10 $159.60 $319.20 $223.44 $279.30 $255.36 $319.20 $311.22 $179.55 $163.59 $167.58 $159.60 $299.25 $259.35
WWH LAB/RAD FEE SCHEDULE - 4206 707681500 76815 (IA) RAD US OB LIMITED ANY TRI 1 OR MORE FETUSES 622.00 $559.80 $248.80 $497.60 $348.32 $435.40 $398.08 $497.60 $485.16 $279.90 $255.02 $261.24 $248.80 $466.50 $404.30
WWH LAB/RAD FEE SCHEDULE - 4206 707681600 76816 (IA) RAD US OB FOLLOW UP ANY TRI SINGLE TRANSABD 553.00 $497.70 $221.20 $442.40 $309.68 $387.10 $353.92 $442.40 $431.34 $248.85 $226.73 $232.26 $221.20 $414.75 $359.45
WWH LAB/RAD FEE SCHEDULE - 4206 707681700 76817 (IA) RAD US OB TRANSVAGINAL 826.00 $743.40 $330.40 $660.80 $462.56 $578.20 $528.64 $660.80 $644.28 $371.70 $338.66 $346.92 $330.40 $619.50 $536.90
WWH LAB/RAD FEE SCHEDULE - 4206 707681752 76817 (IA) RAD US OB TRANSVAGINAL LTD 826.00 $743.40 $330.40 $660.80 $462.56 $578.20 $528.64 $660.80 $644.28 $371.70 $338.66 $346.92 $330.40 $619.50 $536.90
WWH LAB/RAD FEE SCHEDULE - 4206 707681800 76818 (IA) RAD US OB BIOPHYSICAL PROFILE W NONSTRESS TESTING 806.00 $725.40 $322.40 $644.80 $451.36 $564.20 $515.84 $644.80 $628.68 $362.70 $330.46 $338.52 $322.40 $604.50 $523.90
WWH LAB/RAD FEE SCHEDULE - 4206 707681900 76819 (IA) RAD US OB BIOPHYSICAL PROFILE WO NONSTRESS TESTING 817.00 $735.30 $326.80 $653.60 $457.52 $571.90 $522.88 $653.60 $637.26 $367.65 $334.97 $343.14 $326.80 $612.75 $531.05
WWH LAB/RAD FEE SCHEDULE - 4206 707682000 76820 (IA) RAD US FETAL DOPPLER VELOCIMETRY UMBILICAL ARTERY 327.00 $294.30 $130.80 $261.60 $183.12 $228.90 $209.28 $261.60 $255.06 $147.15 $134.07 $137.34 $130.80 $245.25 $212.55
WWH LAB/RAD FEE SCHEDULE - 4206 707683000 76830 (IA) RAD US TRANSVAGINAL 699.00 $629.10 $279.60 $559.20 $391.44 $489.30 $447.36 $559.20 $545.22 $314.55 $286.59 $293.58 $279.60 $524.25 $454.35
WWH LAB/RAD FEE SCHEDULE - 4206 707683001 76830 (IA) RAD US PELVIS COMPLETE TV ADD ON "1,030.00" $927.00 $412.00 $824.00 $576.80 $721.00 $659.20 $824.00 $803.40 $463.50 $422.30 $432.60 $412.00 $772.50 $669.50
WWH LAB/RAD FEE SCHEDULE - 4206 707683002 76830 (IA) RAD US TRANSVAGINAL FOLLICLE STUDY "1,030.00" $927.00 $412.00 $824.00 $576.80 $721.00 $659.20 $824.00 $803.40 $463.50 $422.30 $432.60 $412.00 $772.50 $669.50
WWH LAB/RAD FEE SCHEDULE - 4206 707683100 76831 (IA) RAD US HYSTEROSONOGRAM 762.00 $685.80 $304.80 $609.60 $426.72 $533.40 $487.68 $609.60 $594.36 $342.90 $312.42 $320.04 $304.80 $571.50 $495.30
WWH LAB/RAD FEE SCHEDULE - 4206 707685600 76856 (IA) RAD US PELVIS COMPLETE NONOBSTETRIC 983.00 $884.70 $393.20 $786.40 $550.48 $688.10 $629.12 $786.40 $766.74 $442.35 $403.03 $412.86 $393.20 $737.25 $638.95
WWH LAB/RAD FEE SCHEDULE - 4206 707685700 76857 (IA) RAD US PELVIS LIMITED STUDY 272.00 $244.80 $108.80 $217.60 $152.32 $190.40 $174.08 $217.60 $212.16 $122.40 $111.52 $114.24 $108.80 $204.00 $176.80
WWH LAB/RAD FEE SCHEDULE - 4206 707687000 76870 (IA) RAD US SCROTUM 889.00 $800.10 $355.60 $711.20 $497.84 $622.30 $568.96 $711.20 $693.42 $400.05 $364.49 $373.38 $355.60 $666.75 $577.85
WWH LAB/RAD FEE SCHEDULE - 4206 707687200 76872 (IA) RAD US TRANSRECTAL 684.00 $615.60 $273.60 $547.20 $383.04 $478.80 $437.76 $547.20 $533.52 $307.80 $280.44 $287.28 $273.60 $513.00 $444.60
WWH LAB/RAD FEE SCHEDULE - 4206 707687300 76873 (IA) RAD US PROSTATE VOLUME STUDY PRE IMPLANT 664.00 $597.60 $265.60 $531.20 $371.84 $464.80 $424.96 $531.20 $517.92 $298.80 $272.24 $278.88 $265.60 $498.00 $431.60
WWH LAB/RAD FEE SCHEDULE - 4206 707688200 76882 (IA) RAD US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG 322.00 $289.80 $128.80 $257.60 $180.32 $225.40 $206.08 $257.60 $251.16 $144.90 $132.02 $135.24 $128.80 $241.50 $209.30
WWH LAB/RAD FEE SCHEDULE - 4206 707693704 76937 (IA) RAD US GUIDED VASCULAR ACCESS 156.00 $140.40 $62.40 $124.80 $87.36 $109.20 $99.84 $124.80 $121.68 $70.20 $63.96 $65.52 $62.40 $117.00 $101.40
WWH LAB/RAD FEE SCHEDULE - 4206 707694204 76942 (IA) RAD US GUIDED NEEDLE PLACEMENT 618.00 $556.20 $247.20 $494.40 $346.08 $432.60 $395.52 $494.40 $482.04 $278.10 $253.38 $259.56 $247.20 $463.50 $401.70
WWH LAB/RAD FEE SCHEDULE - 4206 707694600 76946 (IA) RAD US GUIDANCE AMNIOCENTESIS 375.00 $337.50 $150.00 $300.00 $210.00 $262.50 $240.00 $300.00 $292.50 $168.75 $153.75 $157.50 $150.00 $281.25 $243.75
WWH LAB/RAD FEE SCHEDULE - 4206 707698100 76981 (IA) RAD US ELASTOGRAPHY PARENCHYMA 304.00 $273.60 $121.60 $243.20 $170.24 $212.80 $194.56 $243.20 $237.12 $136.80 $124.64 $127.68 $121.60 $228.00 $197.60
WWH LAB/RAD FEE SCHEDULE - 4206 707700105 77001 (IA) RAD XR FLUROSCOPY FOR CENTRAL VENOUS ACCESS DEVICE PLACEMENT 639.00 $575.10 $255.60 $511.20 $357.84 $447.30 $408.96 $511.20 $498.42 $287.55 $261.99 $268.38 $255.60 $479.25 $415.35
WWH LAB/RAD FEE SCHEDULE - 4206 707700205 77002 (IA) RAD XR FLUORO GUIDANCE FOR NEEDLE PLACEMENT 570.00 $513.00 $228.00 $456.00 $319.20 $399.00 $364.80 $456.00 $444.60 $256.50 $233.70 $239.40 $228.00 $427.50 $370.50
WWH LAB/RAD FEE SCHEDULE - 4206 707700305 77003 (IA) RAD XR FLUORO GUIDED SPINAL INJECTION 541.00 $486.90 $216.40 $432.80 $302.96 $378.70 $346.24 $432.80 $421.98 $243.45 $221.81 $227.22 $216.40 $405.75 $351.65
WWH LAB/RAD FEE SCHEDULE - 4206 707701201 77012 (IA) RAD CT GUIDED NEEDLE PLACEMENT "1,019.00" $917.10 $407.60 $815.20 $570.64 $713.30 $652.16 $815.20 $794.82 $458.55 $417.79 $427.98 $407.60 $764.25 $662.35
WWH LAB/RAD FEE SCHEDULE - 4206 707706300 77063 (IA) RAD XR SCREENING MAMMO TOMOSYNTHESIS BILAT 81.00 $72.90 $32.40 $64.80 $45.36 $56.70 $51.84 $64.80 $63.18 $36.45 $33.21 $34.02 $32.40 $60.75 $52.65
WWH LAB/RAD FEE SCHEDULE - 4206 707706352 77063 (IA) RAD XR SCREENING MAMMO TOMOSYNTHESIS UNILAT 173.00 $155.70 $69.20 $138.40 $96.88 $121.10 $110.72 $138.40 $134.94 $77.85 $70.93 $72.66 $69.20 $129.75 $112.45
WWH LAB/RAD FEE SCHEDULE - 4206 707706500 77065 (IA) RAD XR MAMMO UNI DIAGNOSTIC WWO CAD 490.00 $441.00 $196.00 $392.00 $274.40 $343.00 $313.60 $392.00 $382.20 $220.50 $200.90 $205.80 $196.00 $367.50 $318.50
WWH LAB/RAD FEE SCHEDULE - 4206 707706501 77065 (IA) RAD XR MAMMO UNI DIAGNOSTIC 3D WWO CAD 490.00 $441.00 $196.00 $392.00 $274.40 $343.00 $313.60 $392.00 $382.20 $220.50 $200.90 $205.80 $196.00 $367.50 $318.50
WWH LAB/RAD FEE SCHEDULE - 4206 707706563 77065 (IA) RAD XR MAMMO UNI DIAGNOSTIC W IMPLANT WWO CAD 490.00 $441.00 $196.00 $392.00 $274.40 $343.00 $313.60 $392.00 $382.20 $220.50 $200.90 $205.80 $196.00 $367.50 $318.50
WWH LAB/RAD FEE SCHEDULE - 4206 707706600 77066 (IA) RAD XR MAMMO BILAT DIAGNOSTIC WWO CAD 554.00 $498.60 $221.60 $443.20 $310.24 $387.80 $354.56 $443.20 $432.12 $249.30 $227.14 $232.68 $221.60 $415.50 $360.10
WWH LAB/RAD FEE SCHEDULE - 4206 707706601 77066 (IA) RAD XR MAMMO BILAT DIAGNOSTIC 3D WWO CAD 554.00 $498.60 $221.60 $443.20 $310.24 $387.80 $354.56 $443.20 $432.12 $249.30 $227.14 $232.68 $221.60 $415.50 $360.10
WWH LAB/RAD FEE SCHEDULE - 4206 707706700 77067 (IA) RAD XR MAMMO BILAT SCREENING WWO CAD 509.00 $458.10 $203.60 $407.20 $285.04 $356.30 $325.76 $407.20 $397.02 $229.05 $208.69 $213.78 $203.60 $381.75 $330.85
WWH LAB/RAD FEE SCHEDULE - 4206 707706701 77067 (IA) RAD XR MAMMO UNI SCREENING 3D WWO CAD 481.00 $432.90 $192.40 $384.80 $269.36 $336.70 $307.84 $384.80 $375.18 $216.45 $197.21 $202.02 $192.40 $360.75 $312.65
WWH LAB/RAD FEE SCHEDULE - 4206 707706702 77067 (IA) RAD XR MAMMO BILAT SCREENING 3D WWO CAD 509.00 $458.10 $203.60 $407.20 $285.04 $356.30 $325.76 $407.20 $397.02 $229.05 $208.69 $213.78 $203.60 $381.75 $330.85
WWH LAB/RAD FEE SCHEDULE - 4206 707706752 77067 (IA) RAD XR MAMMO BILAT SCREENING LTD WWO CAD 481.00 $432.90 $192.40 $384.80 $269.36 $336.70 $307.84 $384.80 $375.18 $216.45 $197.21 $202.02 $192.40 $360.75 $312.65
WWH LAB/RAD FEE SCHEDULE - 4206 707706761 77067 (IA) RAD XR MAMMO BILAT SCREENING W IMPLANT WWO CAD 481.00 $432.90 $192.40 $384.80 $269.36 $336.70 $307.84 $384.80 $375.18 $216.45 $197.21 $202.02 $192.40 $360.75 $312.65
WWH LAB/RAD FEE SCHEDULE - 4206 707707200 77072 (IA) RAD XR BONE AGE STUDIES 174.00 $156.60 $69.60 $139.20 $97.44 $121.80 $111.36 $139.20 $135.72 $78.30 $71.34 $73.08 $69.60 $130.50 $113.10
WWH LAB/RAD FEE SCHEDULE - 4206 707707400 77074 (IA) RAD XR BONE SURVEY LIMITED STUDY 364.00 $327.60 $145.60 $291.20 $203.84 $254.80 $232.96 $291.20 $283.92 $163.80 $149.24 $152.88 $145.60 $273.00 $236.60
WWH LAB/RAD FEE SCHEDULE - 4206 707707500 77075 (IA) RAD XR BONE SURVEY COMPLETE 491.00 $441.90 $196.40 $392.80 $274.96 $343.70 $314.24 $392.80 $382.98 $220.95 $201.31 $206.22 $196.40 $368.25 $319.15
WWH LAB/RAD FEE SCHEDULE - 4206 707707600 77076 (IA) RAD XR BONE SURVEY INFANT/CHILD 503.00 $452.70 $201.20 $402.40 $281.68 $352.10 $321.92 $402.40 $392.34 $226.35 $206.23 $211.26 $201.20 $377.25 $326.95
WWH LAB/RAD FEE SCHEDULE - 4206 707708000 77080 (IA) RAD XR DEXA BONE DENSITY 1 SITE AXIAL SKELETON 387.00 $348.30 $154.80 $309.60 $216.72 $270.90 $247.68 $309.60 $301.86 $174.15 $158.67 $162.54 $154.80 $290.25 $251.55
WWH LAB/RAD FEE SCHEDULE - 4206 707708001 77080 (IA) RAD XR DEXA BONE DENSITY 2 SITES AXIAL SKELETON 408.00 $367.20 $163.20 $326.40 $228.48 $285.60 $261.12 $326.40 $318.24 $183.60 $167.28 $171.36 $163.20 $306.00 $265.20
WWH LAB/RAD FEE SCHEDULE - 4206 707708100 77081 (IA) RAD XR DEXA BONE DENSITY PERIPHERAL SKELETON 156.00 $140.40 $62.40 $124.80 $87.36 $109.20 $99.84 $124.80 $121.68 $70.20 $63.96 $65.52 $62.40 $117.00 $101.40
WWH LAB/RAD FEE SCHEDULE - 4206 707801300 78013 (IA) RAD NM THYROID IMAGING WITH VASCULAR FLOW 882.00 $793.80 $352.80 $705.60 $493.92 $617.40 $564.48 $705.60 $687.96 $396.90 $361.62 $370.44 $352.80 $661.50 $573.30
WWH LAB/RAD FEE SCHEDULE - 4206 707801400 78014 (IA) RAD NM THYROID UPTAKE W FLOW QUANTITATIVE MEASURE "1,058.00" $952.20 $423.20 $846.40 $592.48 $740.60 $677.12 $846.40 $825.24 $476.10 $433.78 $444.36 $423.20 $793.50 $687.70
WWH LAB/RAD FEE SCHEDULE - 4206 707807000 78070 (IA) RAD NM PARATHYROID SCAN 662.00 $595.80 $264.80 $529.60 $370.72 $463.40 $423.68 $529.60 $516.36 $297.90 $271.42 $278.04 $264.80 $496.50 $430.30
WWH LAB/RAD FEE SCHEDULE - 4206 707819500 78195 (IA) RAD NM LYMPHATICS AND LYMPH NODE IMAGING "3,499.00" " $3,149.10 " " $1,399.60 " " $2,799.20 " " $1,959.44 " " $2,449.30 " " $2,239.36 " " $2,799.20 " " $2,729.22 " " $1,574.55 " " $1,434.59 " " $1,469.58 " " $1,399.60 " " $2,624.25 " " $2,274.35 "
WWH LAB/RAD FEE SCHEDULE - 4206 707821500 78215 (IA) RAD NM LIVER SPLEEN STATIC ONLY 643.00 $578.70 $257.20 $514.40 $360.08 $450.10 $411.52 $514.40 $501.54 $289.35 $263.63 $270.06 $257.20 $482.25 $417.95
WWH LAB/RAD FEE SCHEDULE - 4206 707821600 78216 (IA) RAD NM LIVER SPLEEN W VASCULAR FLOW 569.00 $512.10 $227.60 $455.20 $318.64 $398.30 $364.16 $455.20 $443.82 $256.05 $233.29 $238.98 $227.60 $426.75 $369.85
WWH LAB/RAD FEE SCHEDULE - 4206 707822600 78226 (IA) RAD NM HEPATOBILIARY "1,988.00" " $1,789.20 " $795.20 " $1,590.40 " " $1,113.28 " " $1,391.60 " " $1,272.32 " " $1,590.40 " " $1,550.64 " $894.60 $815.08 $834.96 $795.20 " $1,491.00 " " $1,292.20 "
WWH LAB/RAD FEE SCHEDULE - 4206 707822700 78227 (IA) RAD NM HEPATOBILIARY W PHARM INTERVENTION "2,435.00" " $2,191.50 " $974.00 " $1,948.00 " " $1,363.60 " " $1,704.50 " " $1,558.40 " " $1,948.00 " " $1,899.30 " " $1,095.75 " $998.35 " $1,022.70 " $974.00 " $1,826.25 " " $1,582.75 "
WWH LAB/RAD FEE SCHEDULE - 4206 707826100 78261 (IA) RAD NM GASTRIC MUCOSA IMAGING "1,120.00" " $1,008.00 " $448.00 $896.00 $627.20 $784.00 $716.80 $896.00 $873.60 $504.00 $459.20 $470.40 $448.00 $840.00 $728.00
WWH LAB/RAD FEE SCHEDULE - 4206 707826400 78264 (IA) RAD NM GASTRIC EMPTYING "1,652.00" " $1,486.80 " $660.80 " $1,321.60 " $925.12 " $1,156.40 " " $1,057.28 " " $1,321.60 " " $1,288.56 " $743.40 $677.32 $693.84 $660.80 " $1,239.00 " " $1,073.80 "
WWH LAB/RAD FEE SCHEDULE - 4206 707826500 78265 (IA) RAD NM GASTRIC EMPTYING W SMALL BOWEL "2,680.00" " $2,412.00 " " $1,072.00 " " $2,144.00 " " $1,500.80 " " $1,876.00 " " $1,715.20 " " $2,144.00 " " $2,090.40 " " $1,206.00 " " $1,098.80 " " $1,125.60 " " $1,072.00 " " $2,010.00 " " $1,742.00 "
WWH LAB/RAD FEE SCHEDULE - 4206 707827800 78278 (IA) RAD NM GI BLOOD LOSS "2,512.00" " $2,260.80 " " $1,004.80 " " $2,009.60 " " $1,406.72 " " $1,758.40 " " $1,607.68 " " $2,009.60 " " $1,959.36 " " $1,130.40 " " $1,029.92 " " $1,055.04 " " $1,004.80 " " $1,884.00 " " $1,632.80 "
WWH LAB/RAD FEE SCHEDULE - 4206 707829000 78290 (IA) RAD NM MECKELS "1,705.00" " $1,534.50 " $682.00 " $1,364.00 " $954.80 " $1,193.50 " " $1,091.20 " " $1,364.00 " " $1,329.90 " $767.25 $699.05 $716.10 $682.00 " $1,278.75 " " $1,108.25 "
WWH LAB/RAD FEE SCHEDULE - 4206 707830000 78300 (IA) RAD NM BONE SCAN LIMITED AREA "1,082.00" $973.80 $432.80 $865.60 $605.92 $757.40 $692.48 $865.60 $843.96 $486.90 $443.62 $454.44 $432.80 $811.50 $703.30
WWH LAB/RAD FEE SCHEDULE - 4206 707830500 78305 (IA) RAD NM BONE SCAN MULTIPLE AREAS "1,066.00" $959.40 $426.40 $852.80 $596.96 $746.20 $682.24 $852.80 $831.48 $479.70 $437.06 $447.72 $426.40 $799.50 $692.90
WWH LAB/RAD FEE SCHEDULE - 4206 707830600 78306 (IA) RAD NM BONE SCAN WHOLE BODY "1,640.00" " $1,476.00 " $656.00 " $1,312.00 " $918.40 " $1,148.00 " " $1,049.60 " " $1,312.00 " " $1,279.20 " $738.00 $672.40 $688.80 $656.00 " $1,230.00 " " $1,066.00 "
WWH LAB/RAD FEE SCHEDULE - 4206 707831500 78315 (IA) RAD NM BONE SCAN 3 PHASE "1,932.00" " $1,738.80 " $772.80 " $1,545.60 " " $1,081.92 " " $1,352.40 " " $1,236.48 " " $1,545.60 " " $1,506.96 " $869.40 $792.12 $811.44 $772.80 " $1,449.00 " " $1,255.80 "
WWH LAB/RAD FEE SCHEDULE - 4206 707845100 78451 (IA) RAD NM MYOCARD SPECT SINGLE STUDY REST OR STRESS "2,285.00" " $2,056.50 " $914.00 " $1,828.00 " " $1,279.60 " " $1,599.50 " " $1,462.40 " " $1,828.00 " " $1,782.30 " " $1,028.25 " $936.85 $959.70 $914.00 " $1,713.75 " " $1,485.25 "
WWH LAB/RAD FEE SCHEDULE - 4206 707845200 78452 (IA) RAD NM CARDIAC MYOCARD MULT SPECT WWO EF AND WM "4,882.00" " $4,393.80 " " $1,952.80 " " $3,905.60 " " $2,733.92 " " $3,417.40 " " $3,124.48 " " $3,905.60 " " $3,807.96 " " $2,196.90 " " $2,001.62 " " $2,050.44 " " $1,952.80 " " $3,661.50 " " $3,173.30 "
WWH LAB/RAD FEE SCHEDULE - 4206 707847200 78472 (IA) RAD NM CARDIAC MUGA LEFT VENTRICLE 992.00 $892.80 $396.80 $793.60 $555.52 $694.40 $634.88 $793.60 $773.76 $446.40 $406.72 $416.64 $396.80 $744.00 $644.80
WWH LAB/RAD FEE SCHEDULE - 4206 707857900 78579 (IA) RAD NM LUNG VENTILATION SCAN 839.00 $755.10 $335.60 $671.20 $469.84 $587.30 $536.96 $671.20 $654.42 $377.55 $343.99 $352.38 $335.60 $629.25 $545.35
WWH LAB/RAD FEE SCHEDULE - 4206 707858000 78580 (IA) RAD NM LUNG PERFUSION SCAN "2,084.00" " $1,875.60 " $833.60 " $1,667.20 " " $1,167.04 " " $1,458.80 " " $1,333.76 " " $1,667.20 " " $1,625.52 " $937.80 $854.44 $875.28 $833.60 " $1,563.00 " " $1,354.60 "
WWH LAB/RAD FEE SCHEDULE - 4206 707858200 78582 (IA) RAD NM LUNG VENTILATION AND PERFUSION SCAN "2,706.00" " $2,435.40 " " $1,082.40 " " $2,164.80 " " $1,515.36 " " $1,894.20 " " $1,731.84 " " $2,164.80 " " $2,110.68 " " $1,217.70 " " $1,109.46 " " $1,136.52 " " $1,082.40 " " $2,029.50 " " $1,758.90 "
WWH LAB/RAD FEE SCHEDULE - 4206 707870700 78707 (IA) RAD NM RENAL SCAN 824.00 $741.60 $329.60 $659.20 $461.44 $576.80 $527.36 $659.20 $642.72 $370.80 $337.84 $346.08 $329.60 $618.00 $535.60
WWH LAB/RAD FEE SCHEDULE - 4206 707870800 78708 (IA) RAD NM RENAL SINGLE W PHARM "1,698.00" " $1,528.20 " $679.20 " $1,358.40 " $950.88 " $1,188.60 " " $1,086.72 " " $1,358.40 " " $1,324.44 " $764.10 $696.18 $713.16 $679.20 " $1,273.50 " " $1,103.70 "
WWH LAB/RAD FEE SCHEDULE - 4206 707874000 78740 (IA) RAD NM VOIDING CYSTOGRAM "1,123.00" " $1,010.70 " $449.20 $898.40 $628.88 $786.10 $718.72 $898.40 $875.94 $505.35 $460.43 $471.66 $449.20 $842.25 $729.95
WWH LAB/RAD FEE SCHEDULE - 4206 7078814PI 78814 (IA) RAD PET CT LIMITED INITIAL TREATMENT "6,377.00" " $5,739.30 " " $2,550.80 " " $5,101.60 " " $3,571.12 " " $4,463.90 " " $4,081.28 " " $5,101.60 " " $4,974.06 " " $2,869.65 " " $2,614.57 " " $2,678.34 " " $2,550.80 " " $4,782.75 " " $4,145.05 "
WWH LAB/RAD FEE SCHEDULE - 4206 7078814PS 78814 (IA) RAD PET CT LIMITED SUBSEQUENT TREATMENT "6,377.00" " $5,739.30 " " $2,550.80 " " $5,101.60 " " $3,571.12 " " $4,463.90 " " $4,081.28 " " $5,101.60 " " $4,974.06 " " $2,869.65 " " $2,614.57 " " $2,678.34 " " $2,550.80 " " $4,782.75 " " $4,145.05 "
WWH LAB/RAD FEE SCHEDULE - 4206 7078815PI 78815 (IA) RAD PET CT SKULL BASE TO MID THIGH INITIAL TREAT "6,400.00" " $5,760.00 " " $2,560.00 " " $5,120.00 " " $3,584.00 " " $4,480.00 " " $4,096.00 " " $5,120.00 " " $4,992.00 " " $2,880.00 " " $2,624.00 " " $2,688.00 " " $2,560.00 " " $4,800.00 " " $4,160.00 "
WWH LAB/RAD FEE SCHEDULE - 4206 7078815PS 78815 (IA) RAD PET CT SKULL BASE TO MID THIGH SUBSEQUENT TREAT "6,400.00" " $5,760.00 " " $2,560.00 " " $5,120.00 " " $3,584.00 " " $4,480.00 " " $4,096.00 " " $5,120.00 " " $4,992.00 " " $2,880.00 " " $2,624.00 " " $2,688.00 " " $2,560.00 " " $4,800.00 " " $4,160.00 "
WWH LAB/RAD FEE SCHEDULE - 4206 7078816PI 78816 (IA) RAD PET CT WHOLE BODY INITIAL TREAT "6,400.00" " $5,760.00 " " $2,560.00 " " $5,120.00 " " $3,584.00 " " $4,480.00 " " $4,096.00 " " $5,120.00 " " $4,992.00 " " $2,880.00 " " $2,624.00 " " $2,688.00 " " $2,560.00 " " $4,800.00 " " $4,160.00 "
WWH LAB/RAD FEE SCHEDULE - 4206 7078816PS 78816 (IA) RAD PET CT WHOLE BODY SUBSEQUENT TREAT "6,400.00" " $5,760.00 " " $2,560.00 " " $5,120.00 " " $3,584.00 " " $4,480.00 " " $4,096.00 " " $5,120.00 " " $4,992.00 " " $2,880.00 " " $2,624.00 " " $2,688.00 " " $2,560.00 " " $4,800.00 " " $4,160.00 "
WWH LAB/RAD FEE SCHEDULE - 4206 709335600 93356 (IA) RAD ECHO MYOCARDIAL STRAIN IMAGING 456.00 $410.40 $182.40 $364.80 $255.36 $319.20 $291.84 $364.80 $355.68 $205.20 $186.96 $191.52 $182.40 $342.00 $296.40
WWH LAB/RAD FEE SCHEDULE - 4206 709388000 93880 (IA) RAD US CAROTID DUPLEX BILATERAL "1,551.00" " $1,395.90 " $620.40 " $1,240.80 " $868.56 " $1,085.70 " $992.64 " $1,240.80 " " $1,209.78 " $697.95 $635.91 $651.42 $620.40 " $1,163.25 " " $1,008.15 "
WWH LAB/RAD FEE SCHEDULE - 4206 709388200 93882 (IA) RAD US CAROTID DUPLEX LIMITED STUDY 349.00 $314.10 $139.60 $279.20 $195.44 $244.30 $223.36 $279.20 $272.22 $157.05 $143.09 $146.58 $139.60 $261.75 $226.85
WWH LAB/RAD FEE SCHEDULE - 4206 709392200 93922 (IA) RAD US UPPER OR LOWER BRACHIAL INDEX LTD STUDY BILAT 692.00 $622.80 $276.80 $553.60 $387.52 $484.40 $442.88 $553.60 $539.76 $311.40 $283.72 $290.64 $276.80 $519.00 $449.80
WWH LAB/RAD FEE SCHEDULE - 4206 709392260 93922 (IA) RAD US TOE PRESSURE ONLY BILAT 692.00 $622.80 $276.80 $553.60 $387.52 $484.40 $442.88 $553.60 $539.76 $311.40 $283.72 $290.64 $276.80 $519.00 $449.80
WWH LAB/RAD FEE SCHEDULE - 4206 709392300 93923 (IA) RAD US UPPER OR LOWER BRACHIAL INDEX BILATERAL COMPLETE 920.00 $828.00 $368.00 $736.00 $515.20 $644.00 $588.80 $736.00 $717.60 $414.00 $377.20 $386.40 $368.00 $690.00 $598.00
WWH LAB/RAD FEE SCHEDULE - 4206 709392360 93923 (IA) RAD US ARTERIAL SEG PRESSURES BILAT EXTREM W DIGIT 920.00 $828.00 $368.00 $736.00 $515.20 $644.00 $588.80 $736.00 $717.60 $414.00 $377.20 $386.40 $368.00 $690.00 $598.00
WWH LAB/RAD FEE SCHEDULE - 4206 709392361 93923 (IA) RAD US ARTERIAL SEG W TOE PRESSURES 920.00 $828.00 $368.00 $736.00 $515.20 $644.00 $588.80 $736.00 $717.60 $414.00 $377.20 $386.40 $368.00 $690.00 $598.00
WWH LAB/RAD FEE SCHEDULE - 4206 709392400 93924 (IA) RAD US ANKLE BRACHIAL BILAT COMPLETE POST STRESS TEST COMPLETE 672.00 $604.80 $268.80 $537.60 $376.32 $470.40 $430.08 $537.60 $524.16 $302.40 $275.52 $282.24 $268.80 $504.00 $436.80
WWH LAB/RAD FEE SCHEDULE - 4206 709392460 93924 (IA) RAD US ARTERIAL SEG PRESSURES W EXERCISE 672.00 $604.80 $268.80 $537.60 $376.32 $470.40 $430.08 $537.60 $524.16 $302.40 $275.52 $282.24 $268.80 $504.00 $436.80
WWH LAB/RAD FEE SCHEDULE - 4206 709392500 93925 (IA) RAD US LOWER EXTREMITY BILATERAL COMPLETE 899.00 $809.10 $359.60 $719.20 $503.44 $629.30 $575.36 $719.20 $701.22 $404.55 $368.59 $377.58 $359.60 $674.25 $584.35
WWH LAB/RAD FEE SCHEDULE - 4206 709392600 93926 (IA) RAD US ARTERIAL LOWER EXTREMITY LIMITED STUDY 668.00 $601.20 $267.20 $534.40 $374.08 $467.60 $427.52 $534.40 $521.04 $300.60 $273.88 $280.56 $267.20 $501.00 $434.20
WWH LAB/RAD FEE SCHEDULE - 4206 709393000 93930 (IA) RAD US ARTERIAL UPPER EXTREMITY BILATERAL COMPLETE 571.00 $513.90 $228.40 $456.80 $319.76 $399.70 $365.44 $456.80 $445.38 $256.95 $234.11 $239.82 $228.40 $428.25 $371.15
WWH LAB/RAD FEE SCHEDULE - 4206 709393100 93931 (IA) RAD US ARTERIAL UPPER EXTREMITY UNLATERAL OR LTD STUDY 552.00 $496.80 $220.80 $441.60 $309.12 $386.40 $353.28 $441.60 $430.56 $248.40 $226.32 $231.84 $220.80 $414.00 $358.80
WWH LAB/RAD FEE SCHEDULE - 4206 709397000 93970 (IA) RAD US DUPLEX SCAN EXTREMITY BILATERAL COMPLETE "1,394.00" " $1,254.60 " $557.60 " $1,115.20 " $780.64 $975.80 $892.16 " $1,115.20 " " $1,087.32 " $627.30 $571.54 $585.48 $557.60 " $1,045.50 " $906.10
WWH LAB/RAD FEE SCHEDULE - 4206 709397060 93970 (IA) RAD US VEIN MAPPING EXTREMITY BILATERAL "1,394.00" " $1,254.60 " $557.60 " $1,115.20 " $780.64 $975.80 $892.16 " $1,115.20 " " $1,087.32 " $627.30 $571.54 $585.48 $557.60 " $1,045.50 " $906.10
WWH LAB/RAD FEE SCHEDULE - 4206 709397061 93970 (IA) RAD US VENOUS INSUFFICIENCY LOWER EXTREMITY BILATERAL "1,394.00" " $1,254.60 " $557.60 " $1,115.20 " $780.64 $975.80 $892.16 " $1,115.20 " " $1,087.32 " $627.30 $571.54 $585.48 $557.60 " $1,045.50 " $906.10
WWH LAB/RAD FEE SCHEDULE - 4206 709397100 93971 (IA) RAD US DUPLEX SCAN EXTREMITY UNI OR LTD STUDY 891.00 $801.90 $356.40 $712.80 $498.96 $623.70 $570.24 $712.80 $694.98 $400.95 $365.31 $374.22 $356.40 $668.25 $579.15
WWH LAB/RAD FEE SCHEDULE - 4206 709397160 93971 (IA) RAD US VENOUS INSUFF OR VEIN MAPPING EXTREMITY UNILATERAL 891.00 $801.90 $356.40 $712.80 $498.96 $623.70 $570.24 $712.80 $694.98 $400.95 $365.31 $374.22 $356.40 $668.25 $579.15
WWH LAB/RAD FEE SCHEDULE - 4206 709397500 93975 (IA) RAD US DUPLEX SCAN ABDOMEN COMPLETE "1,014.00" $912.60 $405.60 $811.20 $567.84 $709.80 $648.96 $811.20 $790.92 $456.30 $415.74 $425.88 $405.60 $760.50 $659.10
WWH LAB/RAD FEE SCHEDULE - 4206 709397600 93976 (IA) RAD US DUPLEX SCAN ABDOMEN LTD STUDY 561.00 $504.90 $224.40 $448.80 $314.16 $392.70 $359.04 $448.80 $437.58 $252.45 $230.01 $235.62 $224.40 $420.75 $364.65
WWH LAB/RAD FEE SCHEDULE - 4206 709397601 93976 (IA) RAD US OVARY DUPLEX LIMITED 561.00 $504.90 $224.40 $448.80 $314.16 $392.70 $359.04 $448.80 $437.58 $252.45 $230.01 $235.62 $224.40 $420.75 $364.65
WWH LAB/RAD FEE SCHEDULE - 4206 709397660 93976 (IA) RAD US SCROTUM OR OVARY DUPLEX LIMITED STUDY 561.00 $504.90 $224.40 $448.80 $314.16 $392.70 $359.04 $448.80 $437.58 $252.45 $230.01 $235.62 $224.40 $420.75 $364.65
WWH LAB/RAD FEE SCHEDULE - 4206 709397800 93978 (IA) RAD US DUPLEX AORTA ILIACS INF VENA CAVA COMPLETE 535.00 $481.50 $214.00 $428.00 $299.60 $374.50 $342.40 $428.00 $417.30 $240.75 $219.35 $224.70 $214.00 $401.25 $347.75
WWH LAB/RAD FEE SCHEDULE - 4206 709397900 93979 (IA) RAD US DUPLEX AORTA ILIACS INF VENA CAVA LTD STUDY 509.00 $458.10 $203.60 $407.20 $285.04 $356.30 $325.76 $407.20 $397.02 $229.05 $208.69 $213.78 $203.60 $381.75 $330.85
WWH LAB/RAD FEE SCHEDULE - 4206 70C890000 C8900 (IA) RAD MR ANGIO ABDOMEN W "4,093.00" " $3,683.70 " " $1,637.20 " " $3,274.40 " " $2,292.08 " " $2,865.10 " " $2,619.52 " " $3,274.40 " " $3,192.54 " " $1,841.85 " " $1,678.13 " " $1,719.06 " " $1,637.20 " " $3,069.75 " " $2,660.45 "
WWH LAB/RAD FEE SCHEDULE - 4206 70C890100 C8901 (IA) RAD MR ANGIO ABDOMEN WO "4,093.00" " $3,683.70 " " $1,637.20 " " $3,274.40 " " $2,292.08 " " $2,865.10 " " $2,619.52 " " $3,274.40 " " $3,192.54 " " $1,841.85 " " $1,678.13 " " $1,719.06 " " $1,637.20 " " $3,069.75 " " $2,660.45 "
WWH LAB/RAD FEE SCHEDULE - 4206 70C890200 C8902 (IA) RAD MR ANGIO ABDOMEN WWO "4,093.00" " $3,683.70 " " $1,637.20 " " $3,274.40 " " $2,292.08 " " $2,865.10 " " $2,619.52 " " $3,274.40 " " $3,192.54 " " $1,841.85 " " $1,678.13 " " $1,719.06 " " $1,637.20 " " $3,069.75 " " $2,660.45 "
WWH LAB/RAD FEE SCHEDULE - 4206 70C890800 C8908 (IA) RAD MR BREAST BILATERAL WWO "2,318.00" " $2,086.20 " $927.20 " $1,854.40 " " $1,298.08 " " $1,622.60 " " $1,483.52 " " $1,854.40 " " $1,808.04 " " $1,043.10 " $950.38 $973.56 $927.20 " $1,738.50 " " $1,506.70 "
WWH LAB/RAD FEE SCHEDULE - 4206 70C890900 C8909 (IA) RAD MR ANGIO CHEST W "4,141.00" " $3,726.90 " " $1,656.40 " " $3,312.80 " " $2,318.96 " " $2,898.70 " " $2,650.24 " " $3,312.80 " " $3,229.98 " " $1,863.45 " " $1,697.81 " " $1,739.22 " " $1,656.40 " " $3,105.75 " " $2,691.65 "
WWH LAB/RAD FEE SCHEDULE - 4206 70C891000 C8910 (IA) RAD MR ANGIO CHEST WO "4,141.00" " $3,726.90 " " $1,656.40 " " $3,312.80 " " $2,318.96 " " $2,898.70 " " $2,650.24 " " $3,312.80 " " $3,229.98 " " $1,863.45 " " $1,697.81 " " $1,739.22 " " $1,656.40 " " $3,105.75 " " $2,691.65 "
WWH LAB/RAD FEE SCHEDULE - 4206 70C891052 C8910 (IA) RAD MR ANGIO CHEST WO LTD "4,141.00" " $3,726.90 " " $1,656.40 " " $3,312.80 " " $2,318.96 " " $2,898.70 " " $2,650.24 " " $3,312.80 " " $3,229.98 " " $1,863.45 " " $1,697.81 " " $1,739.22 " " $1,656.40 " " $3,105.75 " " $2,691.65 "
WWH LAB/RAD FEE SCHEDULE - 4206 70C891100 C8911 (IA) RAD MR ANGIO CHEST WWO "4,141.00" " $3,726.90 " " $1,656.40 " " $3,312.80 " " $2,318.96 " " $2,898.70 " " $2,650.24 " " $3,312.80 " " $3,229.98 " " $1,863.45 " " $1,697.81 " " $1,739.22 " " $1,656.40 " " $3,105.75 " " $2,691.65 "
WWH LAB/RAD FEE SCHEDULE - 4206 70C891200 C8912 (IA) RAD MR ANGIO LOWER EXTREMITY W "4,114.00" " $3,702.60 " " $1,645.60 " " $3,291.20 " " $2,303.84 " " $2,879.80 " " $2,632.96 " " $3,291.20 " " $3,208.92 " " $1,851.30 " " $1,686.74 " " $1,727.88 " " $1,645.60 " " $3,085.50 " " $2,674.10 "
WWH LAB/RAD FEE SCHEDULE - 4206 70C891300 C8913 (IA) RAD MR ANGIO LOWER EXTREMITY WO "4,114.00" " $3,702.60 " " $1,645.60 " " $3,291.20 " " $2,303.84 " " $2,879.80 " " $2,632.96 " " $3,291.20 " " $3,208.92 " " $1,851.30 " " $1,686.74 " " $1,727.88 " " $1,645.60 " " $3,085.50 " " $2,674.10 "
WWH LAB/RAD FEE SCHEDULE - 4206 70C891400 C8914 (IA) RAD MR ANGIO LOWER EXTREMITY WWO "4,114.00" " $3,702.60 " " $1,645.60 " " $3,291.20 " " $2,303.84 " " $2,879.80 " " $2,632.96 " " $3,291.20 " " $3,208.92 " " $1,851.30 " " $1,686.74 " " $1,727.88 " " $1,645.60 " " $3,085.50 " " $2,674.10 "
WWH LAB/RAD FEE SCHEDULE - 4206 70C891800 C8918 (IA) RAD MR ANGIO PELVIS W "4,109.00" " $3,698.10 " " $1,643.60 " " $3,287.20 " " $2,301.04 " " $2,876.30 " " $2,629.76 " " $3,287.20 " " $3,205.02 " " $1,849.05 " " $1,684.69 " " $1,725.78 " " $1,643.60 " " $3,081.75 " " $2,670.85 "
WWH LAB/RAD FEE SCHEDULE - 4206 70C891900 C8919 (IA) RAD MR ANGIO PELVIS WO "4,109.00" " $3,698.10 " " $1,643.60 " " $3,287.20 " " $2,301.04 " " $2,876.30 " " $2,629.76 " " $3,287.20 " " $3,205.02 " " $1,849.05 " " $1,684.69 " " $1,725.78 " " $1,643.60 " " $3,081.75 " " $2,670.85 "
WWH LAB/RAD FEE SCHEDULE - 4206 70C892000 C8920 (IA) RAD MR ANGIO PELVIS WWO "4,109.00" " $3,698.10 " " $1,643.60 " " $3,287.20 " " $2,301.04 " " $2,876.30 " " $2,629.76 " " $3,287.20 " " $3,205.02 " " $1,849.05 " " $1,684.69 " " $1,725.78 " " $1,643.60 " " $3,081.75 " " $2,670.85 "
WWH LAB/RAD FEE SCHEDULE - 4206 70C893700 C8937 (IA) RAD MR BREAST CAD 464.00 $417.60 $185.60 $371.20 $259.84 $324.80 $296.96 $371.20 $361.92 $208.80 $190.24 $194.88 $185.60 $348.00 $301.60
WWH LAB/RAD FEE SCHEDULE - 4206 70G025200 G0252 (IA) RAD PET CT BREAST CANCER INITIAL DX OR SURG PLAN "3,847.00" " $3,462.30 " " $1,538.80 " " $3,077.60 " " $2,154.32 " " $2,692.90 " " $2,462.08 " " $3,077.60 " " $3,000.66 " " $1,731.15 " " $1,577.27 " " $1,615.74 " " $1,538.80 " " $2,885.25 " " $2,500.55 "
WWH LAB/RAD FEE SCHEDULE - 4206 70G027900 G0279 (IA) RAD XR DIAGNOSTIC MAMMO TOMOSYNTHESIS BILAT 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH LAB/RAD FEE SCHEDULE - 4206 70G027901 G0279 (IA) RAD XR DIAGNOSTIC MAMMO TOMOSYNTHESIS UNILAT 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH LAB/RAD FEE SCHEDULE - 4206 80048 80048 PR BASIC METABOLIC PANEL CALCIUM TOTAL 107.00 $96.30 $42.80 $85.60 $59.92 $74.90 $68.48 $85.60 $83.46 $48.15 $43.87 $44.94 $42.80 $80.25 $69.55
WWH LAB/RAD FEE SCHEDULE - 4206 80053 80053 PR COMPREHENSIVE METABOLIC PANEL 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 80164 80164 PR DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL 141.00 $126.90 $56.40 $112.80 $78.96 $98.70 $90.24 $112.80 $109.98 $63.45 $57.81 $59.22 $56.40 $105.75 $91.65
WWH LAB/RAD FEE SCHEDULE - 4206 80167 80167 PR DRUG ASSAY FELBAMATE 94.00 $84.60 $37.60 $75.20 $52.64 $65.80 $60.16 $75.20 $73.32 $42.30 $38.54 $39.48 $37.60 $70.50 $61.10
WWH LAB/RAD FEE SCHEDULE - 4206 80175 80175 PR DRUG SCREEN QUANTITATIVE LAMOTRIGINE 67.00 $60.30 $26.80 $53.60 $37.52 $46.90 $42.88 $53.60 $52.26 $30.15 $27.47 $28.14 $26.80 $50.25 $43.55
WWH LAB/RAD FEE SCHEDULE - 4206 80177 80177 PR DRUG SCREEN QUANTITATIVE LEVETIRACETAM 92.00 $82.80 $36.80 $73.60 $51.52 $64.40 $58.88 $73.60 $71.76 $41.40 $37.72 $38.64 $36.80 $69.00 $59.80
WWH LAB/RAD FEE SCHEDULE - 4206 80178 80178 PR DRUG SCREEN QUANTITATIVE LITHIUM 67.00 $60.30 $26.80 $53.60 $37.52 $46.90 $42.88 $53.60 $52.26 $30.15 $27.47 $28.14 $26.80 $50.25 $43.55
WWH LAB/RAD FEE SCHEDULE - 4206 80183 80183 PR DRUG SCREEN QUANTITATIVE OXCARBAZEPINE 137.00 $123.30 $54.80 $109.60 $76.72 $95.90 $87.68 $109.60 $106.86 $61.65 $56.17 $57.54 $54.80 $102.75 $89.05
WWH LAB/RAD FEE SCHEDULE - 4206 80189 80189 PR DRUG ASSAY ITRACONAZOLE 224.00 $201.60 $89.60 $179.20 $125.44 $156.80 $143.36 $179.20 $174.72 $100.80 $91.84 $94.08 $89.60 $168.00 $145.60
WWH LAB/RAD FEE SCHEDULE - 4206 80197 80197 PR DRUG SCREEN QUANTITATIVE TACROLIMUS 121.00 $108.90 $48.40 $96.80 $67.76 $84.70 $77.44 $96.80 $94.38 $54.45 $49.61 $50.82 $48.40 $90.75 $78.65
WWH LAB/RAD FEE SCHEDULE - 4206 80198 80198 PR DRUG SCREEN QUANTITATIVE THEOPHYLLINE 115.00 $103.50 $46.00 $92.00 $64.40 $80.50 $73.60 $92.00 $89.70 $51.75 $47.15 $48.30 $46.00 $86.25 $74.75
WWH LAB/RAD FEE SCHEDULE - 4206 80201 80201 PR DRUG SCREEN QUANTITATIVE TOPIRAMATE 117.00 $105.30 $46.80 $93.60 $65.52 $81.90 $74.88 $93.60 $91.26 $52.65 $47.97 $49.14 $46.80 $87.75 $76.05
WWH LAB/RAD FEE SCHEDULE - 4206 80203 80203 PR DRUG SCREEN QUANTITATIVE ZONISAMIDE 164.00 $147.60 $65.60 $131.20 $91.84 $114.80 $104.96 $131.20 $127.92 $73.80 $67.24 $68.88 $65.60 $123.00 $106.60
WWH LAB/RAD FEE SCHEDULE - 4206 80307 80307 PR DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE 259.00 $233.10 $103.60 $207.20 $145.04 $181.30 $165.76 $207.20 $202.02 $116.55 $106.19 $108.78 $103.60 $194.25 $168.35
WWH LAB/RAD FEE SCHEDULE - 4206 81003 81003 PR URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY 28.00 $25.20 $11.20 $22.40 $15.68 $19.60 $17.92 $22.40 $21.84 $12.60 $11.48 $11.76 $11.20 $21.00 $18.20
WWH LAB/RAD FEE SCHEDULE - 4206 81025 81025 PR GENERAL LAB 8102500 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH LAB/RAD FEE SCHEDULE - 4206 81220 81220 PR CFTR GENE ANALYSIS COMMON VARIANTS "1,033.00" $929.70 $413.20 $826.40 $578.48 $723.10 $661.12 $826.40 $805.74 $464.85 $423.53 $433.86 $413.20 $774.75 $671.45
WWH LAB/RAD FEE SCHEDULE - 4206 81241 81241 PR F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT 396.00 $356.40 $158.40 $316.80 $221.76 $277.20 $253.44 $316.80 $308.88 $178.20 $162.36 $166.32 $158.40 $297.00 $257.40
WWH LAB/RAD FEE SCHEDULE - 4206 81243 81243 PR FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES 436.00 $392.40 $174.40 $348.80 $244.16 $305.20 $279.04 $348.80 $340.08 $196.20 $178.76 $183.12 $174.40 $327.00 $283.40
WWH LAB/RAD FEE SCHEDULE - 4206 81329 81329 PR SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS 314.00 $282.60 $125.60 $251.20 $175.84 $219.80 $200.96 $251.20 $244.92 $141.30 $128.74 $131.88 $125.60 $235.50 $204.10
WWH LAB/RAD FEE SCHEDULE - 4206 81374 81374 PR HLA I LOW RESOLUTION ONE ANTIGEN EQUIVALENT EACH 260.00 $234.00 $104.00 $208.00 $145.60 $182.00 $166.40 $208.00 $202.80 $117.00 $106.60 $109.20 $104.00 $195.00 $169.00
WWH LAB/RAD FEE SCHEDULE - 4206 81514 81514 PR GENERAL LAB 8151400 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH LAB/RAD FEE SCHEDULE - 4206 82043 82043 PR URINE ALBUMIN QUANTITATIVE 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 82085 82085 PR ASSAY OF ALDOLASE 74.00 $66.60 $29.60 $59.20 $41.44 $51.80 $47.36 $59.20 $57.72 $33.30 $30.34 $31.08 $29.60 $55.50 $48.10
WWH LAB/RAD FEE SCHEDULE - 4206 82088 82088 PR ASSAY OF ALDOSTERONE 168.00 $151.20 $67.20 $134.40 $94.08 $117.60 $107.52 $134.40 $131.04 $75.60 $68.88 $70.56 $67.20 $126.00 $109.20
WWH LAB/RAD FEE SCHEDULE - 4206 82172 82172 PR APOLIPOPROTEIN EACH 50.00 $45.00 $20.00 $40.00 $28.00 $35.00 $32.00 $40.00 $39.00 $22.50 $20.50 $21.00 $20.00 $37.50 $32.50
WWH LAB/RAD FEE SCHEDULE - 4206 82175 82175 PR ASSAY OF ARSENIC 190.00 $171.00 $76.00 $152.00 $106.40 $133.00 $121.60 $152.00 $148.20 $85.50 $77.90 $79.80 $76.00 $142.50 $123.50
WWH LAB/RAD FEE SCHEDULE - 4206 82180 82180 PR ASSAY OF ASCORBIC ACID BLOOD 103.00 $92.70 $41.20 $82.40 $57.68 $72.10 $65.92 $82.40 $80.34 $46.35 $42.23 $43.26 $41.20 $77.25 $66.95
WWH LAB/RAD FEE SCHEDULE - 4206 82271 82271 PR BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES 15.00 $13.50 $6.00 $12.00 $8.40 $10.50 $9.60 $12.00 $11.70 $6.75 $6.15 $6.30 $6.00 $11.25 $9.75
WWH LAB/RAD FEE SCHEDULE - 4206 82300 82300 PR CADMIUM 218.00 $196.20 $87.20 $174.40 $122.08 $152.60 $139.52 $174.40 $170.04 $98.10 $89.38 $91.56 $87.20 $163.50 $141.70
WWH LAB/RAD FEE SCHEDULE - 4206 82306 82306 PR 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED 220.00 $198.00 $88.00 $176.00 $123.20 $154.00 $140.80 $176.00 $171.60 $99.00 $90.20 $92.40 $88.00 $165.00 $143.00
WWH LAB/RAD FEE SCHEDULE - 4206 82340 82340 PR CALCIUM URINE QUANTITATIVE TIMED SPECIMEN 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH LAB/RAD FEE SCHEDULE - 4206 82379 82379 PR CARNITINE QUANTITATIVE EACH SPECIMEN 90.00 $81.00 $36.00 $72.00 $50.40 $63.00 $57.60 $72.00 $70.20 $40.50 $36.90 $37.80 $36.00 $67.50 $58.50
WWH LAB/RAD FEE SCHEDULE - 4206 82390 82390 PR CERULOPLASMIN 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 82397 82397 PR CHEMILUMINESCENT ASSAY 405.00 $364.50 $162.00 $324.00 $226.80 $283.50 $259.20 $324.00 $315.90 $182.25 $166.05 $170.10 $162.00 $303.75 $263.25
WWH LAB/RAD FEE SCHEDULE - 4206 82523 82523 PR COLLAGEN CROSS LINKS ANY METHOD 156.00 $140.40 $62.40 $124.80 $87.36 $109.20 $99.84 $124.80 $121.68 $70.20 $63.96 $65.52 $62.40 $117.00 $101.40
WWH LAB/RAD FEE SCHEDULE - 4206 82525 82525 PR ASSAY OF COPPER 132.00 $118.80 $52.80 $105.60 $73.92 $92.40 $84.48 $105.60 $102.96 $59.40 $54.12 $55.44 $52.80 $99.00 $85.80
WWH LAB/RAD FEE SCHEDULE - 4206 82533 82533 PR CORTISOL TOTAL 288.00 $259.20 $115.20 $230.40 $161.28 $201.60 $184.32 $230.40 $224.64 $129.60 $118.08 $120.96 $115.20 $216.00 $187.20
WWH LAB/RAD FEE SCHEDULE - 4206 82542 82542 PR COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC 425.00 $382.50 $170.00 $340.00 $238.00 $297.50 $272.00 $340.00 $331.50 $191.25 $174.25 $178.50 $170.00 $318.75 $276.25
WWH LAB/RAD FEE SCHEDULE - 4206 82570 82570 PR CREATININE OTHER SOURCE 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH LAB/RAD FEE SCHEDULE - 4206 82607 82607 PR CYANOCOBALAMIN VITAMIN B-12 177.00 $159.30 $70.80 $141.60 $99.12 $123.90 $113.28 $141.60 $138.06 $79.65 $72.57 $74.34 $70.80 $132.75 $115.05
WWH LAB/RAD FEE SCHEDULE - 4206 82626 82626 PR DEHYDROEPIANDROSTERONE 266.00 $239.40 $106.40 $212.80 $148.96 $186.20 $170.24 $212.80 $207.48 $119.70 $109.06 $111.72 $106.40 $199.50 $172.90
WWH LAB/RAD FEE SCHEDULE - 4206 82627 82627 PR DEHYDROEPIANDROSTERONE-SULFATE 220.00 $198.00 $88.00 $176.00 $123.20 $154.00 $140.80 $176.00 $171.60 $99.00 $90.20 $92.40 $88.00 $165.00 $143.00
WWH LAB/RAD FEE SCHEDULE - 4206 82642 82642 PR DIHYDROTESTOSTERONE (DHT) 109.00 $98.10 $43.60 $87.20 $61.04 $76.30 $69.76 $87.20 $85.02 $49.05 $44.69 $45.78 $43.60 $81.75 $70.85
WWH LAB/RAD FEE SCHEDULE - 4206 82652 82652 PR 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED 332.00 $298.80 $132.80 $265.60 $185.92 $232.40 $212.48 $265.60 $258.96 $149.40 $136.12 $139.44 $132.80 $249.00 $215.80
WWH LAB/RAD FEE SCHEDULE - 4206 82653 82653 PR ELASTASE PANCREATIC FECAL QUANTITATIVE 115.00 $103.50 $46.00 $92.00 $64.40 $80.50 $73.60 $92.00 $89.70 $51.75 $47.15 $48.30 $46.00 $86.25 $74.75
WWH LAB/RAD FEE SCHEDULE - 4206 82668 82668 PR ASSAY OF ERYTHROPOIETIN 174.00 $156.60 $69.60 $139.20 $97.44 $121.80 $111.36 $139.20 $135.72 $78.30 $71.34 $73.08 $69.60 $130.50 $113.10
WWH LAB/RAD FEE SCHEDULE - 4206 82670 82670 PR ASSAY OF ESTRADIOL 264.00 $237.60 $105.60 $211.20 $147.84 $184.80 $168.96 $211.20 $205.92 $118.80 $108.24 $110.88 $105.60 $198.00 $171.60
WWH LAB/RAD FEE SCHEDULE - 4206 82705 82705 PR FAT/LIPIDS FECES QUALITATIVE 176.00 $158.40 $70.40 $140.80 $98.56 $123.20 $112.64 $140.80 $137.28 $79.20 $72.16 $73.92 $70.40 $132.00 $114.40
WWH LAB/RAD FEE SCHEDULE - 4206 82746 82746 PR ASSAY OF FOLIC ACID SERUM 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH LAB/RAD FEE SCHEDULE - 4206 82784 82784 PR ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH 98.00 $88.20 $39.20 $78.40 $54.88 $68.60 $62.72 $78.40 $76.44 $44.10 $40.18 $41.16 $39.20 $73.50 $63.70
WWH LAB/RAD FEE SCHEDULE - 4206 82785 82785 PR ASSAY OF GAMMAGLOBULIN IGE 148.00 $133.20 $59.20 $118.40 $82.88 $103.60 $94.72 $118.40 $115.44 $66.60 $60.68 $62.16 $59.20 $111.00 $96.20
WWH LAB/RAD FEE SCHEDULE - 4206 82787 82787 PR GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES 95.00 $85.50 $38.00 $76.00 $53.20 $66.50 $60.80 $76.00 $74.10 $42.75 $38.95 $39.90 $38.00 $71.25 $61.75
WWH LAB/RAD FEE SCHEDULE - 4206 82943 82943 PR ASSAY OF GLUCAGON 146.00 $131.40 $58.40 $116.80 $81.76 $102.20 $93.44 $116.80 $113.88 $65.70 $59.86 $61.32 $58.40 $109.50 $94.90
WWH LAB/RAD FEE SCHEDULE - 4206 82947 82947 PR GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 82962 82962 PR GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE 29.00 $26.10 $11.60 $23.20 $16.24 $20.30 $18.56 $23.20 $22.62 $13.05 $11.89 $12.18 $11.60 $21.75 $18.85
WWH LAB/RAD FEE SCHEDULE - 4206 82985 82985 PR ASSAY OF GLYCATED PROTEIN 74.00 $66.60 $29.60 $59.20 $41.44 $51.80 $47.36 $59.20 $57.72 $33.30 $30.34 $31.08 $29.60 $55.50 $48.10
WWH LAB/RAD FEE SCHEDULE - 4206 83001 83001 PR GONADOTROPIN FOLLICLE STIMULATING HORMONE 220.00 $198.00 $88.00 $176.00 $123.20 $154.00 $140.80 $176.00 $171.60 $99.00 $90.20 $92.40 $88.00 $165.00 $143.00
WWH LAB/RAD FEE SCHEDULE - 4206 83002 83002 PR GONADOTROPIN LUTEINIZING HORMONE 196.00 $176.40 $78.40 $156.80 $109.76 $137.20 $125.44 $156.80 $152.88 $88.20 $80.36 $82.32 $78.40 $147.00 $127.40
WWH LAB/RAD FEE SCHEDULE - 4206 83018 83018 PR HEAVY METAL QUANTIATIVE EACH NES 139.00 $125.10 $55.60 $111.20 $77.84 $97.30 $88.96 $111.20 $108.42 $62.55 $56.99 $58.38 $55.60 $104.25 $90.35
WWH LAB/RAD FEE SCHEDULE - 4206 83090 83090 PR ASSAY OF HOMOCYSTEINE 190.00 $171.00 $76.00 $152.00 $106.40 $133.00 $121.60 $152.00 $148.20 $85.50 $77.90 $79.80 $76.00 $142.50 $123.50
WWH LAB/RAD FEE SCHEDULE - 4206 83516 83516 PR IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 83519 83519 PR IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY 171.00 $153.90 $68.40 $136.80 $95.76 $119.70 $109.44 $136.80 $133.38 $76.95 $70.11 $71.82 $68.40 $128.25 $111.15
WWH LAB/RAD FEE SCHEDULE - 4206 83520 83520 PR IMMUNOASSAY ANALYTE QUANTITATIVE NOS 118.00 $106.20 $47.20 $94.40 $66.08 $82.60 $75.52 $94.40 $92.04 $53.10 $48.38 $49.56 $47.20 $88.50 $76.70
WWH LAB/RAD FEE SCHEDULE - 4206 83525 83525 PR ASSAY OF INSULIN TOTAL 146.00 $131.40 $58.40 $116.80 $81.76 $102.20 $93.44 $116.80 $113.88 $65.70 $59.86 $61.32 $58.40 $109.50 $94.90
WWH LAB/RAD FEE SCHEDULE - 4206 83540 83540 PR ASSAY OF IRON 63.00 $56.70 $25.20 $50.40 $35.28 $44.10 $40.32 $50.40 $49.14 $28.35 $25.83 $26.46 $25.20 $47.25 $40.95
WWH LAB/RAD FEE SCHEDULE - 4206 83550 83550 PR IRON BINDING CAPACITY 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH LAB/RAD FEE SCHEDULE - 4206 83655 83655 PR ASSAY OF LEAD 103.00 $92.70 $41.20 $82.40 $57.68 $72.10 $65.92 $82.40 $80.34 $46.35 $42.23 $43.26 $41.20 $77.25 $66.95
WWH LAB/RAD FEE SCHEDULE - 4206 83695 83695 PR LIPOPROTEIN (A) 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH LAB/RAD FEE SCHEDULE - 4206 83704 83704 PR LIPOPROTEIN BLOOD QUAN NUMBERS & SUBCLASSES 116.00 $104.40 $46.40 $92.80 $64.96 $81.20 $74.24 $92.80 $90.48 $52.20 $47.56 $48.72 $46.40 $87.00 $75.40
WWH LAB/RAD FEE SCHEDULE - 4206 83789 83789 PR MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA 87.00 $78.30 $34.80 $69.60 $48.72 $60.90 $55.68 $69.60 $67.86 $39.15 $35.67 $36.54 $34.80 $65.25 $56.55
WWH LAB/RAD FEE SCHEDULE - 4206 83825 83825 PR ASSAY OF MERCURY QUANTITATIVE 218.00 $196.20 $87.20 $174.40 $122.08 $152.60 $139.52 $174.40 $170.04 $98.10 $89.38 $91.56 $87.20 $163.50 $141.70
WWH LAB/RAD FEE SCHEDULE - 4206 83835 83835 PR METANEPHRINES 206.00 $185.40 $82.40 $164.80 $115.36 $144.20 $131.84 $164.80 $160.68 $92.70 $84.46 $86.52 $82.40 $154.50 $133.90
WWH LAB/RAD FEE SCHEDULE - 4206 83880 83880 PR NATRIURETIC PEPTIDE 217.00 $195.30 $86.80 $173.60 $121.52 $151.90 $138.88 $173.60 $169.26 $97.65 $88.97 $91.14 $86.80 $162.75 $141.05
WWH LAB/RAD FEE SCHEDULE - 4206 83883 83883 PR ASSAY OF NEPHELOMETRY EACH ANALYTE NES 143.00 $128.70 $57.20 $114.40 $80.08 $100.10 $91.52 $114.40 $111.54 $64.35 $58.63 $60.06 $57.20 $107.25 $92.95
WWH LAB/RAD FEE SCHEDULE - 4206 83921 83921 PR ORGANIC ACID 1 QUANTITATIVE 133.00 $119.70 $53.20 $106.40 $74.48 $93.10 $85.12 $106.40 $103.74 $59.85 $54.53 $55.86 $53.20 $99.75 $86.45
WWH LAB/RAD FEE SCHEDULE - 4206 83930 83930 PR ASSAY OF OSMOLALITY BLOOD 63.00 $56.70 $25.20 $50.40 $35.28 $44.10 $40.32 $50.40 $49.14 $28.35 $25.83 $26.46 $25.20 $47.25 $40.95
WWH LAB/RAD FEE SCHEDULE - 4206 83935 83935 PR ASSAY OF OSMOLALITY URINE 71.00 $63.90 $28.40 $56.80 $39.76 $49.70 $45.44 $56.80 $55.38 $31.95 $29.11 $29.82 $28.40 $53.25 $46.15
WWH LAB/RAD FEE SCHEDULE - 4206 83970 83970 PR ASSAY OF PARATHORMONE 384.00 $345.60 $153.60 $307.20 $215.04 $268.80 $245.76 $307.20 $299.52 $172.80 $157.44 $161.28 $153.60 $288.00 $249.60
WWH LAB/RAD FEE SCHEDULE - 4206 83993 83993 PR ASSAY OF CALPROTECTIN FECAL 225.00 $202.50 $90.00 $180.00 $126.00 $157.50 $144.00 $180.00 $175.50 $101.25 $92.25 $94.50 $90.00 $168.75 $146.25
WWH LAB/RAD FEE SCHEDULE - 4206 84110 84110 PR ASSAY OF PORPHOBILINOGEN URINE QUANTITATIVE 76.00 $68.40 $30.40 $60.80 $42.56 $53.20 $48.64 $60.80 $59.28 $34.20 $31.16 $31.92 $30.40 $57.00 $49.40
WWH LAB/RAD FEE SCHEDULE - 4206 84143 84143 PR 17-HYDROXYPREGNENOLONE 82.00 $73.80 $32.80 $65.60 $45.92 $57.40 $52.48 $65.60 $63.96 $36.90 $33.62 $34.44 $32.80 $61.50 $53.30
WWH LAB/RAD FEE SCHEDULE - 4206 84144 84144 PR ASSAY OF PROGESTERONE 173.00 $155.70 $69.20 $138.40 $96.88 $121.10 $110.72 $138.40 $134.94 $77.85 $70.93 $72.66 $69.20 $129.75 $112.45
WWH LAB/RAD FEE SCHEDULE - 4206 84146 84146 PR ASSAY OF PROLACTIN 229.00 $206.10 $91.60 $183.20 $128.24 $160.30 $146.56 $183.20 $178.62 $103.05 $93.89 $96.18 $91.60 $171.75 $148.85
WWH LAB/RAD FEE SCHEDULE - 4206 84150 84150 PR ASSAY OF PROSTAGLNDIN EACH 163.00 $146.70 $65.20 $130.40 $91.28 $114.10 $104.32 $130.40 $127.14 $73.35 $66.83 $68.46 $65.20 $122.25 $105.95
WWH LAB/RAD FEE SCHEDULE - 4206 84156 84156 PR PROTEIN TOTAL XCPT REFRACTOMETRY URINE 38.00 $34.20 $15.20 $30.40 $21.28 $26.60 $24.32 $30.40 $29.64 $17.10 $15.58 $15.96 $15.20 $28.50 $24.70
WWH LAB/RAD FEE SCHEDULE - 4206 84165 84165 PR PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM 104.00 $93.60 $41.60 $83.20 $58.24 $72.80 $66.56 $83.20 $81.12 $46.80 $42.64 $43.68 $41.60 $78.00 $67.60
WWH LAB/RAD FEE SCHEDULE - 4206 84207 84207 PR ASSAY OF PYRIDOXAL PHOSPHATE 293.00 $263.70 $117.20 $234.40 $164.08 $205.10 $187.52 $234.40 $228.54 $131.85 $120.13 $123.06 $117.20 $219.75 $190.45
WWH LAB/RAD FEE SCHEDULE - 4206 84255 84255 PR ASSAY OF SELENIUM 224.00 $201.60 $89.60 $179.20 $125.44 $156.80 $143.36 $179.20 $174.72 $100.80 $91.84 $94.08 $89.60 $168.00 $145.60
WWH LAB/RAD FEE SCHEDULE - 4206 84270 84270 PR ASSAY OF SEX HORMONE BINDING GLOBULIN 216.00 $194.40 $86.40 $172.80 $120.96 $151.20 $138.24 $172.80 $168.48 $97.20 $88.56 $90.72 $86.40 $162.00 $140.40
WWH LAB/RAD FEE SCHEDULE - 4206 84300 84300 PR ASSAY OF URINE SODIUM 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH LAB/RAD FEE SCHEDULE - 4206 84305 84305 PR ASSAY OF SOMATOMEDIN 202.00 $181.80 $80.80 $161.60 $113.12 $141.40 $129.28 $161.60 $157.56 $90.90 $82.82 $84.84 $80.80 $151.50 $131.30
WWH LAB/RAD FEE SCHEDULE - 4206 84402 84402 PR ASSAY OF TESTOSTERONE FREE 264.00 $237.60 $105.60 $211.20 $147.84 $184.80 $168.96 $211.20 $205.92 $118.80 $108.24 $110.88 $105.60 $198.00 $171.60
WWH LAB/RAD FEE SCHEDULE - 4206 84403 84403 PR ASSAY OF TESTOSTERONE TOTAL 244.00 $219.60 $97.60 $195.20 $136.64 $170.80 $156.16 $195.20 $190.32 $109.80 $100.04 $102.48 $97.60 $183.00 $158.60
WWH LAB/RAD FEE SCHEDULE - 4206 84410 84410 PR ASSAY BIOVLBL TESTOSTERONE DIRECT MEASUREMENT 368.00 $331.20 $147.20 $294.40 $206.08 $257.60 $235.52 $294.40 $287.04 $165.60 $150.88 $154.56 $147.20 $276.00 $239.20
WWH LAB/RAD FEE SCHEDULE - 4206 84425 84425 PR ASSAY OF THIAMINE-VITAMIN B-1 222.00 $199.80 $88.80 $177.60 $124.32 $155.40 $142.08 $177.60 $173.16 $99.90 $91.02 $93.24 $88.80 $166.50 $144.30
WWH LAB/RAD FEE SCHEDULE - 4206 84432 84432 PR ASSAY OF THYROGLOBULIN 169.00 $152.10 $67.60 $135.20 $94.64 $118.30 $108.16 $135.20 $131.82 $76.05 $69.29 $70.98 $67.60 $126.75 $109.85
WWH LAB/RAD FEE SCHEDULE - 4206 84433 84433 PR ASY THIOPURIN S-MTHYLTRNSFRS 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH LAB/RAD FEE SCHEDULE - 4206 84436 84436 PR ASSAY OF THYROXINE TOTAL 71.00 $63.90 $28.40 $56.80 $39.76 $49.70 $45.44 $56.80 $55.38 $31.95 $29.11 $29.82 $28.40 $53.25 $46.15
WWH LAB/RAD FEE SCHEDULE - 4206 84443 84443 PR ASSAY OF THYROID STIMULATING HORMONE TSH 119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
WWH LAB/RAD FEE SCHEDULE - 4206 84445 84445 PR THYROID STIMULATING IMMUNE GLOBULINS TSI 347.00 $312.30 $138.80 $277.60 $194.32 $242.90 $222.08 $277.60 $270.66 $156.15 $142.27 $145.74 $138.80 $260.25 $225.55
WWH LAB/RAD FEE SCHEDULE - 4206 84446 84446 PR ASSAY OF TOCOPHEROL ALPHA VITAMIN E 150.00 $135.00 $60.00 $120.00 $84.00 $105.00 $96.00 $120.00 $117.00 $67.50 $61.50 $63.00 $60.00 $112.50 $97.50
WWH LAB/RAD FEE SCHEDULE - 4206 84466 84466 PR ASSAY OF L7383TRANSFERRIN 135.00 $121.50 $54.00 $108.00 $75.60 $94.50 $86.40 $108.00 $105.30 $60.75 $55.35 $56.70 $54.00 $101.25 $87.75
WWH LAB/RAD FEE SCHEDULE - 4206 84479 84479 PR THYROID HORM UPTK/THYROID HORMONE BINDING RATIO 44.00 $39.60 $17.60 $35.20 $24.64 $30.80 $28.16 $35.20 $34.32 $19.80 $18.04 $18.48 $17.60 $33.00 $28.60
WWH LAB/RAD FEE SCHEDULE - 4206 84480 84480 PR ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 97.00 $87.30 $38.80 $77.60 $54.32 $67.90 $62.08 $77.60 $75.66 $43.65 $39.77 $40.74 $38.80 $72.75 $63.05
WWH LAB/RAD FEE SCHEDULE - 4206 84482 84482 PR TRIIODOTHYRONINE T3 REVERSE 166.00 $149.40 $66.40 $132.80 $92.96 $116.20 $106.24 $132.80 $129.48 $74.70 $68.06 $69.72 $66.40 $124.50 $107.90
WWH LAB/RAD FEE SCHEDULE - 4206 84590 84590 PR ASSAY OF VITAMIN A 95.00 $85.50 $38.00 $76.00 $53.20 $66.50 $60.80 $76.00 $74.10 $42.75 $38.95 $39.90 $38.00 $71.25 $61.75
WWH LAB/RAD FEE SCHEDULE - 4206 84630 84630 PR ASSAY OF ZINC 119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
WWH LAB/RAD FEE SCHEDULE - 4206 85060 85060 PR BLOOD SMEAR PERIPHERAL INTERP PHYS W/WRIT REPORT 130.00 $117.00 $52.00 $104.00 $72.80 $91.00 $83.20 $104.00 $101.40 $58.50 $53.30 $54.60 $52.00 $97.50 $84.50
WWH LAB/RAD FEE SCHEDULE - 4206 85280 85280 PR CLOTTING FACTOR XII HAGEMAN 143.00 $128.70 $57.20 $114.40 $80.08 $100.10 $91.52 $114.40 $111.54 $64.35 $58.63 $60.06 $57.20 $107.25 $92.95
WWH LAB/RAD FEE SCHEDULE - 4206 85549 85549 PR MURAMIDASE 93.00 $83.70 $37.20 $74.40 $52.08 $65.10 $59.52 $74.40 $72.54 $41.85 $38.13 $39.06 $37.20 $69.75 $60.45
WWH LAB/RAD FEE SCHEDULE - 4206 85610 85610 PR PROTHROMBIN TIME 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH LAB/RAD FEE SCHEDULE - 4206 85660 85660 PR SICKLING RBC REDUCTION 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH LAB/RAD FEE SCHEDULE - 4206 86003 86003 PR ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH 42.00 $37.80 $16.80 $33.60 $23.52 $29.40 $26.88 $33.60 $32.76 $18.90 $17.22 $17.64 $16.80 $31.50 $27.30
WWH LAB/RAD FEE SCHEDULE - 4206 86015 86015 PR ACTIN SMOOTH MUSCLE ANTIBODY EACH 148.00 $133.20 $59.20 $118.40 $82.88 $103.60 $94.72 $118.40 $115.44 $66.60 $60.68 $62.16 $59.20 $111.00 $96.20
WWH LAB/RAD FEE SCHEDULE - 4206 86038 86038 PR ANTINUCLEAR ANTIBODIES ANA 141.00 $126.90 $56.40 $112.80 $78.96 $98.70 $90.24 $112.80 $109.98 $63.45 $57.81 $59.22 $56.40 $105.75 $91.65
WWH LAB/RAD FEE SCHEDULE - 4206 86039 86039 PR ANTINUCLEAR ANTIBODIES ANA TITER 118.00 $106.20 $47.20 $94.40 $66.08 $82.60 $75.52 $94.40 $92.04 $53.10 $48.38 $49.56 $47.20 $88.50 $76.70
WWH LAB/RAD FEE SCHEDULE - 4206 86060 86060 PR ANTISTREPTOLYSIN O TITER 54.00 $48.60 $21.60 $43.20 $30.24 $37.80 $34.56 $43.20 $42.12 $24.30 $22.14 $22.68 $21.60 $40.50 $35.10
WWH LAB/RAD FEE SCHEDULE - 4206 86141 86141 PR C-REACTIVE PROTEIN HIGH SENSITIVITY 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH LAB/RAD FEE SCHEDULE - 4206 86147 86147 PR CARDIOLIPIN ANTIBODY EACH IG CLASS 165.00 $148.50 $66.00 $132.00 $92.40 $115.50 $105.60 $132.00 $128.70 $74.25 $67.65 $69.30 $66.00 $123.75 $107.25
WWH LAB/RAD FEE SCHEDULE - 4206 86157 86157 PR COLD AGGLUTININ TITER 56.00 $50.40 $22.40 $44.80 $31.36 $39.20 $35.84 $44.80 $43.68 $25.20 $22.96 $23.52 $22.40 $42.00 $36.40
WWH LAB/RAD FEE SCHEDULE - 4206 86160 86160 PR COMPLEMENT ANTIGEN EACH COMPONENT 126.00 $113.40 $50.40 $100.80 $70.56 $88.20 $80.64 $100.80 $98.28 $56.70 $51.66 $52.92 $50.40 $94.50 $81.90
WWH LAB/RAD FEE SCHEDULE - 4206 86161 86161 PR COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT 93.00 $83.70 $37.20 $74.40 $52.08 $65.10 $59.52 $74.40 $72.54 $41.85 $38.13 $39.06 $37.20 $69.75 $60.45
WWH LAB/RAD FEE SCHEDULE - 4206 86162 86162 PR COMPLEMENT TOTAL HEMOLYTIC 182.00 $163.80 $72.80 $145.60 $101.92 $127.40 $116.48 $145.60 $141.96 $81.90 $74.62 $76.44 $72.80 $136.50 $118.30
WWH LAB/RAD FEE SCHEDULE - 4206 86200 86200 PR CYCLIC CITRULLINATED PEPTIDE ANTIBODY 135.00 $121.50 $54.00 $108.00 $75.60 $94.50 $86.40 $108.00 $105.30 $60.75 $55.35 $56.70 $54.00 $101.25 $87.75
WWH LAB/RAD FEE SCHEDULE - 4206 86215 86215 PR DEOXYRIBONUCLEASE ANTIBODY 110.00 $99.00 $44.00 $88.00 $61.60 $77.00 $70.40 $88.00 $85.80 $49.50 $45.10 $46.20 $44.00 $82.50 $71.50
WWH LAB/RAD FEE SCHEDULE - 4206 86225 86225 PR DNA ANTIBODY NATIVE/DOUBLE STRANDED 143.00 $128.70 $57.20 $114.40 $80.08 $100.10 $91.52 $114.40 $111.54 $64.35 $58.63 $60.06 $57.20 $107.25 $92.95
WWH LAB/RAD FEE SCHEDULE - 4206 86235 86235 PR EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 86255 86255 PR FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY 156.00 $140.40 $62.40 $124.80 $87.36 $109.20 $99.84 $124.80 $121.68 $70.20 $63.96 $65.52 $62.40 $117.00 $101.40
WWH LAB/RAD FEE SCHEDULE - 4206 86256 86256 PR FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY 137.00 $123.30 $54.80 $109.60 $76.72 $95.90 $87.68 $109.60 $106.86 $61.65 $56.17 $57.54 $54.80 $102.75 $89.05
WWH LAB/RAD FEE SCHEDULE - 4206 86258 86258 PR GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 86300 86300 PR IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3 216.00 $194.40 $86.40 $172.80 $120.96 $151.20 $138.24 $172.80 $168.48 $97.20 $88.56 $90.72 $86.40 $162.00 $140.40
WWH LAB/RAD FEE SCHEDULE - 4206 86304 86304 PR IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 212.00 $190.80 $84.80 $169.60 $118.72 $148.40 $135.68 $169.60 $165.36 $95.40 $86.92 $89.04 $84.80 $159.00 $137.80
WWH LAB/RAD FEE SCHEDULE - 4206 86317 86317 PR IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN NOS 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 86334 86334 PR IMMUNOFIXJ ELECTROPHORESIS SERUM 169.00 $152.10 $67.60 $135.20 $94.64 $118.30 $108.16 $135.20 $131.82 $76.05 $69.29 $70.98 $67.60 $126.75 $109.85
WWH LAB/RAD FEE SCHEDULE - 4206 86340 86340 PR INTRINSIC FACTOR ANTIBODIES 150.00 $135.00 $60.00 $120.00 $84.00 $105.00 $96.00 $120.00 $117.00 $67.50 $61.50 $63.00 $60.00 $112.50 $97.50
WWH LAB/RAD FEE SCHEDULE - 4206 86341 86341 PR ISLET CELL ANTIBODY 194.00 $174.60 $77.60 $155.20 $108.64 $135.80 $124.16 $155.20 $151.32 $87.30 $79.54 $81.48 $77.60 $145.50 $126.10
WWH LAB/RAD FEE SCHEDULE - 4206 86357 86357 PR NATURAL KILLER CELLS TOTAL COUNT 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 86359 86359 PR T CELLS TOTAL COUNT 143.00 $128.70 $57.20 $114.40 $80.08 $100.10 $91.52 $114.40 $111.54 $64.35 $58.63 $60.06 $57.20 $107.25 $92.95
WWH LAB/RAD FEE SCHEDULE - 4206 86360 86360 PR T CELLS ABSOLUTE CD4&CD8 COUNT RATIO 157.00 $141.30 $62.80 $125.60 $87.92 $109.90 $100.48 $125.60 $122.46 $70.65 $64.37 $65.94 $62.80 $117.75 $102.05
WWH LAB/RAD FEE SCHEDULE - 4206 86376 86376 PR MICROSOMAL ANTIBODIES EACH 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH LAB/RAD FEE SCHEDULE - 4206 86382 86382 PR NEUTRALIZATION TEST VIRAL 139.00 $125.10 $55.60 $111.20 $77.84 $97.30 $88.96 $111.20 $108.42 $62.55 $56.99 $58.38 $55.60 $104.25 $90.35
WWH LAB/RAD FEE SCHEDULE - 4206 86430 86430 PR RHEUMATOID FACTOR QUALITATIVE 57.00 $51.30 $22.80 $45.60 $31.92 $39.90 $36.48 $45.60 $44.46 $25.65 $23.37 $23.94 $22.80 $42.75 $37.05
WWH LAB/RAD FEE SCHEDULE - 4206 86431 86431 PR RHEUMATOID FACTOR QUANTITATIVE 59.00 $53.10 $23.60 $47.20 $33.04 $41.30 $37.76 $47.20 $46.02 $26.55 $24.19 $24.78 $23.60 $44.25 $38.35
WWH LAB/RAD FEE SCHEDULE - 4206 86480 86480 PR TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON 193.00 $173.70 $77.20 $154.40 $108.08 $135.10 $123.52 $154.40 $150.54 $86.85 $79.13 $81.06 $77.20 $144.75 $125.45
WWH LAB/RAD FEE SCHEDULE - 4206 86611 86611 PR ANTIBODY BARTONELLA 48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
WWH LAB/RAD FEE SCHEDULE - 4206 86617 86617 PR ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST 102.00 $91.80 $40.80 $81.60 $57.12 $71.40 $65.28 $81.60 $79.56 $45.90 $41.82 $42.84 $40.80 $76.50 $66.30
WWH LAB/RAD FEE SCHEDULE - 4206 86618 86618 PR ANTIBODY BORRELIA BURGDORFERI LYME DISEASE 163.00 $146.70 $65.20 $130.40 $91.28 $114.10 $104.32 $130.40 $127.14 $73.35 $66.83 $68.46 $65.20 $122.25 $105.95
WWH LAB/RAD FEE SCHEDULE - 4206 86622 86622 PR ANTIBODY BRUCELLA 75.00 $67.50 $30.00 $60.00 $42.00 $52.50 $48.00 $60.00 $58.50 $33.75 $30.75 $31.50 $30.00 $56.25 $48.75
WWH LAB/RAD FEE SCHEDULE - 4206 86631 86631 PR GENERAL LAB 8663103 LC 88.00 $79.20 $35.20 $70.40 $49.28 $61.60 $56.32 $70.40 $68.64 $39.60 $36.08 $36.96 $35.20 $66.00 $57.20
WWH LAB/RAD FEE SCHEDULE - 4206 86644 86644 PR ANTIBODY CYTOMEGALOVIRUS CMV 131.00 $117.90 $52.40 $104.80 $73.36 $91.70 $83.84 $104.80 $102.18 $58.95 $53.71 $55.02 $52.40 $98.25 $85.15
WWH LAB/RAD FEE SCHEDULE - 4206 86645 86645 PR ANTIBODY CYTOMEGALOVIRUS CMV IGM 170.00 $153.00 $68.00 $136.00 $95.20 $119.00 $108.80 $136.00 $132.60 $76.50 $69.70 $71.40 $68.00 $127.50 $110.50
WWH LAB/RAD FEE SCHEDULE - 4206 86658 86658 PR ANTIBODY ENTEROVIRUS 48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
WWH LAB/RAD FEE SCHEDULE - 4206 86664 86664 PR ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA 112.00 $100.80 $44.80 $89.60 $62.72 $78.40 $71.68 $89.60 $87.36 $50.40 $45.92 $47.04 $44.80 $84.00 $72.80
WWH LAB/RAD FEE SCHEDULE - 4206 86665 86665 PR ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 86666 86666 PR ANTIBODY EHRLICHIA 103.00 $92.70 $41.20 $82.40 $57.68 $72.10 $65.92 $82.40 $80.34 $46.35 $42.23 $43.26 $41.20 $77.25 $66.95
WWH LAB/RAD FEE SCHEDULE - 4206 86671 86671 PR ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIED 137.00 $123.30 $54.80 $109.60 $76.72 $95.90 $87.68 $109.60 $106.86 $61.65 $56.17 $57.54 $54.80 $102.75 $89.05
WWH LAB/RAD FEE SCHEDULE - 4206 86695 86695 PR GENERAL LAB 8669500 99.00 $89.10 $39.60 $79.20 $55.44 $69.30 $63.36 $79.20 $77.22 $44.55 $40.59 $41.58 $39.60 $74.25 $64.35
WWH LAB/RAD FEE SCHEDULE - 4206 86696 86696 PR GENERAL LAB 8669600 107.00 $96.30 $42.80 $85.60 $59.92 $74.90 $68.48 $85.60 $83.46 $48.15 $43.87 $44.94 $42.80 $80.25 $69.55
WWH LAB/RAD FEE SCHEDULE - 4206 86704 86704 PR GENERAL LAB 8670400 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH LAB/RAD FEE SCHEDULE - 4206 86706 86706 PR GENERAL LAB 8670600 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH LAB/RAD FEE SCHEDULE - 4206 86708 86708 PR GENERAL LAB 8670800 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH LAB/RAD FEE SCHEDULE - 4206 86709 86709 PR GENERAL LAB 8670900 119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
WWH LAB/RAD FEE SCHEDULE - 4206 86713 86713 PR ANTIBODY LEGIONELLA 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH LAB/RAD FEE SCHEDULE - 4206 86735 86735 PR ANTIBODY MUMPS 128.00 $115.20 $51.20 $102.40 $71.68 $89.60 $81.92 $102.40 $99.84 $57.60 $52.48 $53.76 $51.20 $96.00 $83.20
WWH LAB/RAD FEE SCHEDULE - 4206 86738 86738 PR ANTIBODY MYCOPLSM 134.00 $120.60 $53.60 $107.20 $75.04 $93.80 $85.76 $107.20 $104.52 $60.30 $54.94 $56.28 $53.60 $100.50 $87.10
WWH LAB/RAD FEE SCHEDULE - 4206 86747 86747 PR ANTIBODY PARVOVIRUS 82.00 $73.80 $32.80 $65.60 $45.92 $57.40 $52.48 $65.60 $63.96 $36.90 $33.62 $34.44 $32.80 $61.50 $53.30
WWH LAB/RAD FEE SCHEDULE - 4206 86753 86753 PR ANTIBODY PROTOZOA NES 102.00 $91.80 $40.80 $81.60 $57.12 $71.40 $65.28 $81.60 $79.56 $45.90 $41.82 $42.84 $40.80 $76.50 $66.30
WWH LAB/RAD FEE SCHEDULE - 4206 86762 86762 PR ANTIBODY RUBELLA 115.00 $103.50 $46.00 $92.00 $64.40 $80.50 $73.60 $92.00 $89.70 $51.75 $47.15 $48.30 $46.00 $86.25 $74.75
WWH LAB/RAD FEE SCHEDULE - 4206 86765 86765 PR ANTIBODY RUBEOLA 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH LAB/RAD FEE SCHEDULE - 4206 86769 86769 PR SARS-COV-2 COVID-19 ANTIBODY 216.00 $194.40 $86.40 $172.80 $120.96 $151.20 $138.24 $172.80 $168.48 $97.20 $88.56 $90.72 $86.40 $162.00 $140.40
WWH LAB/RAD FEE SCHEDULE - 4206 86780 86780 PR GENERAL LAB 8678001 70.00 $63.00 $28.00 $56.00 $39.20 $49.00 $44.80 $56.00 $54.60 $31.50 $28.70 $29.40 $28.00 $52.50 $45.50
WWH LAB/RAD FEE SCHEDULE - 4206 86787 86787 PR ANTIBODY VARICELLA-ZOSTER 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH LAB/RAD FEE SCHEDULE - 4206 86788 86788 PR ANTIBODY WEST NILE VIRUS IGM 89.00 $80.10 $35.60 $71.20 $49.84 $62.30 $56.96 $71.20 $69.42 $40.05 $36.49 $37.38 $35.60 $66.75 $57.85
WWH LAB/RAD FEE SCHEDULE - 4206 86789 86789 PR ANTIBODY WEST NILE VIRUS 83.00 $74.70 $33.20 $66.40 $46.48 $58.10 $53.12 $66.40 $64.74 $37.35 $34.03 $34.86 $33.20 $62.25 $53.95
WWH LAB/RAD FEE SCHEDULE - 4206 86800 86800 PR THYROGLOBULIN ANTIBODY 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH LAB/RAD FEE SCHEDULE - 4206 86803 86803 PR GENERAL LAB 8680300 148.00 $133.20 $59.20 $118.40 $82.88 $103.60 $94.72 $118.40 $115.44 $66.60 $60.68 $62.16 $59.20 $111.00 $96.20
WWH LAB/RAD FEE SCHEDULE - 4206 87015 87015 PR CONCENTRATION INFECTIOUS AGENTS 21.00 $18.90 $8.40 $16.80 $11.76 $14.70 $13.44 $16.80 $16.38 $9.45 $8.61 $8.82 $8.40 $15.75 $13.65
WWH LAB/RAD FEE SCHEDULE - 4206 87077 87077 PR CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH LAB/RAD FEE SCHEDULE - 4206 87101 87101 PR CUL FNGI MOLD/YEAST PRSMPTV ID SKN HAIR/NAIL 78.00 $70.20 $31.20 $62.40 $43.68 $54.60 $49.92 $62.40 $60.84 $35.10 $31.98 $32.76 $31.20 $58.50 $50.70
WWH LAB/RAD FEE SCHEDULE - 4206 87107 87107 PR CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD 72.00 $64.80 $28.80 $57.60 $40.32 $50.40 $46.08 $57.60 $56.16 $32.40 $29.52 $30.24 $28.80 $54.00 $46.80
WWH LAB/RAD FEE SCHEDULE - 4206 87168 87168 PR MACROSCOPIC EXAMINATION ARTHROPOD 39.00 $35.10 $15.60 $31.20 $21.84 $27.30 $24.96 $31.20 $30.42 $17.55 $15.99 $16.38 $15.60 $29.25 $25.35
WWH LAB/RAD FEE SCHEDULE - 4206 87169 87169 PR MACROSCOPIC EXAMINATION PARASITE 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH LAB/RAD FEE SCHEDULE - 4206 87177 87177 PR OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH LAB/RAD FEE SCHEDULE - 4206 87186 87186 PR SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ 93.00 $83.70 $37.20 $74.40 $52.08 $65.10 $59.52 $74.40 $72.54 $41.85 $38.13 $39.06 $37.20 $69.75 $60.45
WWH LAB/RAD FEE SCHEDULE - 4206 87207 87207 PR SMR PRIM SRC SPEC STAIN BODIES/PARASITS 49.00 $44.10 $19.60 $39.20 $27.44 $34.30 $31.36 $39.20 $38.22 $22.05 $20.09 $20.58 $19.60 $36.75 $31.85
WWH LAB/RAD FEE SCHEDULE - 4206 87209 87209 PR SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS 73.00 $65.70 $29.20 $58.40 $40.88 $51.10 $46.72 $58.40 $56.94 $32.85 $29.93 $30.66 $29.20 $54.75 $47.45
WWH LAB/RAD FEE SCHEDULE - 4206 87327 87327 PR IAAD IA CRYPTOCOCCUS NEOFORMANS 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH LAB/RAD FEE SCHEDULE - 4206 87328 87328 PR IAAD IA CRYPTOSPORIDIUM 114.00 $102.60 $45.60 $91.20 $63.84 $79.80 $72.96 $91.20 $88.92 $51.30 $46.74 $47.88 $45.60 $85.50 $74.10
WWH LAB/RAD FEE SCHEDULE - 4206 87329 87329 PR IAAD IA GIARDIA 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH LAB/RAD FEE SCHEDULE - 4206 87338 87338 PR IAAD IA HPYLORI STOOL 143.00 $128.70 $57.20 $114.40 $80.08 $100.10 $91.52 $114.40 $111.54 $64.35 $58.63 $60.06 $57.20 $107.25 $92.95
WWH LAB/RAD FEE SCHEDULE - 4206 87340 87340 PR GENERAL LAB 8734000 122.00 $109.80 $48.80 $97.60 $68.32 $85.40 $78.08 $97.60 $95.16 $54.90 $50.02 $51.24 $48.80 $91.50 $79.30
WWH LAB/RAD FEE SCHEDULE - 4206 87389 87389 PR GENERAL LAB 8738900 162.00 $145.80 $64.80 $129.60 $90.72 $113.40 $103.68 $129.60 $126.36 $72.90 $66.42 $68.04 $64.80 $121.50 $105.30
WWH LAB/RAD FEE SCHEDULE - 4206 87468 87468 PR ANAPLSMA PHGCYTOPHLM AMP PRB 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH LAB/RAD FEE SCHEDULE - 4206 87469 87469 PR BABESIA MICROTI AMP PRB 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH LAB/RAD FEE SCHEDULE - 4206 87480 87480 PR IADNA CANDIDA SPECIES DIRECT PROBE TQ 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH LAB/RAD FEE SCHEDULE - 4206 87481 87481 PR GENERAL LAB 8748100 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH LAB/RAD FEE SCHEDULE - 4206 87484 87484 PR EHRLICHA CHAFFEENSIS AMP PRB 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH LAB/RAD FEE SCHEDULE - 4206 87491 87491 PR GENERAL LAB 8749100 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 87493 87493 PR INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE 339.00 $305.10 $135.60 $271.20 $189.84 $237.30 $216.96 $271.20 $264.42 $152.55 $138.99 $142.38 $135.60 $254.25 $220.35
WWH LAB/RAD FEE SCHEDULE - 4206 87496 87496 PR IADNA CYTOMEGALOVIRUS AMPLIFIED PROBE TQ 170.00 $153.00 $68.00 $136.00 $95.20 $119.00 $108.80 $136.00 $132.60 $76.50 $69.70 $71.40 $68.00 $127.50 $110.50
WWH LAB/RAD FEE SCHEDULE - 4206 87506 87506 PR IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11 750.00 $675.00 $300.00 $600.00 $420.00 $525.00 $480.00 $600.00 $585.00 $337.50 $307.50 $315.00 $300.00 $562.50 $487.50
WWH LAB/RAD FEE SCHEDULE - 4206 87510 87510 PR IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH LAB/RAD FEE SCHEDULE - 4206 87517 87517 PR GENERAL LAB 8751701LC 358.00 $322.20 $143.20 $286.40 $200.48 $250.60 $229.12 $286.40 $279.24 $161.10 $146.78 $150.36 $143.20 $268.50 $232.70
WWH LAB/RAD FEE SCHEDULE - 4206 87529 87529 PR GENERAL LAB 8752900 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH LAB/RAD FEE SCHEDULE - 4206 87532 87532 PR GENERAL LAB 8753202 LC 314.00 $282.60 $125.60 $251.20 $175.84 $219.80 $200.96 $251.20 $244.92 $141.30 $128.74 $131.88 $125.60 $235.50 $204.10
WWH LAB/RAD FEE SCHEDULE - 4206 87591 87591 PR GENERAL LAB 8759100 181.00 $162.90 $72.40 $144.80 $101.36 $126.70 $115.84 $144.80 $141.18 $81.45 $74.21 $76.02 $72.40 $135.75 $117.65
WWH LAB/RAD FEE SCHEDULE - 4206 87593 87593 "PR MONKEY POX (ORTHOPOXVIRUS), DNA, PCR" 169.00 $152.10 $67.60 $135.20 $94.64 $118.30 $108.16 $135.20 $131.82 $76.05 $69.29 $70.98 $67.60 $126.75 $109.85
WWH LAB/RAD FEE SCHEDULE - 4206 87624 87624 PR GENERAL LAB 8762400 198.00 $178.20 $79.20 $158.40 $110.88 $138.60 $126.72 $158.40 $154.44 $89.10 $81.18 $83.16 $79.20 $148.50 $128.70
WWH LAB/RAD FEE SCHEDULE - 4206 87660 87660 PR IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH LAB/RAD FEE SCHEDULE - 4206 87661 87661 PR GENERAL LAB 8766100 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH LAB/RAD FEE SCHEDULE - 4206 87798 87798 PR GENERAL LAB 8779800 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH LAB/RAD FEE SCHEDULE - 4206 87801 87801 PR GENERAL LAB 8780100 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH LAB/RAD FEE SCHEDULE - 4206 87880 87880 PR IAADIADOO STREPTOCOCCUS GROUP A 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH LAB/RAD FEE SCHEDULE - 4206 88175 88175 PR CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS 101.00 $90.90 $40.40 $80.80 $56.56 $70.70 $64.64 $80.80 $78.78 $45.45 $41.41 $42.42 $40.40 $75.75 $65.65
WWH LAB/RAD FEE SCHEDULE - 4206 89051 89051 PR CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT 57.00 $51.30 $22.80 $45.60 $31.92 $39.90 $36.48 $45.60 $44.46 $25.65 $23.37 $23.94 $22.80 $42.75 $37.05
WWH LAB/RAD FEE SCHEDULE - 4206 89060 89060 PR CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID 68.00 $61.20 $27.20 $54.40 $38.08 $47.60 $43.52 $54.40 $53.04 $30.60 $27.88 $28.56 $27.20 $51.00 $44.20
WWH LAB/RAD FEE SCHEDULE - 4206 90738 90738 PR JAPANESE ENCEPHALITIS VACCINE INACTIVATED IM 468.00 $421.20 $187.20 $374.40 $262.08 $327.60 $299.52 $374.40 $365.04 $210.60 $191.88 $196.56 $187.20 $351.00 $304.20
WWH LAB/RAD FEE SCHEDULE - 4206 G0145 G0145 "PR SCR C/V CYTO,THINLAYER,RESCR" 96.00 $86.40 $38.40 $76.80 $53.76 $67.20 $61.44 $76.80 $74.88 $43.20 $39.36 $40.32 $38.40 $72.00 $62.40
WWH LAB/RAD FEE SCHEDULE - 4206 OC1371 OC1371 (IA) PR OCH COVID 19 HIGH THROUGHPUT INHOUSE 81.00 $72.90 $32.40 $64.80 $45.36 $56.70 $51.84 $64.80 $63.18 $36.45 $33.21 $34.02 $32.40 $60.75 $52.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 0001A 0001A (IA) PR IMM ADMN SARSCOV2 30MCG/0.3ML DIL RECON 1ST DOSE (PFIZER) 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 0002A 0002A (IA) PR IMM ADMN SARSCOV2 30MCG/0.3ML DIL RECON 2ND DOSE (PFIZER) 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 0003A 0003A (IA) PR IMM ADMN SARSCOV2 30 MCG/0.3 ML 3RD DOSE (PFIZER) 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 0004A 0004A (IA) PR IMM ADMN SARSCOV2 30MCG/0.3ML DIL RECON BST DOSE (PFIZER) 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 0011A 0011A (IA) PR IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE (MODERNA) 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 0012A 0012A (IA) PR IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE (MODERNA) 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 0013A 0013A (IA) PR IMM ADMN SARSCOV2 100 MCG/0.5 ML 3RD DOSE (MODERNA) 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 0051A 0051A (IA) PR IMM ADMN SARSCOV2 30MCG/0.3ML TRIS-SUCROSE 1ST (PFIZER) 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 0052A 0052A (IA) PR IMM ADMN SARSCOV2 30MCG/0.3ML TRIS-SUCROSE 2ND (PFIZER) 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 0054A 0054A (IA) PR IMM ADMN SARSCOV2 30MCG/0.3ML TRIS-SUCROSE BST (PFIZER) 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 0064A 0064A (IA) PR IMM ADMN SARSCOV2 50 MCG/0.25 ML BOOSTER DOSE (MODERNA) 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 0071A 0071A (IA) PR IMM ADMN SARSCOV2 10MCG/0.2ML TRIS-SUCROSE 1ST (PFIZER) 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 0072A 0072A (IA) PR IMM ADMN SARSCOV2 10MCG/0.2ML TRIS-SUCROSE 2ND (PFIZER) 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 0073A 0073A (IA) PR IMM ADMN SARSCOV2 10MCG/0.2ML TRIS-SUCROSE 3RD (PFIZER) 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 0074A 0074A (IA) PR IMM ADMN SARSCOV2 10MCG/0.2ML TRIS-SUCROSE BST (PFIZER) 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 0111A 0111A (IA) PR IMM ADMN SARSCOV2 25 MCG/0.25 ML 1ST DOSE (MODERNA) 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 0112A 0112A (IA) PR IMM ADMN SARSCOV2 25 MCG/0.25 ML 2ND DOSE (MODERNA) 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 0124A 0124A (IA) PR IMM ADMN SARSCOV2 30MCG/0.3 ML BIVALENT BST (PFIZER) 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 0134A 0134A (IA) PR IMM ADMN SARSCOV2 50MCG/0.5 ML BIVALENT BST (MODERNA) 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 0141A 0141A (IA) PR IMM ADMN SARSCOV2 BIVALENT 25 MCG/0.25 ML 1ST (MODERNA) 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 0144A 0144A (IA) PR IMM ADMN SARSCOV2 25MCG/0.25 ML BIVALENT BST (MODERNA) 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 0154A 0154A (IA) PR IMM ADMN SARSCOV2 10MCG/0.2 ML BIVALENT BST (PFIZER) 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 0164A 0164A (IA) PR IMM ADMN SARSCOV2 10MCG/0.2 ML BIVALENT ADDL (MODERNA) 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 0173A 0173A (IA) PR IMM ADMN SARSCOV2 3 MCG/0.2 ML BIVALENT 3RD (PFIZER) 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 100000.1 100000.1 LOS INCL IN PROCEDURE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 10021 10021 PR FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION 558.00 $502.20 $223.20 $446.40 $312.48 $390.60 $357.12 $446.40 $435.24 $251.10 $228.78 $234.36 $223.20 $418.50 $362.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 10030 10030 PR IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE "1,066.00" $959.40 $426.40 $852.80 $596.96 $746.20 $682.24 $852.80 $831.48 $479.70 $437.06 $447.72 $426.40 $799.50 $692.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 10040 10040 PR ACNE SURGERY 239.00 $215.10 $95.60 $191.20 $133.84 $167.30 $152.96 $191.20 $186.42 $107.55 $97.99 $100.38 $95.60 $179.25 $155.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 10060 10060 PR INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE 452.00 $406.80 $180.80 $361.60 $253.12 $316.40 $289.28 $361.60 $352.56 $203.40 $185.32 $189.84 $180.80 $339.00 $293.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 10061 10061 PR INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE 824.00 $741.60 $329.60 $659.20 $461.44 $576.80 $527.36 $659.20 $642.72 $370.80 $337.84 $346.08 $329.60 $618.00 $535.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 10080 10080 PR INCISION & DRAINAGE PILONIDAL CYST SIMPLE 754.00 $678.60 $301.60 $603.20 $422.24 $527.80 $482.56 $603.20 $588.12 $339.30 $309.14 $316.68 $301.60 $565.50 $490.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 10081 10081 PR INCISION & DRAINAGE PILONIDAL CYST COMPLICATED 969.00 $872.10 $387.60 $775.20 $542.64 $678.30 $620.16 $775.20 $755.82 $436.05 $397.29 $406.98 $387.60 $726.75 $629.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 10120 10120 PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE 486.00 $437.40 $194.40 $388.80 $272.16 $340.20 $311.04 $388.80 $379.08 $218.70 $199.26 $204.12 $194.40 $364.50 $315.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 10121 10121 PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL 819.00 $737.10 $327.60 $655.20 $458.64 $573.30 $524.16 $655.20 $638.82 $368.55 $335.79 $343.98 $327.60 $614.25 $532.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 10140 10140 PR I&D HEMATOMA SEROMA/FLUID COLLECTION 646.00 $581.40 $258.40 $516.80 $361.76 $452.20 $413.44 $516.80 $503.88 $290.70 $264.86 $271.32 $258.40 $484.50 $419.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 10160 10160 PR PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST 470.00 $423.00 $188.00 $376.00 $263.20 $329.00 $300.80 $376.00 $366.60 $211.50 $192.70 $197.40 $188.00 $352.50 $305.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 10180 10180 PR INCISION & DRAINAGE COMPLEX PO WOUND INFECTION 925.00 $832.50 $370.00 $740.00 $518.00 $647.50 $592.00 $740.00 $721.50 $416.25 $379.25 $388.50 $370.00 $693.75 $601.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11000 11000 PR DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF 192.00 $172.80 $76.80 $153.60 $107.52 $134.40 $122.88 $153.60 $149.76 $86.40 $78.72 $80.64 $76.80 $144.00 $124.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11005 11005 PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL "3,182.00" " $2,863.80 " " $1,272.80 " " $2,545.60 " " $1,781.92 " " $2,227.40 " " $2,036.48 " " $2,545.60 " " $2,481.96 " " $1,431.90 " " $1,304.62 " " $1,336.44 " " $1,272.80 " " $2,386.50 " " $2,068.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11008 11008 PR REMOVAL PROSTHETIC MATRL ABDL WALL FOR INFECTION "1,223.00" " $1,100.70 " $489.20 $978.40 $684.88 $856.10 $782.72 $978.40 $953.94 $550.35 $501.43 $513.66 $489.20 $917.25 $794.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11012 11012 PR DBRDMT FX&/DISLC SUBQ T/M/F BONE "2,497.00" " $2,247.30 " $998.80 " $1,997.60 " " $1,398.32 " " $1,747.90 " " $1,598.08 " " $1,997.60 " " $1,947.66 " " $1,123.65 " " $1,023.77 " " $1,048.74 " $998.80 " $1,872.75 " " $1,623.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11042 11042 PR DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< 379.00 $341.10 $151.60 $303.20 $212.24 $265.30 $242.56 $303.20 $295.62 $170.55 $155.39 $159.18 $151.60 $284.25 $246.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11043 11043 PR DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/< 958.00 $862.20 $383.20 $766.40 $536.48 $670.60 $613.12 $766.40 $747.24 $431.10 $392.78 $402.36 $383.20 $718.50 $622.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11044 11044 PR DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/< "1,809.00" " $1,628.10 " $723.60 " $1,447.20 " " $1,013.04 " " $1,266.30 " " $1,157.76 " " $1,447.20 " " $1,411.02 " $814.05 $741.69 $759.78 $723.60 " $1,356.75 " " $1,175.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11045 11045 PR DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM 88.00 $79.20 $35.20 $70.40 $49.28 $61.60 $56.32 $70.40 $68.64 $39.60 $36.08 $36.96 $35.20 $66.00 $57.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11046 11046 PR DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM 245.00 $220.50 $98.00 $196.00 $137.20 $171.50 $156.80 $196.00 $191.10 $110.25 $100.45 $102.90 $98.00 $183.75 $159.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11047 11047 PR DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM 480.00 $432.00 $192.00 $384.00 $268.80 $336.00 $307.20 $384.00 $374.40 $216.00 $196.80 $201.60 $192.00 $360.00 $312.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11055 11055 PR PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1 160.00 $144.00 $64.00 $128.00 $89.60 $112.00 $102.40 $128.00 $124.80 $72.00 $65.60 $67.20 $64.00 $120.00 $104.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11056 11056 PR PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4 132.00 $118.80 $52.80 $105.60 $73.92 $92.40 $84.48 $105.60 $102.96 $59.40 $54.12 $55.44 $52.80 $99.00 $85.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11057 11057 PR PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4 139.00 $125.10 $55.60 $111.20 $77.84 $97.30 $88.96 $111.20 $108.42 $62.55 $56.99 $58.38 $55.60 $104.25 $90.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11102 11102 PR TANGENTIAL BIOPSY SKIN SINGLE LESION 266.00 $239.40 $106.40 $212.80 $148.96 $186.20 $170.24 $212.80 $207.48 $119.70 $109.06 $111.72 $106.40 $199.50 $172.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11103 11103 PR TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION 163.00 $146.70 $65.20 $130.40 $91.28 $114.10 $104.32 $130.40 $127.14 $73.35 $66.83 $68.46 $65.20 $122.25 $105.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11104 11104 PR PUNCH BIOPSY SKIN SINGLE LESION 319.00 $287.10 $127.60 $255.20 $178.64 $223.30 $204.16 $255.20 $248.82 $143.55 $130.79 $133.98 $127.60 $239.25 $207.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11105 11105 PR PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION 117.00 $105.30 $46.80 $93.60 $65.52 $81.90 $74.88 $93.60 $91.26 $52.65 $47.97 $49.14 $46.80 $87.75 $76.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11106 11106 PR INCISIONAL BIOPSY SKIN SINGLE LESION 276.00 $248.40 $110.40 $220.80 $154.56 $193.20 $176.64 $220.80 $215.28 $124.20 $113.16 $115.92 $110.40 $207.00 $179.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11200 11200 PR REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15 396.00 $356.40 $158.40 $316.80 $221.76 $277.20 $253.44 $316.80 $308.88 $178.20 $162.36 $166.32 $158.40 $297.00 $257.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11201 11201 PR REMOVAL SK TGS MLT FIBRQ TAGS ANY AREA EA 10 81.00 $72.90 $32.40 $64.80 $45.36 $56.70 $51.84 $64.80 $63.18 $36.45 $33.21 $34.02 $32.40 $60.75 $52.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11300 11300 PR SHAVING SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5CM/< 309.00 $278.10 $123.60 $247.20 $173.04 $216.30 $197.76 $247.20 $241.02 $139.05 $126.69 $129.78 $123.60 $231.75 $200.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11301 11301 PR SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM 376.00 $338.40 $150.40 $300.80 $210.56 $263.20 $240.64 $300.80 $293.28 $169.20 $154.16 $157.92 $150.40 $282.00 $244.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11302 11302 PR SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM 382.00 $343.80 $152.80 $305.60 $213.92 $267.40 $244.48 $305.60 $297.96 $171.90 $156.62 $160.44 $152.80 $286.50 $248.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11303 11303 PR SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM 399.00 $359.10 $159.60 $319.20 $223.44 $279.30 $255.36 $319.20 $311.22 $179.55 $163.59 $167.58 $159.60 $299.25 $259.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11305 11305 PR SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/< 307.00 $276.30 $122.80 $245.60 $171.92 $214.90 $196.48 $245.60 $239.46 $138.15 $125.87 $128.94 $122.80 $230.25 $199.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11306 11306 PR SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM 330.00 $297.00 $132.00 $264.00 $184.80 $231.00 $211.20 $264.00 $257.40 $148.50 $135.30 $138.60 $132.00 $247.50 $214.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11307 11307 PR SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM 446.00 $401.40 $178.40 $356.80 $249.76 $312.20 $285.44 $356.80 $347.88 $200.70 $182.86 $187.32 $178.40 $334.50 $289.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11308 11308 PR SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM 299.00 $269.10 $119.60 $239.20 $167.44 $209.30 $191.36 $239.20 $233.22 $134.55 $122.59 $125.58 $119.60 $224.25 $194.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11310 11310 PR SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/< 359.00 $323.10 $143.60 $287.20 $201.04 $251.30 $229.76 $287.20 $280.02 $161.55 $147.19 $150.78 $143.60 $269.25 $233.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11311 11311 PR SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM 362.00 $325.80 $144.80 $289.60 $202.72 $253.40 $231.68 $289.60 $282.36 $162.90 $148.42 $152.04 $144.80 $271.50 $235.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11312 11312 PR SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM 331.00 $297.90 $132.40 $264.80 $185.36 $231.70 $211.84 $264.80 $258.18 $148.95 $135.71 $139.02 $132.40 $248.25 $215.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11313 11313 PR SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM 478.00 $430.20 $191.20 $382.40 $267.68 $334.60 $305.92 $382.40 $372.84 $215.10 $195.98 $200.76 $191.20 $358.50 $310.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11400 11400 PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/< 424.00 $381.60 $169.60 $339.20 $237.44 $296.80 $271.36 $339.20 $330.72 $190.80 $173.84 $178.08 $169.60 $318.00 $275.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11401 11401 PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM 675.00 $607.50 $270.00 $540.00 $378.00 $472.50 $432.00 $540.00 $526.50 $303.75 $276.75 $283.50 $270.00 $506.25 $438.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11402 11402 PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM 563.00 $506.70 $225.20 $450.40 $315.28 $394.10 $360.32 $450.40 $439.14 $253.35 $230.83 $236.46 $225.20 $422.25 $365.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11403 11403 PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM 664.00 $597.60 $265.60 $531.20 $371.84 $464.80 $424.96 $531.20 $517.92 $298.80 $272.24 $278.88 $265.60 $498.00 $431.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11404 11404 PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM 899.00 $809.10 $359.60 $719.20 $503.44 $629.30 $575.36 $719.20 $701.22 $404.55 $368.59 $377.58 $359.60 $674.25 $584.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11406 11406 PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM "1,118.00" " $1,006.20 " $447.20 $894.40 $626.08 $782.60 $715.52 $894.40 $872.04 $503.10 $458.38 $469.56 $447.20 $838.50 $726.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11420 11420 PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/< 557.00 $501.30 $222.80 $445.60 $311.92 $389.90 $356.48 $445.60 $434.46 $250.65 $228.37 $233.94 $222.80 $417.75 $362.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11421 11421 PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM 524.00 $471.60 $209.60 $419.20 $293.44 $366.80 $335.36 $419.20 $408.72 $235.80 $214.84 $220.08 $209.60 $393.00 $340.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11422 11422 PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM 583.00 $524.70 $233.20 $466.40 $326.48 $408.10 $373.12 $466.40 $454.74 $262.35 $239.03 $244.86 $233.20 $437.25 $378.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11423 11423 PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM 676.00 $608.40 $270.40 $540.80 $378.56 $473.20 $432.64 $540.80 $527.28 $304.20 $277.16 $283.92 $270.40 $507.00 $439.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11424 11424 PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM 782.00 $703.80 $312.80 $625.60 $437.92 $547.40 $500.48 $625.60 $609.96 $351.90 $320.62 $328.44 $312.80 $586.50 $508.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11426 11426 PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM "1,170.00" " $1,053.00 " $468.00 $936.00 $655.20 $819.00 $748.80 $936.00 $912.60 $526.50 $479.70 $491.40 $468.00 $877.50 $760.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11440 11440 PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/< 488.00 $439.20 $195.20 $390.40 $273.28 $341.60 $312.32 $390.40 $380.64 $219.60 $200.08 $204.96 $195.20 $366.00 $317.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11441 11441 PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM 610.00 $549.00 $244.00 $488.00 $341.60 $427.00 $390.40 $488.00 $475.80 $274.50 $250.10 $256.20 $244.00 $457.50 $396.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11442 11442 PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM 683.00 $614.70 $273.20 $546.40 $382.48 $478.10 $437.12 $546.40 $532.74 $307.35 $280.03 $286.86 $273.20 $512.25 $443.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11443 11443 PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM 749.00 $674.10 $299.60 $599.20 $419.44 $524.30 $479.36 $599.20 $584.22 $337.05 $307.09 $314.58 $299.60 $561.75 $486.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11444 11444 PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM "1,139.00" " $1,025.10 " $455.60 $911.20 $637.84 $797.30 $728.96 $911.20 $888.42 $512.55 $466.99 $478.38 $455.60 $854.25 $740.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11446 11446 PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M > 4.0CM "1,720.00" " $1,548.00 " $688.00 " $1,376.00 " $963.20 " $1,204.00 " " $1,100.80 " " $1,376.00 " " $1,341.60 " $774.00 $705.20 $722.40 $688.00 " $1,290.00 " " $1,118.00 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11450 11450 PR EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR "1,404.00" " $1,263.60 " $561.60 " $1,123.20 " $786.24 $982.80 $898.56 " $1,123.20 " " $1,095.12 " $631.80 $575.64 $589.68 $561.60 " $1,053.00 " $912.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11600 11600 PR EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/< 608.00 $547.20 $243.20 $486.40 $340.48 $425.60 $389.12 $486.40 $474.24 $273.60 $249.28 $255.36 $243.20 $456.00 $395.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11601 11601 PR EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM 717.00 $645.30 $286.80 $573.60 $401.52 $501.90 $458.88 $573.60 $559.26 $322.65 $293.97 $301.14 $286.80 $537.75 $466.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11602 11602 PR EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM 824.00 $741.60 $329.60 $659.20 $461.44 $576.80 $527.36 $659.20 $642.72 $370.80 $337.84 $346.08 $329.60 $618.00 $535.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11603 11603 PR EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM 845.00 $760.50 $338.00 $676.00 $473.20 $591.50 $540.80 $676.00 $659.10 $380.25 $346.45 $354.90 $338.00 $633.75 $549.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11604 11604 PR EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM "1,064.00" $957.60 $425.60 $851.20 $595.84 $744.80 $680.96 $851.20 $829.92 $478.80 $436.24 $446.88 $425.60 $798.00 $691.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11606 11606 PR EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM "1,522.00" " $1,369.80 " $608.80 " $1,217.60 " $852.32 " $1,065.40 " $974.08 " $1,217.60 " " $1,187.16 " $684.90 $624.02 $639.24 $608.80 " $1,141.50 " $989.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11620 11620 PR EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/< 625.00 $562.50 $250.00 $500.00 $350.00 $437.50 $400.00 $500.00 $487.50 $281.25 $256.25 $262.50 $250.00 $468.75 $406.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11621 11621 PR EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM 717.00 $645.30 $286.80 $573.60 $401.52 $501.90 $458.88 $573.60 $559.26 $322.65 $293.97 $301.14 $286.80 $537.75 $466.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11622 11622 PR EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM 876.00 $788.40 $350.40 $700.80 $490.56 $613.20 $560.64 $700.80 $683.28 $394.20 $359.16 $367.92 $350.40 $657.00 $569.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11623 11623 PR EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM 968.00 $871.20 $387.20 $774.40 $542.08 $677.60 $619.52 $774.40 $755.04 $435.60 $396.88 $406.56 $387.20 $726.00 $629.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11624 11624 PR EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM "1,146.00" " $1,031.40 " $458.40 $916.80 $641.76 $802.20 $733.44 $916.80 $893.88 $515.70 $469.86 $481.32 $458.40 $859.50 $744.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11626 11626 PR EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM "1,383.00" " $1,244.70 " $553.20 " $1,106.40 " $774.48 $968.10 $885.12 " $1,106.40 " " $1,078.74 " $622.35 $567.03 $580.86 $553.20 " $1,037.25 " $898.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11640 11640 PR EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/< 640.00 $576.00 $256.00 $512.00 $358.40 $448.00 $409.60 $512.00 $499.20 $288.00 $262.40 $268.80 $256.00 $480.00 $416.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11641 11641 PR EXCISION MALIGNANT LESION F/E/E/N/L 0.6-1.0 CM 816.00 $734.40 $326.40 $652.80 $456.96 $571.20 $522.24 $652.80 $636.48 $367.20 $334.56 $342.72 $326.40 $612.00 $530.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11642 11642 PR EXCISION MALIGNANT LESION F/E/E/N/L 1.1-2.0 CM 936.00 $842.40 $374.40 $748.80 $524.16 $655.20 $599.04 $748.80 $730.08 $421.20 $383.76 $393.12 $374.40 $702.00 $608.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11643 11643 PR EXCISION MALIGNANT LESION F/E/E/N/L 2.1-3.0 CM "1,094.00" $984.60 $437.60 $875.20 $612.64 $765.80 $700.16 $875.20 $853.32 $492.30 $448.54 $459.48 $437.60 $820.50 $711.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11644 11644 PR EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM "1,344.00" " $1,209.60 " $537.60 " $1,075.20 " $752.64 $940.80 $860.16 " $1,075.20 " " $1,048.32 " $604.80 $551.04 $564.48 $537.60 " $1,008.00 " $873.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11646 11646 PR EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM "1,918.00" " $1,726.20 " $767.20 " $1,534.40 " " $1,074.08 " " $1,342.60 " " $1,227.52 " " $1,534.40 " " $1,496.04 " $863.10 $786.38 $805.56 $767.20 " $1,438.50 " " $1,246.70 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11719 11719 PR TRIMMING NONDYSTROPHIC NAILS ANY NUMBER 77.00 $69.30 $30.80 $61.60 $43.12 $53.90 $49.28 $61.60 $60.06 $34.65 $31.57 $32.34 $30.80 $57.75 $50.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11720 11720 PR DEBRIDEMENT NAIL ANY METHOD 1-5 112.00 $100.80 $44.80 $89.60 $62.72 $78.40 $71.68 $89.60 $87.36 $50.40 $45.92 $47.04 $44.80 $84.00 $72.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11721 11721 PR DEBRIDEMENT NAIL ANY METHOD 6/> 93.00 $83.70 $37.20 $74.40 $52.08 $65.10 $59.52 $74.40 $72.54 $41.85 $38.13 $39.06 $37.20 $69.75 $60.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11730 11730 PR AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 420.00 $378.00 $168.00 $336.00 $235.20 $294.00 $268.80 $336.00 $327.60 $189.00 $172.20 $176.40 $168.00 $315.00 $273.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11732 11732 PR AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL 163.00 $146.70 $65.20 $130.40 $91.28 $114.10 $104.32 $130.40 $127.14 $73.35 $66.83 $68.46 $65.20 $122.25 $105.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11740 11740 PR EVACUATION SUBUNGUAL HEMATOMA 194.00 $174.60 $77.60 $155.20 $108.64 $135.80 $124.16 $155.20 $151.32 $87.30 $79.54 $81.48 $77.60 $145.50 $126.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11750 11750 PR EXCISION NAIL MATRIX PERMANENT REMOVAL 616.00 $554.40 $246.40 $492.80 $344.96 $431.20 $394.24 $492.80 $480.48 $277.20 $252.56 $258.72 $246.40 $462.00 $400.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11755 11755 PR BIOPSY NAIL UNIT SEPARATE PROCEDURE 306.00 $275.40 $122.40 $244.80 $171.36 $214.20 $195.84 $244.80 $238.68 $137.70 $125.46 $128.52 $122.40 $229.50 $198.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11760 11760 PR REPAIR NAIL BED 636.00 $572.40 $254.40 $508.80 $356.16 $445.20 $407.04 $508.80 $496.08 $286.20 $260.76 $267.12 $254.40 $477.00 $413.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11765 11765 PR WEDGE EXCISION SKIN NAIL FOLD 397.00 $357.30 $158.80 $317.60 $222.32 $277.90 $254.08 $317.60 $309.66 $178.65 $162.77 $166.74 $158.80 $297.75 $258.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11770 11770 PR EXCISION PILONIDAL CYST/SINUS SIMPLE "1,079.00" $971.10 $431.60 $863.20 $604.24 $755.30 $690.56 $863.20 $841.62 $485.55 $442.39 $453.18 $431.60 $809.25 $701.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11771 11771 PR EXCISION PILONIDAL CYST/SINUS EXTENSIVE "2,426.00" " $2,183.40 " $970.40 " $1,940.80 " " $1,358.56 " " $1,698.20 " " $1,552.64 " " $1,940.80 " " $1,892.28 " " $1,091.70 " $994.66 " $1,018.92 " $970.40 " $1,819.50 " " $1,576.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11772 11772 PR EXCISION PILONIDAL CYST/SINUS COMPLICATED "2,519.00" " $2,267.10 " " $1,007.60 " " $2,015.20 " " $1,410.64 " " $1,763.30 " " $1,612.16 " " $2,015.20 " " $1,964.82 " " $1,133.55 " " $1,032.79 " " $1,057.98 " " $1,007.60 " " $1,889.25 " " $1,637.35 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11900 11900 PR INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS 185.00 $166.50 $74.00 $148.00 $103.60 $129.50 $118.40 $148.00 $144.30 $83.25 $75.85 $77.70 $74.00 $138.75 $120.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11976 11976 PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES 526.00 $473.40 $210.40 $420.80 $294.56 $368.20 $336.64 $420.80 $410.28 $236.70 $215.66 $220.92 $210.40 $394.50 $341.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11981 11981 PR INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT 470.00 $423.00 $188.00 $376.00 $263.20 $329.00 $300.80 $376.00 $366.60 $211.50 $192.70 $197.40 $188.00 $352.50 $305.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11982 11982 PR REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT 485.00 $436.50 $194.00 $388.00 $271.60 $339.50 $310.40 $388.00 $378.30 $218.25 $198.85 $203.70 $194.00 $363.75 $315.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 11983 11983 PR RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT 660.00 $594.00 $264.00 $528.00 $369.60 $462.00 $422.40 $528.00 $514.80 $297.00 $270.60 $277.20 $264.00 $495.00 $429.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 12001 12001 PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< 521.00 $468.90 $208.40 $416.80 $291.76 $364.70 $333.44 $416.80 $406.38 $234.45 $213.61 $218.82 $208.40 $390.75 $338.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 12002 12002 PR SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM 615.00 $553.50 $246.00 $492.00 $344.40 $430.50 $393.60 $492.00 $479.70 $276.75 $252.15 $258.30 $246.00 $461.25 $399.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 12004 12004 PR SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM 761.00 $684.90 $304.40 $608.80 $426.16 $532.70 $487.04 $608.80 $593.58 $342.45 $312.01 $319.62 $304.40 $570.75 $494.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 12005 12005 PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM "1,080.00" $972.00 $432.00 $864.00 $604.80 $756.00 $691.20 $864.00 $842.40 $486.00 $442.80 $453.60 $432.00 $810.00 $702.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 12006 12006 PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM "1,343.00" " $1,208.70 " $537.20 " $1,074.40 " $752.08 $940.10 $859.52 " $1,074.40 " " $1,047.54 " $604.35 $550.63 $564.06 $537.20 " $1,007.25 " $872.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 12011 12011 PR REPAIR SUPERF WOUND FACE EARS EYELIDS NOSE LIPS <= 2.5 CM 615.00 $553.50 $246.00 $492.00 $344.40 $430.50 $393.60 $492.00 $479.70 $276.75 $252.15 $258.30 $246.00 $461.25 $399.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 12013 12013 PR REPAIR SUPERF WOUND FACE EARS EYELIDS NOSE LIPS 2.6-5 CM 709.00 $638.10 $283.60 $567.20 $397.04 $496.30 $453.76 $567.20 $553.02 $319.05 $290.69 $297.78 $283.60 $531.75 $460.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 12014 12014 PR REPAIR SUPERF WOUND FACE EARS EYELIDS NOSE LIPS 5.1-7.5 CM 988.00 $889.20 $395.20 $790.40 $553.28 $691.60 $632.32 $790.40 $770.64 $444.60 $405.08 $414.96 $395.20 $741.00 $642.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 12015 12015 PR REPAIR SUPERF WOUND FACE EARS EYELIDS NOSE LIPS 7.6-12.5 CM "1,105.00" $994.50 $442.00 $884.00 $618.80 $773.50 $707.20 $884.00 $861.90 $497.25 $453.05 $464.10 $442.00 $828.75 $718.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 12020 12020 PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE "1,046.00" $941.40 $418.40 $836.80 $585.76 $732.20 $669.44 $836.80 $815.88 $470.70 $428.86 $439.32 $418.40 $784.50 $679.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 12031 12031 PR REPAIR INTERMED WOUND SCALP TRUNK EXTREM < OR = 2.5CM 906.00 $815.40 $362.40 $724.80 $507.36 $634.20 $579.84 $724.80 $706.68 $407.70 $371.46 $380.52 $362.40 $679.50 $588.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 12032 12032 PR REPAIR INTERMED WOUND SCALP TRUNK EXTREM 2.6-7.5 CM "1,341.00" " $1,206.90 " $536.40 " $1,072.80 " $750.96 $938.70 $858.24 " $1,072.80 " " $1,045.98 " $603.45 $549.81 $563.22 $536.40 " $1,005.75 " $871.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 12034 12034 PR REPAIR INTERMED WOUND SCALP TRUNK EXTREM 7.6-12.5 CM "1,276.00" " $1,148.40 " $510.40 " $1,020.80 " $714.56 $893.20 $816.64 " $1,020.80 " $995.28 $574.20 $523.16 $535.92 $510.40 $957.00 $829.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 12035 12035 PR REPAIR INTERMED WOUND SCALP TRUNK EXTREM 12.6-20 CM "1,702.00" " $1,531.80 " $680.80 " $1,361.60 " $953.12 " $1,191.40 " " $1,089.28 " " $1,361.60 " " $1,327.56 " $765.90 $697.82 $714.84 $680.80 " $1,276.50 " " $1,106.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 12036 12036 PR REPAIR INTERMED WOUND SCALP TRUNK EXTREM 20.1-30 CM "1,627.00" " $1,464.30 " $650.80 " $1,301.60 " $911.12 " $1,138.90 " " $1,041.28 " " $1,301.60 " " $1,269.06 " $732.15 $667.07 $683.34 $650.80 " $1,220.25 " " $1,057.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 12041 12041 PR REPAIR INTERMED WOUND NECK HANDS FEET EXT GEN < OR = 2.5 CM 930.00 $837.00 $372.00 $744.00 $520.80 $651.00 $595.20 $744.00 $725.40 $418.50 $381.30 $390.60 $372.00 $697.50 $604.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 12042 12042 PR REPAIR INTERMED WOUND NECK HANDS FEET EXT GEN 2.6-7.5 CM "1,170.00" " $1,053.00 " $468.00 $936.00 $655.20 $819.00 $748.80 $936.00 $912.60 $526.50 $479.70 $491.40 $468.00 $877.50 $760.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 12044 12044 PR REPAIR INTERMED WOUND NECK HANDS FEET EXT GEN 7.6-12.5 CM "1,485.00" " $1,336.50 " $594.00 " $1,188.00 " $831.60 " $1,039.50 " $950.40 " $1,188.00 " " $1,158.30 " $668.25 $608.85 $623.70 $594.00 " $1,113.75 " $965.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 12045 12045 PR REPAIR INTERMED WOUND NECK HANDS FEET EXT GEN 12.6-20 CM "1,124.00" " $1,011.60 " $449.60 $899.20 $629.44 $786.80 $719.36 $899.20 $876.72 $505.80 $460.84 $472.08 $449.60 $843.00 $730.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 12051 12051 PR REPAIR INTERMED WOUND FACE EARS EYELIDS NOSE LIPS <= 2.5 CM 796.00 $716.40 $318.40 $636.80 $445.76 $557.20 $509.44 $636.80 $620.88 $358.20 $326.36 $334.32 $318.40 $597.00 $517.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 12052 12052 PR REPAIR INTERMED WOUND FACE EARS EYELIDS NOSE LIPS 2.5-5.0 CM "1,053.00" $947.70 $421.20 $842.40 $589.68 $737.10 $673.92 $842.40 $821.34 $473.85 $431.73 $442.26 $421.20 $789.75 $684.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 12053 12053 PR REPAIR INTERMED WOUND FACE EARS EYELIDS NOSE LIPS 5.1-7.5 CM "1,544.00" " $1,389.60 " $617.60 " $1,235.20 " $864.64 " $1,080.80 " $988.16 " $1,235.20 " " $1,204.32 " $694.80 $633.04 $648.48 $617.60 " $1,158.00 " " $1,003.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 12057 12057 PR REPAIR INTERMED WOUND FACE EARS EYELIDS NOSE LIPS OVER 30 CM "2,303.00" " $2,072.70 " $921.20 " $1,842.40 " " $1,289.68 " " $1,612.10 " " $1,473.92 " " $1,842.40 " " $1,796.34 " " $1,036.35 " $944.23 $967.26 $921.20 " $1,727.25 " " $1,496.95 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 13101 13101 PR REPAIR COMPLEX TRUNK 2.6-7.5 CM "1,158.00" " $1,042.20 " $463.20 $926.40 $648.48 $810.60 $741.12 $926.40 $903.24 $521.10 $474.78 $486.36 $463.20 $868.50 $752.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 13102 13102 PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/< 428.00 $385.20 $171.20 $342.40 $239.68 $299.60 $273.92 $342.40 $333.84 $192.60 $175.48 $179.76 $171.20 $321.00 $278.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 13121 13121 PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM "1,729.00" " $1,556.10 " $691.60 " $1,383.20 " $968.24 " $1,210.30 " " $1,106.56 " " $1,383.20 " " $1,348.62 " $778.05 $708.89 $726.18 $691.60 " $1,296.75 " " $1,123.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 13122 13122 PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/< 591.00 $531.90 $236.40 $472.80 $330.96 $413.70 $378.24 $472.80 $460.98 $265.95 $242.31 $248.22 $236.40 $443.25 $384.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 13131 13131 PR REPAIR COMPLEX WOUND HEAD FACE NECK HANDS FEET 1.1-2.5 CM "1,194.00" " $1,074.60 " $477.60 $955.20 $668.64 $835.80 $764.16 $955.20 $931.32 $537.30 $489.54 $501.48 $477.60 $895.50 $776.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 13132 13132 PR REPAIR COMPLEX WOUND HEAD FACE NECK HANDS FEET 2.6-7.5 CM "2,758.00" " $2,482.20 " " $1,103.20 " " $2,206.40 " " $1,544.48 " " $1,930.60 " " $1,765.12 " " $2,206.40 " " $2,151.24 " " $1,241.10 " " $1,130.78 " " $1,158.36 " " $1,103.20 " " $2,068.50 " " $1,792.70 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 13133 13133 PR REPAIR COMPLEX WOUND FACE NECK HANDS FEET EA ADDL 5CM OR LESS 683.00 $614.70 $273.20 $546.40 $382.48 $478.10 $437.12 $546.40 $532.74 $307.35 $280.03 $286.86 $273.20 $512.25 $443.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 13151 13151 PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM "1,314.00" " $1,182.60 " $525.60 " $1,051.20 " $735.84 $919.80 $840.96 " $1,051.20 " " $1,024.92 " $591.30 $538.74 $551.88 $525.60 $985.50 $854.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 13160 13160 PR SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC "3,079.00" " $2,771.10 " " $1,231.60 " " $2,463.20 " " $1,724.24 " " $2,155.30 " " $1,970.56 " " $2,463.20 " " $2,401.62 " " $1,385.55 " " $1,262.39 " " $1,293.18 " " $1,231.60 " " $2,309.25 " " $2,001.35 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 14000 14000 PR ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/< "2,310.00" " $2,079.00 " $924.00 " $1,848.00 " " $1,293.60 " " $1,617.00 " " $1,478.40 " " $1,848.00 " " $1,801.80 " " $1,039.50 " $947.10 $970.20 $924.00 " $1,732.50 " " $1,501.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 14001 14001 PR ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM "2,872.00" " $2,584.80 " " $1,148.80 " " $2,297.60 " " $1,608.32 " " $2,010.40 " " $1,838.08 " " $2,297.60 " " $2,240.16 " " $1,292.40 " " $1,177.52 " " $1,206.24 " " $1,148.80 " " $2,154.00 " " $1,866.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 14020 14020 PR ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/< "2,134.00" " $1,920.60 " $853.60 " $1,707.20 " " $1,195.04 " " $1,493.80 " " $1,365.76 " " $1,707.20 " " $1,664.52 " $960.30 $874.94 $896.28 $853.60 " $1,600.50 " " $1,387.10 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 14021 14021 PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM "2,956.00" " $2,660.40 " " $1,182.40 " " $2,364.80 " " $1,655.36 " " $2,069.20 " " $1,891.84 " " $2,364.80 " " $2,305.68 " " $1,330.20 " " $1,211.96 " " $1,241.52 " " $1,182.40 " " $2,217.00 " " $1,921.40 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 14040 14040 PR ADJ TISS XFER HEAD FACE NECK HANDS FEET <10SQCM "2,186.00" " $1,967.40 " $874.40 " $1,748.80 " " $1,224.16 " " $1,530.20 " " $1,399.04 " " $1,748.80 " " $1,705.08 " $983.70 $896.26 $918.12 $874.40 " $1,639.50 " " $1,420.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 14060 14060 PR ADJ TISS XFER LID NOSE EAR LIPS <10SQCM "2,410.00" " $2,169.00 " $964.00 " $1,928.00 " " $1,349.60 " " $1,687.00 " " $1,542.40 " " $1,928.00 " " $1,879.80 " " $1,084.50 " $988.10 " $1,012.20 " $964.00 " $1,807.50 " " $1,566.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 14301 14301 PR ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM "4,980.00" " $4,482.00 " " $1,992.00 " " $3,984.00 " " $2,788.80 " " $3,486.00 " " $3,187.20 " " $3,984.00 " " $3,884.40 " " $2,241.00 " " $2,041.80 " " $2,091.60 " " $1,992.00 " " $3,735.00 " " $3,237.00 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 14302 14302 PR ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM "1,054.00" $948.60 $421.60 $843.20 $590.24 $737.80 $674.56 $843.20 $822.12 $474.30 $432.14 $442.68 $421.60 $790.50 $685.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 15100 15100 PR SPLIT AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD "2,794.00" " $2,514.60 " " $1,117.60 " " $2,235.20 " " $1,564.64 " " $1,955.80 " " $1,788.16 " " $2,235.20 " " $2,179.32 " " $1,257.30 " " $1,145.54 " " $1,173.48 " " $1,117.60 " " $2,095.50 " " $1,816.10 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 15120 15120 PR SPLIT AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM//=100SCM ADL 100SQCM 234.00 $210.60 $93.60 $187.20 $131.04 $163.80 $149.76 $187.20 $182.52 $105.30 $95.94 $98.28 $93.60 $175.50 $152.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 15275 15275 PR SUB GRFT F/S/N/H/F/G/M/D <100SQ CM 1ST 25 SQ CM 796.00 $716.40 $318.40 $636.80 $445.76 $557.20 $509.44 $636.80 $620.88 $358.20 $326.36 $334.32 $318.40 $597.00 $517.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 15276 15276 PR SUB GRFT F/S/N/H/F/G/M/D<100SQ CM EA ADDL25SQ CM 183.00 $164.70 $73.20 $146.40 $102.48 $128.10 $117.12 $146.40 $142.74 $82.35 $75.03 $76.86 $73.20 $137.25 $118.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 15734 15734 PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK "7,216.00" " $6,494.40 " " $2,886.40 " " $5,772.80 " " $4,040.96 " " $5,051.20 " " $4,618.24 " " $5,772.80 " " $5,628.48 " " $3,247.20 " " $2,958.56 " " $3,030.72 " " $2,886.40 " " $5,412.00 " " $4,690.40 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 15830 15830 PR EXCISION SKIN ABD INFRAUMBILICAL PANNICULECTOMY "6,819.00" " $6,137.10 " " $2,727.60 " " $5,455.20 " " $3,818.64 " " $4,773.30 " " $4,364.16 " " $5,455.20 " " $5,318.82 " " $3,068.55 " " $2,795.79 " " $2,863.98 " " $2,727.60 " " $5,114.25 " " $4,432.35 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 15839 15839 PR EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA "3,418.00" " $3,076.20 " " $1,367.20 " " $2,734.40 " " $1,914.08 " " $2,392.60 " " $2,187.52 " " $2,734.40 " " $2,666.04 " " $1,538.10 " " $1,401.38 " " $1,435.56 " " $1,367.20 " " $2,563.50 " " $2,221.70 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 15847 15847 PR EXCISION EXCESSIVE SKIN & SUBQ TISSUE ABDOMEN "3,208.00" " $2,887.20 " " $1,283.20 " " $2,566.40 " " $1,796.48 " " $2,245.60 " " $2,053.12 " " $2,566.40 " " $2,502.24 " " $1,443.60 " " $1,315.28 " " $1,347.36 " " $1,283.20 " " $2,406.00 " " $2,085.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 15852 15852 PR DRESSING CHANGE UNDER ANESTHESIA 208.00 $187.20 $83.20 $166.40 $116.48 $145.60 $133.12 $166.40 $162.24 $93.60 $85.28 $87.36 $83.20 $156.00 $135.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 16000 16000 PR INITIAL TX 1ST DEGREE BURN LOCAL TX 297.00 $267.30 $118.80 $237.60 $166.32 $207.90 $190.08 $237.60 $231.66 $133.65 $121.77 $124.74 $118.80 $222.75 $193.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 16020 16020 PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL 323.00 $290.70 $129.20 $258.40 $180.88 $226.10 $206.72 $258.40 $251.94 $145.35 $132.43 $135.66 $129.20 $242.25 $209.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 16025 16025 PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM 425.00 $382.50 $170.00 $340.00 $238.00 $297.50 $272.00 $340.00 $331.50 $191.25 $174.25 $178.50 $170.00 $318.75 $276.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 16030 16030 PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE 840.00 $756.00 $336.00 $672.00 $470.40 $588.00 $537.60 $672.00 $655.20 $378.00 $344.40 $352.80 $336.00 $630.00 $546.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 17000 17000 PR DESTRUCTION PREMALIGNANT LESION 1ST 239.00 $215.10 $95.60 $191.20 $133.84 $167.30 $152.96 $191.20 $186.42 $107.55 $97.99 $100.38 $95.60 $179.25 $155.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 17003 17003 PR DESTRUCTION PREMALIGNANT LESION 2-14 EA 32.00 $28.80 $12.80 $25.60 $17.92 $22.40 $20.48 $25.60 $24.96 $14.40 $13.12 $13.44 $12.80 $24.00 $20.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 17004 17004 PR DESTRUCTION PREMALIGNANT LESION 15/> 644.00 $579.60 $257.60 $515.20 $360.64 $450.80 $412.16 $515.20 $502.32 $289.80 $264.04 $270.48 $257.60 $483.00 $418.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 17106 17106 PR DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM "1,165.00" " $1,048.50 " $466.00 $932.00 $652.40 $815.50 $745.60 $932.00 $908.70 $524.25 $477.65 $489.30 $466.00 $873.75 $757.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 17110 17110 PR DESTRUCTION BENIGN LESIONS UP TO 14 354.00 $318.60 $141.60 $283.20 $198.24 $247.80 $226.56 $283.20 $276.12 $159.30 $145.14 $148.68 $141.60 $265.50 $230.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 17111 17111 PR DESTRUCTION BENIGN LESIONS 15/> 535.00 $481.50 $214.00 $428.00 $299.60 $374.50 $342.40 $428.00 $417.30 $240.75 $219.35 $224.70 $214.00 $401.25 $347.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 17250 17250 PR CHEMICAL CAUTERIZATION OF GRANULATION TISSUE 261.00 $234.90 $104.40 $208.80 $146.16 $182.70 $167.04 $208.80 $203.58 $117.45 $107.01 $109.62 $104.40 $195.75 $169.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 17262 17262 PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM 577.00 $519.30 $230.80 $461.60 $323.12 $403.90 $369.28 $461.60 $450.06 $259.65 $236.57 $242.34 $230.80 $432.75 $375.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 17280 17280 PR DESTRUCTION MALIGNANT LESION F/E/E/N/L/M 0.5CM/< 493.00 $443.70 $197.20 $394.40 $276.08 $345.10 $315.52 $394.40 $384.54 $221.85 $202.13 $207.06 $197.20 $369.75 $320.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 17281 17281 PR DESTRUCTION MAL LESION F/E/E/N/L/M 0.6-1.0CM 705.00 $634.50 $282.00 $564.00 $394.80 $493.50 $451.20 $564.00 $549.90 $317.25 $289.05 $296.10 $282.00 $528.75 $458.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 17999.13 17999 PR DRAINAGE ENTERCUTANEOUS FISTULA "1,128.00" " $1,015.20 " $451.20 $902.40 $631.68 $789.60 $721.92 $902.40 $879.84 $507.60 $462.48 $473.76 $451.20 $846.00 $733.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 17999.29 17999 PR EXPLORATION OF SKIN INCISION AFFILIATE ONLY 224.00 $201.60 $89.60 $179.20 $125.44 $156.80 $143.36 $179.20 $174.72 $100.80 $91.84 $94.08 $89.60 $168.00 $145.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 19000 19000 PR PUNCTURE ASPIRATION CYST BREAST 391.00 $351.90 $156.40 $312.80 $218.96 $273.70 $250.24 $312.80 $304.98 $175.95 $160.31 $164.22 $156.40 $293.25 $254.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 19020 19020 PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP "1,523.00" " $1,370.70 " $609.20 " $1,218.40 " $852.88 " $1,066.10 " $974.72 " $1,218.40 " " $1,187.94 " $685.35 $624.43 $639.66 $609.20 " $1,142.25 " $989.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 19101 19101 PR BIOPSY BREAST OPEN INCISIONAL "1,247.00" " $1,122.30 " $498.80 $997.60 $698.32 $872.90 $798.08 $997.60 $972.66 $561.15 $511.27 $523.74 $498.80 $935.25 $810.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 19120 19120 PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION "2,031.00" " $1,827.90 " $812.40 " $1,624.80 " " $1,137.36 " " $1,421.70 " " $1,299.84 " " $1,624.80 " " $1,584.18 " $913.95 $832.71 $853.02 $812.40 " $1,523.25 " " $1,320.15 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 19125 19125 PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES "2,172.00" " $1,954.80 " $868.80 " $1,737.60 " " $1,216.32 " " $1,520.40 " " $1,390.08 " " $1,737.60 " " $1,694.16 " $977.40 $890.52 $912.24 $868.80 " $1,629.00 " " $1,411.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 19300 19300 PR MASTECTOMY GYNECOMASTIA "2,075.00" " $1,867.50 " $830.00 " $1,660.00 " " $1,162.00 " " $1,452.50 " " $1,328.00 " " $1,660.00 " " $1,618.50 " $933.75 $850.75 $871.50 $830.00 " $1,556.25 " " $1,348.75 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 19301 19301 PR MASTECTOMY PARTIAL "2,444.00" " $2,199.60 " $977.60 " $1,955.20 " " $1,368.64 " " $1,710.80 " " $1,564.16 " " $1,955.20 " " $1,906.32 " " $1,099.80 " " $1,002.04 " " $1,026.48 " $977.60 " $1,833.00 " " $1,588.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 19302 19302 PR MASTECTOMY PARTIAL W/AXILLARY LYMPHADENECTOMY "3,925.00" " $3,532.50 " " $1,570.00 " " $3,140.00 " " $2,198.00 " " $2,747.50 " " $2,512.00 " " $3,140.00 " " $3,061.50 " " $1,766.25 " " $1,609.25 " " $1,648.50 " " $1,570.00 " " $2,943.75 " " $2,551.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 19303 19303 PR MASTECTOMY SIMPLE COMPLETE "4,122.00" " $3,709.80 " " $1,648.80 " " $3,297.60 " " $2,308.32 " " $2,885.40 " " $2,638.08 " " $3,297.60 " " $3,215.16 " " $1,854.90 " " $1,690.02 " " $1,731.24 " " $1,648.80 " " $3,091.50 " " $2,679.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 19307 19307 PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN "5,061.00" " $4,554.90 " " $2,024.40 " " $4,048.80 " " $2,834.16 " " $3,542.70 " " $3,239.04 " " $4,048.80 " " $3,947.58 " " $2,277.45 " " $2,075.01 " " $2,125.62 " " $2,024.40 " " $3,795.75 " " $3,289.65 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 20101 20101 PR EXPLORATION PENETRATING WOUND SPX CHEST "1,626.00" " $1,463.40 " $650.40 " $1,300.80 " $910.56 " $1,138.20 " " $1,040.64 " " $1,300.80 " " $1,268.28 " $731.70 $666.66 $682.92 $650.40 " $1,219.50 " " $1,056.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 20102 20102 PR EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK "1,884.00" " $1,695.60 " $753.60 " $1,507.20 " " $1,055.04 " " $1,318.80 " " $1,205.76 " " $1,507.20 " " $1,469.52 " $847.80 $772.44 $791.28 $753.60 " $1,413.00 " " $1,224.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 20103 20103 PR EXPLORATION PENETRATING WOUND SPX EXTREMITY "2,749.00" " $2,474.10 " " $1,099.60 " " $2,199.20 " " $1,539.44 " " $1,924.30 " " $1,759.36 " " $2,199.20 " " $2,144.22 " " $1,237.05 " " $1,127.09 " " $1,154.58 " " $1,099.60 " " $2,061.75 " " $1,786.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 20200 20200 PR BIOPSY MUSCLE SUPERFICIAL 627.00 $564.30 $250.80 $501.60 $351.12 $438.90 $401.28 $501.60 $489.06 $282.15 $257.07 $263.34 $250.80 $470.25 $407.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 20205 20205 PR BIOPSY MUSCLE DEEP 964.00 $867.60 $385.60 $771.20 $539.84 $674.80 $616.96 $771.20 $751.92 $433.80 $395.24 $404.88 $385.60 $723.00 $626.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 20225 20225 PR BIOPSY BONE TROCAR/NEEDLE DEEP "1,014.00" $912.60 $405.60 $811.20 $567.84 $709.80 $648.96 $811.20 $790.92 $456.30 $415.74 $425.88 $405.60 $760.50 $659.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 20240 20240 PR BIOPSY BONE OPEN SUPERFICIAL 835.00 $751.50 $334.00 $668.00 $467.60 $584.50 $534.40 $668.00 $651.30 $375.75 $342.35 $350.70 $334.00 $626.25 $542.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 20520 20520 PR REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE 643.00 $578.70 $257.20 $514.40 $360.08 $450.10 $411.52 $514.40 $501.54 $289.35 $263.63 $270.06 $257.20 $482.25 $417.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 20525 20525 PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP "2,243.00" " $2,018.70 " $897.20 " $1,794.40 " " $1,256.08 " " $1,570.10 " " $1,435.52 " " $1,794.40 " " $1,749.54 " " $1,009.35 " $919.63 $942.06 $897.20 " $1,682.25 " " $1,457.95 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 20526 20526 PR INJECTION THERAPEUTIC CARPAL TUNNEL 358.00 $322.20 $143.20 $286.40 $200.48 $250.60 $229.12 $286.40 $279.24 $161.10 $146.78 $150.36 $143.20 $268.50 $232.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 20550 20550 PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS 282.00 $253.80 $112.80 $225.60 $157.92 $197.40 $180.48 $225.60 $219.96 $126.90 $115.62 $118.44 $112.80 $211.50 $183.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 20551 20551 PR INJECTION SINGLE TENDON ORIGIN/INSERTION 226.00 $203.40 $90.40 $180.80 $126.56 $158.20 $144.64 $180.80 $176.28 $101.70 $92.66 $94.92 $90.40 $169.50 $146.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 20552 20552 PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES 317.00 $285.30 $126.80 $253.60 $177.52 $221.90 $202.88 $253.60 $247.26 $142.65 $129.97 $133.14 $126.80 $237.75 $206.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 20553 20553 PR INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES 290.00 $261.00 $116.00 $232.00 $162.40 $203.00 $185.60 $232.00 $226.20 $130.50 $118.90 $121.80 $116.00 $217.50 $188.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 20600 20600 PR ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US 289.00 $260.10 $115.60 $231.20 $161.84 $202.30 $184.96 $231.20 $225.42 $130.05 $118.49 $121.38 $115.60 $216.75 $187.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 20604 20604 PR ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT 316.00 $284.40 $126.40 $252.80 $176.96 $221.20 $202.24 $252.80 $246.48 $142.20 $129.56 $132.72 $126.40 $237.00 $205.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 20605 20605 PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US 291.00 $261.90 $116.40 $232.80 $162.96 $203.70 $186.24 $232.80 $226.98 $130.95 $119.31 $122.22 $116.40 $218.25 $189.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 20606 20606 PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US 430.00 $387.00 $172.00 $344.00 $240.80 $301.00 $275.20 $344.00 $335.40 $193.50 $176.30 $180.60 $172.00 $322.50 $279.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 20610 20610 PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US 361.00 $324.90 $144.40 $288.80 $202.16 $252.70 $231.04 $288.80 $281.58 $162.45 $148.01 $151.62 $144.40 $270.75 $234.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 20611 20611 PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US 537.00 $483.30 $214.80 $429.60 $300.72 $375.90 $343.68 $429.60 $418.86 $241.65 $220.17 $225.54 $214.80 $402.75 $349.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 20612 20612 PR ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ 346.00 $311.40 $138.40 $276.80 $193.76 $242.20 $221.44 $276.80 $269.88 $155.70 $141.86 $145.32 $138.40 $259.50 $224.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 20670 20670 PR REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE "1,203.00" " $1,082.70 " $481.20 $962.40 $673.68 $842.10 $769.92 $962.40 $938.34 $541.35 $493.23 $505.26 $481.20 $902.25 $781.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 20680 20680 PR REMOVAL IMPLANT DEEP "1,867.00" " $1,680.30 " $746.80 " $1,493.60 " " $1,045.52 " " $1,306.90 " " $1,194.88 " " $1,493.60 " " $1,456.26 " $840.15 $765.47 $784.14 $746.80 " $1,400.25 " " $1,213.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 20900 20900 PR BONE GRAFT ANY DONOR AREA MINOR/SMALL 879.00 $791.10 $351.60 $703.20 $492.24 $615.30 $562.56 $703.20 $685.62 $395.55 $360.39 $369.18 $351.60 $659.25 $571.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 20936 20936 PR AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION "1,010.00" $909.00 $404.00 $808.00 $565.60 $707.00 $646.40 $808.00 $787.80 $454.50 $414.10 $424.20 $404.00 $757.50 $656.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 20985 20985 PR CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS 672.00 $604.80 $268.80 $537.60 $376.32 $470.40 $430.08 $537.60 $524.16 $302.40 $275.52 $282.24 $268.80 $504.00 $436.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 21014 21014 PR EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/> "2,390.00" " $2,151.00 " $956.00 " $1,912.00 " " $1,338.40 " " $1,673.00 " " $1,529.60 " " $1,912.00 " " $1,864.20 " " $1,075.50 " $979.90 " $1,003.80 " $956.00 " $1,792.50 " " $1,553.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 21310 21310 (IA) PR CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION 345.00 $310.50 $138.00 $276.00 $193.20 $241.50 $220.80 $276.00 $269.10 $155.25 $141.45 $144.90 $138.00 $258.75 $224.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 21320 21320 PR CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION "1,088.00" $979.20 $435.20 $870.40 $609.28 $761.60 $696.32 $870.40 $848.64 $489.60 $446.08 $456.96 $435.20 $816.00 $707.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 21480 21480 PR CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ 426.00 $383.40 $170.40 $340.80 $238.56 $298.20 $272.64 $340.80 $332.28 $191.70 $174.66 $178.92 $170.40 $319.50 $276.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 21550 21550 PR BIOPSY SOFT TISSUE NECK/THORAX 896.00 $806.40 $358.40 $716.80 $501.76 $627.20 $573.44 $716.80 $698.88 $403.20 $367.36 $376.32 $358.40 $672.00 $582.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 21552 21552 PR EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/> "1,697.00" " $1,527.30 " $678.80 " $1,357.60 " $950.32 " $1,187.90 " " $1,086.08 " " $1,357.60 " " $1,323.66 " $763.65 $695.77 $712.74 $678.80 " $1,272.75 " " $1,103.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 21554 21554 PR EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/> "3,150.00" " $2,835.00 " " $1,260.00 " " $2,520.00 " " $1,764.00 " " $2,205.00 " " $2,016.00 " " $2,520.00 " " $2,457.00 " " $1,417.50 " " $1,291.50 " " $1,323.00 " " $1,260.00 " " $2,362.50 " " $2,047.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 21555 21555 PR EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM "1,369.00" " $1,232.10 " $547.60 " $1,095.20 " $766.64 $958.30 $876.16 " $1,095.20 " " $1,067.82 " $616.05 $561.29 $574.98 $547.60 " $1,026.75 " $889.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 21556 21556 PR EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM "2,509.00" " $2,258.10 " " $1,003.60 " " $2,007.20 " " $1,405.04 " " $1,756.30 " " $1,605.76 " " $2,007.20 " " $1,957.02 " " $1,129.05 " " $1,028.69 " " $1,053.78 " " $1,003.60 " " $1,881.75 " " $1,630.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 21615 21615 PR EXCISION 1ST &/CERVICAL RIB "4,148.00" " $3,733.20 " " $1,659.20 " " $3,318.40 " " $2,322.88 " " $2,903.60 " " $2,654.72 " " $3,318.40 " " $3,235.44 " " $1,866.60 " " $1,700.68 " " $1,742.16 " " $1,659.20 " " $3,111.00 " " $2,696.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 21820 21820 PR CLOSED TREATMENT STERNUM FRACTURE 745.00 $670.50 $298.00 $596.00 $417.20 $521.50 $476.80 $596.00 $581.10 $335.25 $305.45 $312.90 $298.00 $558.75 $484.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 21930 21930 PR EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM "1,591.00" " $1,431.90 " $636.40 " $1,272.80 " $890.96 " $1,113.70 " " $1,018.24 " " $1,272.80 " " $1,240.98 " $715.95 $652.31 $668.22 $636.40 " $1,193.25 " " $1,034.15 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 21931 21931 PR EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/> "2,674.00" " $2,406.60 " " $1,069.60 " " $2,139.20 " " $1,497.44 " " $1,871.80 " " $1,711.36 " " $2,139.20 " " $2,085.72 " " $1,203.30 " " $1,096.34 " " $1,123.08 " " $1,069.60 " " $2,005.50 " " $1,738.10 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 21933 21933 PR EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/> "3,692.00" " $3,322.80 " " $1,476.80 " " $2,953.60 " " $2,067.52 " " $2,584.40 " " $2,362.88 " " $2,953.60 " " $2,879.76 " " $1,661.40 " " $1,513.72 " " $1,550.64 " " $1,476.80 " " $2,769.00 " " $2,399.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 22310 22310 PR CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING "1,393.00" " $1,253.70 " $557.20 " $1,114.40 " $780.08 $975.10 $891.52 " $1,114.40 " " $1,086.54 " $626.85 $571.13 $585.06 $557.20 " $1,044.75 " $905.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 22612 22612 PR ARTHRODESIS POSTERIOR/POSTEROLATERAL LUMBAR "10,505.00" " $9,454.50 " " $4,202.00 " " $8,404.00 " " $5,882.80 " " $7,353.50 " " $6,723.20 " " $8,404.00 " " $8,193.90 " " $4,727.25 " " $4,307.05 " " $4,412.10 " " $4,202.00 " " $7,878.75 " " $6,828.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 22840 22840 PR POSTERIOR NON-SEGMENTAL INSTRUMENTATION "5,005.00" " $4,504.50 " " $2,002.00 " " $4,004.00 " " $2,802.80 " " $3,503.50 " " $3,203.20 " " $4,004.00 " " $3,903.90 " " $2,252.25 " " $2,052.05 " " $2,102.10 " " $2,002.00 " " $3,753.75 " " $3,253.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 22856 22856 PR TOT DISC ARTHRP ART DISC ANT APPRO 1 NTRSPC CRV "10,829.00" " $9,746.10 " " $4,331.60 " " $8,663.20 " " $6,064.24 " " $7,580.30 " " $6,930.56 " " $8,663.20 " " $8,446.62 " " $4,873.05 " " $4,439.89 " " $4,548.18 " " $4,331.60 " " $8,121.75 " " $7,038.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 22900 22900 PR EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM "2,236.00" " $2,012.40 " $894.40 " $1,788.80 " " $1,252.16 " " $1,565.20 " " $1,431.04 " " $1,788.80 " " $1,744.08 " " $1,006.20 " $916.76 $939.12 $894.40 " $1,677.00 " " $1,453.40 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 22901 22901 PR EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5CM/> "2,746.00" " $2,471.40 " " $1,098.40 " " $2,196.80 " " $1,537.76 " " $1,922.20 " " $1,757.44 " " $2,196.80 " " $2,141.88 " " $1,235.70 " " $1,125.86 " " $1,153.32 " " $1,098.40 " " $2,059.50 " " $1,784.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 22902 22902 PR EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM "1,563.00" " $1,406.70 " $625.20 " $1,250.40 " $875.28 " $1,094.10 " " $1,000.32 " " $1,250.40 " " $1,219.14 " $703.35 $640.83 $656.46 $625.20 " $1,172.25 " " $1,015.95 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 22903 22903 PR EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/> "1,902.00" " $1,711.80 " $760.80 " $1,521.60 " " $1,065.12 " " $1,331.40 " " $1,217.28 " " $1,521.60 " " $1,483.56 " $855.90 $779.82 $798.84 $760.80 " $1,426.50 " " $1,236.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 22999.7 22999 PR REPAIR OF ABDOMINAL WALL "1,756.00" " $1,580.40 " $702.40 " $1,404.80 " $983.36 " $1,229.20 " " $1,123.84 " " $1,404.80 " " $1,369.68 " $790.20 $719.96 $737.52 $702.40 " $1,317.00 " " $1,141.40 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 23030 23030 PR I&D SHOULDER DEEP ABSCESS/HEMATOMA "1,274.00" " $1,146.60 " $509.60 " $1,019.20 " $713.44 $891.80 $815.36 " $1,019.20 " $993.72 $573.30 $522.34 $535.08 $509.60 $955.50 $828.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 23071 23071 PR EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/> "1,884.00" " $1,695.60 " $753.60 " $1,507.20 " " $1,055.04 " " $1,318.80 " " $1,205.76 " " $1,507.20 " " $1,469.52 " $847.80 $772.44 $791.28 $753.60 " $1,413.00 " " $1,224.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 23076 23076 PR EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM "2,701.00" " $2,430.90 " " $1,080.40 " " $2,160.80 " " $1,512.56 " " $1,890.70 " " $1,728.64 " " $2,160.80 " " $2,106.78 " " $1,215.45 " " $1,107.41 " " $1,134.42 " " $1,080.40 " " $2,025.75 " " $1,755.65 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 23120 23120 PR CLAVICULECTOMY PARTIAL "2,642.00" " $2,377.80 " " $1,056.80 " " $2,113.60 " " $1,479.52 " " $1,849.40 " " $1,690.88 " " $2,113.60 " " $2,060.76 " " $1,188.90 " " $1,083.22 " " $1,109.64 " " $1,056.80 " " $1,981.50 " " $1,717.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 23410 23410 PR OPEN REPAIR OF ROTATOR CUFF ACUTE "4,833.00" " $4,349.70 " " $1,933.20 " " $3,866.40 " " $2,706.48 " " $3,383.10 " " $3,093.12 " " $3,866.40 " " $3,769.74 " " $2,174.85 " " $1,981.53 " " $2,029.86 " " $1,933.20 " " $3,624.75 " " $3,141.45 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 23412 23412 PR OPEN REPAIR OF ROTATOR CUFF CHRONIC "4,742.00" " $4,267.80 " " $1,896.80 " " $3,793.60 " " $2,655.52 " " $3,319.40 " " $3,034.88 " " $3,793.60 " " $3,698.76 " " $2,133.90 " " $1,944.22 " " $1,991.64 " " $1,896.80 " " $3,556.50 " " $3,082.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 23430 23430 PR TENODESIS LONG TENDON BICEPS "3,534.00" " $3,180.60 " " $1,413.60 " " $2,827.20 " " $1,979.04 " " $2,473.80 " " $2,261.76 " " $2,827.20 " " $2,756.52 " " $1,590.30 " " $1,448.94 " " $1,484.28 " " $1,413.60 " " $2,650.50 " " $2,297.10 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 23472 23472 PR ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER "6,482.00" " $5,833.80 " " $2,592.80 " " $5,185.60 " " $3,629.92 " " $4,537.40 " " $4,148.48 " " $5,185.60 " " $5,055.96 " " $2,916.90 " " $2,657.62 " " $2,722.44 " " $2,592.80 " " $4,861.50 " " $4,213.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 23500 23500 PR CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION 833.00 $749.70 $333.20 $666.40 $466.48 $583.10 $533.12 $666.40 $649.74 $374.85 $341.53 $349.86 $333.20 $624.75 $541.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 23515 23515 PR OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION "3,550.00" " $3,195.00 " " $1,420.00 " " $2,840.00 " " $1,988.00 " " $2,485.00 " " $2,272.00 " " $2,840.00 " " $2,769.00 " " $1,597.50 " " $1,455.50 " " $1,491.00 " " $1,420.00 " " $2,662.50 " " $2,307.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 23552 23552 PR OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF "3,762.00" " $3,385.80 " " $1,504.80 " " $3,009.60 " " $2,106.72 " " $2,633.40 " " $2,407.68 " " $3,009.60 " " $2,934.36 " " $1,692.90 " " $1,542.42 " " $1,580.04 " " $1,504.80 " " $2,821.50 " " $2,445.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 23570 23570 PR CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION 902.00 $811.80 $360.80 $721.60 $505.12 $631.40 $577.28 $721.60 $703.56 $405.90 $369.82 $378.84 $360.80 $676.50 $586.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 23600 23600 PR CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION "1,347.00" " $1,212.30 " $538.80 " $1,077.60 " $754.32 $942.90 $862.08 " $1,077.60 " " $1,050.66 " $606.15 $552.27 $565.74 $538.80 " $1,010.25 " $875.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 23605 23605 PR CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ "2,265.00" " $2,038.50 " $906.00 " $1,812.00 " " $1,268.40 " " $1,585.50 " " $1,449.60 " " $1,812.00 " " $1,766.70 " " $1,019.25 " $928.65 $951.30 $906.00 " $1,698.75 " " $1,472.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 23620 23620 PR CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ "1,029.00" $926.10 $411.60 $823.20 $576.24 $720.30 $658.56 $823.20 $802.62 $463.05 $421.89 $432.18 $411.60 $771.75 $668.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 23650 23650 PR CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES "1,276.00" " $1,148.40 " $510.40 " $1,020.80 " $714.56 $893.20 $816.64 " $1,020.80 " $995.28 $574.20 $523.16 $535.92 $510.40 $957.00 $829.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 23655 23655 PR CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES "1,692.00" " $1,522.80 " $676.80 " $1,353.60 " $947.52 " $1,184.40 " " $1,082.88 " " $1,353.60 " " $1,319.76 " $761.40 $693.72 $710.64 $676.80 " $1,269.00 " " $1,099.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 23700 23700 PR MANJ W/ANES SHOULDER JOINT W/FIXATION APPARATUS "1,291.00" " $1,161.90 " $516.40 " $1,032.80 " $722.96 $903.70 $826.24 " $1,032.80 " " $1,006.98 " $580.95 $529.31 $542.22 $516.40 $968.25 $839.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 23930 23930 PR I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA "1,417.00" " $1,275.30 " $566.80 " $1,133.60 " $793.52 $991.90 $906.88 " $1,133.60 " " $1,105.26 " $637.65 $580.97 $595.14 $566.80 " $1,062.75 " $921.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 23931 23931 PR INCISION&DRAINAGE UPPER ARM/ELBOW BURSA "1,228.00" " $1,105.20 " $491.20 $982.40 $687.68 $859.60 $785.92 $982.40 $957.84 $552.60 $503.48 $515.76 $491.20 $921.00 $798.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 24071 24071 PR EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/> "1,655.00" " $1,489.50 " $662.00 " $1,324.00 " $926.80 " $1,158.50 " " $1,059.20 " " $1,324.00 " " $1,290.90 " $744.75 $678.55 $695.10 $662.00 " $1,241.25 " " $1,075.75 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 24076 24076 PR EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM "2,287.00" " $2,058.30 " $914.80 " $1,829.60 " " $1,280.72 " " $1,600.90 " " $1,463.68 " " $1,829.60 " " $1,783.86 " " $1,029.15 " $937.67 $960.54 $914.80 " $1,715.25 " " $1,486.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 24105 24105 PR EXCISION OLECRANON BURSA "1,743.00" " $1,568.70 " $697.20 " $1,394.40 " $976.08 " $1,220.10 " " $1,115.52 " " $1,394.40 " " $1,359.54 " $784.35 $714.63 $732.06 $697.20 " $1,307.25 " " $1,132.95 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 24120 24120 PR EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN "2,720.00" " $2,448.00 " " $1,088.00 " " $2,176.00 " " $1,523.20 " " $1,904.00 " " $1,740.80 " " $2,176.00 " " $2,121.60 " " $1,224.00 " " $1,115.20 " " $1,142.40 " " $1,088.00 " " $2,040.00 " " $1,768.00 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 24200 24200 PR RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS 826.00 $743.40 $330.40 $660.80 $462.56 $578.20 $528.64 $660.80 $644.28 $371.70 $338.66 $346.92 $330.40 $619.50 $536.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 24341 24341 PR REPAIR TENDON/MUSCLE UPPER ARM/ELBOW EA "3,697.00" " $3,327.30 " " $1,478.80 " " $2,957.60 " " $2,070.32 " " $2,587.90 " " $2,366.08 " " $2,957.60 " " $2,883.66 " " $1,663.65 " " $1,515.77 " " $1,552.74 " " $1,478.80 " " $2,772.75 " " $2,403.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 24342 24342 PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF "3,713.00" " $3,341.70 " " $1,485.20 " " $2,970.40 " " $2,079.28 " " $2,599.10 " " $2,376.32 " " $2,970.40 " " $2,896.14 " " $1,670.85 " " $1,522.33 " " $1,559.46 " " $1,485.20 " " $2,784.75 " " $2,413.45 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 24500 24500 PR CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION "1,481.00" " $1,332.90 " $592.40 " $1,184.80 " $829.36 " $1,036.70 " $947.84 " $1,184.80 " " $1,155.18 " $666.45 $607.21 $622.02 $592.40 " $1,110.75 " $962.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 24505 24505 PR CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ "2,190.00" " $1,971.00 " $876.00 " $1,752.00 " " $1,226.40 " " $1,533.00 " " $1,401.60 " " $1,752.00 " " $1,708.20 " $985.50 $897.90 $919.80 $876.00 " $1,642.50 " " $1,423.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 24515 24515 PR OPTX HUMERAL SHFT FX W/PLATE/SCREWS W/WOCERCLAGE "4,185.00" " $3,766.50 " " $1,674.00 " " $3,348.00 " " $2,343.60 " " $2,929.50 " " $2,678.40 " " $3,348.00 " " $3,264.30 " " $1,883.25 " " $1,715.85 " " $1,757.70 " " $1,674.00 " " $3,138.75 " " $2,720.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 24530 24530 PR CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ "1,602.00" " $1,441.80 " $640.80 " $1,281.60 " $897.12 " $1,121.40 " " $1,025.28 " " $1,281.60 " " $1,249.56 " $720.90 $656.82 $672.84 $640.80 " $1,201.50 " " $1,041.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 24560 24560 PR CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ "1,427.00" " $1,284.30 " $570.80 " $1,141.60 " $799.12 $998.90 $913.28 " $1,141.60 " " $1,113.06 " $642.15 $585.07 $599.34 $570.80 " $1,070.25 " $927.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 24576 24576 PR CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ "1,388.00" " $1,249.20 " $555.20 " $1,110.40 " $777.28 $971.60 $888.32 " $1,110.40 " " $1,082.64 " $624.60 $569.08 $582.96 $555.20 " $1,041.00 " $902.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 24600 24600 PR TREATMENT CLOSED ELBOW DISLOCATION W/O ANES "1,693.00" " $1,523.70 " $677.20 " $1,354.40 " $948.08 " $1,185.10 " " $1,083.52 " " $1,354.40 " " $1,320.54 " $761.85 $694.13 $711.06 $677.20 " $1,269.75 " " $1,100.45 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 24605 24605 PR TREATMENT CLOSED ELBOW DISLOCATION REQ ANES "1,982.00" " $1,783.80 " $792.80 " $1,585.60 " " $1,109.92 " " $1,387.40 " " $1,268.48 " " $1,585.60 " " $1,545.96 " $891.90 $812.62 $832.44 $792.80 " $1,486.50 " " $1,288.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 24640 24640 PR CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ 517.00 $465.30 $206.80 $413.60 $289.52 $361.90 $330.88 $413.60 $403.26 $232.65 $211.97 $217.14 $206.80 $387.75 $336.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 24650 24650 PR CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION "1,102.00" $991.80 $440.80 $881.60 $617.12 $771.40 $705.28 $881.60 $859.56 $495.90 $451.82 $462.84 $440.80 $826.50 $716.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 24655 24655 PR CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION "1,865.00" " $1,678.50 " $746.00 " $1,492.00 " " $1,044.40 " " $1,305.50 " " $1,193.60 " " $1,492.00 " " $1,454.70 " $839.25 $764.65 $783.30 $746.00 " $1,398.75 " " $1,212.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 24665 24665 PR OPEN TX RADIAL HEAD/NECK FRACTURE "4,112.00" " $3,700.80 " " $1,644.80 " " $3,289.60 " " $2,302.72 " " $2,878.40 " " $2,631.68 " " $3,289.60 " " $3,207.36 " " $1,850.40 " " $1,685.92 " " $1,727.04 " " $1,644.80 " " $3,084.00 " " $2,672.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 24666 24666 PR OPEN TX RADIAL HEAD/NECK FRACTURE PROSTHETIC "3,645.00" " $3,280.50 " " $1,458.00 " " $2,916.00 " " $2,041.20 " " $2,551.50 " " $2,332.80 " " $2,916.00 " " $2,843.10 " " $1,640.25 " " $1,494.45 " " $1,530.90 " " $1,458.00 " " $2,733.75 " " $2,369.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 24670 24670 PR CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ "1,183.00" " $1,064.70 " $473.20 $946.40 $662.48 $828.10 $757.12 $946.40 $922.74 $532.35 $485.03 $496.86 $473.20 $887.25 $768.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 24675 24675 PR CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ "1,921.00" " $1,728.90 " $768.40 " $1,536.80 " " $1,075.76 " " $1,344.70 " " $1,229.44 " " $1,536.80 " " $1,498.38 " $864.45 $787.61 $806.82 $768.40 " $1,440.75 " " $1,248.65 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 24685 24685 PR OPEN TREATMENT ULNAR FRACTURE PROXIMAL END "2,919.00" " $2,627.10 " " $1,167.60 " " $2,335.20 " " $1,634.64 " " $2,043.30 " " $1,868.16 " " $2,335.20 " " $2,276.82 " " $1,313.55 " " $1,196.79 " " $1,225.98 " " $1,167.60 " " $2,189.25 " " $1,897.35 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 24999.1 24999 PR TRANSVERSE HUMERAL LIGAMENT RESECTION 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 24999.5 24999 PR CLOSED TREATMENT ELBOW FX WO MANIPULATION AFFILIATE ONLY 591.00 $531.90 $236.40 $472.80 $330.96 $413.70 $378.24 $472.80 $460.98 $265.95 $242.31 $248.22 $236.40 $443.25 $384.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 25000 25000 PR INCISION EXTENSOR TENDON SHEATH WRIST "1,968.00" " $1,771.20 " $787.20 " $1,574.40 " " $1,102.08 " " $1,377.60 " " $1,259.52 " " $1,574.40 " " $1,535.04 " $885.60 $806.88 $826.56 $787.20 " $1,476.00 " " $1,279.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 25071 25071 PR EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/> "1,945.00" " $1,750.50 " $778.00 " $1,556.00 " " $1,089.20 " " $1,361.50 " " $1,244.80 " " $1,556.00 " " $1,517.10 " $875.25 $797.45 $816.90 $778.00 " $1,458.75 " " $1,264.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 25110 25110 PR EXCISION LESION TENDON SHEATH FOREARM&/WRIST "1,882.00" " $1,693.80 " $752.80 " $1,505.60 " " $1,053.92 " " $1,317.40 " " $1,204.48 " " $1,505.60 " " $1,467.96 " $846.90 $771.62 $790.44 $752.80 " $1,411.50 " " $1,223.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 25111 25111 PR EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY "1,450.00" " $1,305.00 " $580.00 " $1,160.00 " $812.00 " $1,015.00 " $928.00 " $1,160.00 " " $1,131.00 " $652.50 $594.50 $609.00 $580.00 " $1,087.50 " $942.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 25112 25112 PR EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT "2,002.00" " $1,801.80 " $800.80 " $1,601.60 " " $1,121.12 " " $1,401.40 " " $1,281.28 " " $1,601.60 " " $1,561.56 " $900.90 $820.82 $840.84 $800.80 " $1,501.50 " " $1,301.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 25118 25118 PR SYNOVECTOMY EXTENSOR TENDON SHTH WRIST 1 CMPRT "2,135.00" " $1,921.50 " $854.00 " $1,708.00 " " $1,195.60 " " $1,494.50 " " $1,366.40 " " $1,708.00 " " $1,665.30 " $960.75 $875.35 $896.70 $854.00 " $1,601.25 " " $1,387.75 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 25500 25500 PR CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION "1,092.00" $982.80 $436.80 $873.60 $611.52 $764.40 $698.88 $873.60 $851.76 $491.40 $447.72 $458.64 $436.80 $819.00 $709.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 25520 25520 PR CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT "2,277.00" " $2,049.30 " $910.80 " $1,821.60 " " $1,275.12 " " $1,593.90 " " $1,457.28 " " $1,821.60 " " $1,776.06 " " $1,024.65 " $933.57 $956.34 $910.80 " $1,707.75 " " $1,480.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 25525 25525 PR OPEN RDL SHAFT FX CLOSED RAD/ULN JT DISLOCATE "3,684.00" " $3,315.60 " " $1,473.60 " " $2,947.20 " " $2,063.04 " " $2,578.80 " " $2,357.76 " " $2,947.20 " " $2,873.52 " " $1,657.80 " " $1,510.44 " " $1,547.28 " " $1,473.60 " " $2,763.00 " " $2,394.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 25530 25530 PR CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION "1,106.00" $995.40 $442.40 $884.80 $619.36 $774.20 $707.84 $884.80 $862.68 $497.70 $453.46 $464.52 $442.40 $829.50 $718.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 25560 25560 PR CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN "1,179.00" " $1,061.10 " $471.60 $943.20 $660.24 $825.30 $754.56 $943.20 $919.62 $530.55 $483.39 $495.18 $471.60 $884.25 $766.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 25565 25565 PR CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ "1,822.00" " $1,639.80 " $728.80 " $1,457.60 " " $1,020.32 " " $1,275.40 " " $1,166.08 " " $1,457.60 " " $1,421.16 " $819.90 $747.02 $765.24 $728.80 " $1,366.50 " " $1,184.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 25575 25575 PR OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS&ULNA "4,542.00" " $4,087.80 " " $1,816.80 " " $3,633.60 " " $2,543.52 " " $3,179.40 " " $2,906.88 " " $3,633.60 " " $3,542.76 " " $2,043.90 " " $1,862.22 " " $1,907.64 " " $1,816.80 " " $3,406.50 " " $2,952.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 25600 25600 PR CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ "1,317.00" " $1,185.30 " $526.80 " $1,053.60 " $737.52 $921.90 $842.88 " $1,053.60 " " $1,027.26 " $592.65 $539.97 $553.14 $526.80 $987.75 $856.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 25605 25605 PR CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF "2,975.00" " $2,677.50 " " $1,190.00 " " $2,380.00 " " $1,666.00 " " $2,082.50 " " $1,904.00 " " $2,380.00 " " $2,320.50 " " $1,338.75 " " $1,219.75 " " $1,249.50 " " $1,190.00 " " $2,231.25 " " $1,933.75 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 25606 25606 PR PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP "3,091.00" " $2,781.90 " " $1,236.40 " " $2,472.80 " " $1,730.96 " " $2,163.70 " " $1,978.24 " " $2,472.80 " " $2,410.98 " " $1,390.95 " " $1,267.31 " " $1,298.22 " " $1,236.40 " " $2,318.25 " " $2,009.15 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 25607 25607 PR OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP "3,040.00" " $2,736.00 " " $1,216.00 " " $2,432.00 " " $1,702.40 " " $2,128.00 " " $1,945.60 " " $2,432.00 " " $2,371.20 " " $1,368.00 " " $1,246.40 " " $1,276.80 " " $1,216.00 " " $2,280.00 " " $1,976.00 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 25609 25609 PR OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3 FRAG "4,149.00" " $3,734.10 " " $1,659.60 " " $3,319.20 " " $2,323.44 " " $2,904.30 " " $2,655.36 " " $3,319.20 " " $3,236.22 " " $1,867.05 " " $1,701.09 " " $1,742.58 " " $1,659.60 " " $3,111.75 " " $2,696.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 25622 25622 PR CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ "1,076.00" $968.40 $430.40 $860.80 $602.56 $753.20 $688.64 $860.80 $839.28 $484.20 $441.16 $451.92 $430.40 $807.00 $699.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 25630 25630 PR CLTX CARPAL BONE FX W/O MANJ EACH BONE "1,267.00" " $1,140.30 " $506.80 " $1,013.60 " $709.52 $886.90 $810.88 " $1,013.60 " $988.26 $570.15 $519.47 $532.14 $506.80 $950.25 $823.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 25650 25650 PR CLOSED TREATMENT ULNAR STYLOID FRACTURE "1,402.00" " $1,261.80 " $560.80 " $1,121.60 " $785.12 $981.40 $897.28 " $1,121.60 " " $1,093.56 " $630.90 $574.82 $588.84 $560.80 " $1,051.50 " $911.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26010 26010 PR DRAINAGE FINGER ABSCESS SIMPLE "1,106.00" $995.40 $442.40 $884.80 $619.36 $774.20 $707.84 $884.80 $862.68 $497.70 $453.46 $464.52 $442.40 $829.50 $718.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26011 26011 PR DRAINAGE FINGER ABSCESS COMPLICATED "1,418.00" " $1,276.20 " $567.20 " $1,134.40 " $794.08 $992.60 $907.52 " $1,134.40 " " $1,106.04 " $638.10 $581.38 $595.56 $567.20 " $1,063.50 " $921.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26055 26055 PR TENDON SHEATH INCISION "1,841.00" " $1,656.90 " $736.40 " $1,472.80 " " $1,030.96 " " $1,288.70 " " $1,178.24 " " $1,472.80 " " $1,435.98 " $828.45 $754.81 $773.22 $736.40 " $1,380.75 " " $1,196.65 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26160 26160 PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR "2,069.00" " $1,862.10 " $827.60 " $1,655.20 " " $1,158.64 " " $1,448.30 " " $1,324.16 " " $1,655.20 " " $1,613.82 " $931.05 $848.29 $868.98 $827.60 " $1,551.75 " " $1,344.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26210 26210 PR EXCISION/CURETTAGE CYST/TUMOR PHALANX FINGER "2,192.00" " $1,972.80 " $876.80 " $1,753.60 " " $1,227.52 " " $1,534.40 " " $1,402.88 " " $1,753.60 " " $1,709.76 " $986.40 $898.72 $920.64 $876.80 " $1,644.00 " " $1,424.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26410 26410 PR REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH "2,349.00" " $2,114.10 " $939.60 " $1,879.20 " " $1,315.44 " " $1,644.30 " " $1,503.36 " " $1,879.20 " " $1,832.22 " " $1,057.05 " $963.09 $986.58 $939.60 " $1,761.75 " " $1,526.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26418 26418 PR REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH "2,936.00" " $2,642.40 " " $1,174.40 " " $2,348.80 " " $1,644.16 " " $2,055.20 " " $1,879.04 " " $2,348.80 " " $2,290.08 " " $1,321.20 " " $1,203.76 " " $1,233.12 " " $1,174.40 " " $2,202.00 " " $1,908.40 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26600 26600 PR CLTX METACARPAL FX W/O MANIPULATION EACH BONE "1,669.00" " $1,502.10 " $667.60 " $1,335.20 " $934.64 " $1,168.30 " " $1,068.16 " " $1,335.20 " " $1,301.82 " $751.05 $684.29 $700.98 $667.60 " $1,251.75 " " $1,084.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26605 26605 PR CLTX METACARPAL FX W/MANIPULATION EACH BONE "1,492.00" " $1,342.80 " $596.80 " $1,193.60 " $835.52 " $1,044.40 " $954.88 " $1,193.60 " " $1,163.76 " $671.40 $611.72 $626.64 $596.80 " $1,119.00 " $969.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26608 26608 PR PRQ SKELETAL FIXJ METACARPAL FX EACH BONE "2,535.00" " $2,281.50 " " $1,014.00 " " $2,028.00 " " $1,419.60 " " $1,774.50 " " $1,622.40 " " $2,028.00 " " $1,977.30 " " $1,140.75 " " $1,039.35 " " $1,064.70 " " $1,014.00 " " $1,901.25 " " $1,647.75 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26670 26670 PR CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES "1,207.00" " $1,086.30 " $482.80 $965.60 $675.92 $844.90 $772.48 $965.60 $941.46 $543.15 $494.87 $506.94 $482.80 $905.25 $784.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26675 26675 PR CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES "2,036.00" " $1,832.40 " $814.40 " $1,628.80 " " $1,140.16 " " $1,425.20 " " $1,303.04 " " $1,628.80 " " $1,588.08 " $916.20 $834.76 $855.12 $814.40 " $1,527.00 " " $1,323.40 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26700 26700 PR CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES "1,415.00" " $1,273.50 " $566.00 " $1,132.00 " $792.40 $990.50 $905.60 " $1,132.00 " " $1,103.70 " $636.75 $580.15 $594.30 $566.00 " $1,061.25 " $919.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26720 26720 PR CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA 718.00 $646.20 $287.20 $574.40 $402.08 $502.60 $459.52 $574.40 $560.04 $323.10 $294.38 $301.56 $287.20 $538.50 $466.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26725 26725 PR CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA "1,592.00" " $1,432.80 " $636.80 " $1,273.60 " $891.52 " $1,114.40 " " $1,018.88 " " $1,273.60 " " $1,241.76 " $716.40 $652.72 $668.64 $636.80 " $1,194.00 " " $1,034.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26735 26735 PR OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA "2,667.00" " $2,400.30 " " $1,066.80 " " $2,133.60 " " $1,493.52 " " $1,866.90 " " $1,706.88 " " $2,133.60 " " $2,080.26 " " $1,200.15 " " $1,093.47 " " $1,120.14 " " $1,066.80 " " $2,000.25 " " $1,733.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26740 26740 PR CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ "1,030.00" $927.00 $412.00 $824.00 $576.80 $721.00 $659.20 $824.00 $803.40 $463.50 $422.30 $432.60 $412.00 $772.50 $669.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26750 26750 PR CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA 749.00 $674.10 $299.60 $599.20 $419.44 $524.30 $479.36 $599.20 $584.22 $337.05 $307.09 $314.58 $299.60 $561.75 $486.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26755 26755 PR CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA "1,408.00" " $1,267.20 " $563.20 " $1,126.40 " $788.48 $985.60 $901.12 " $1,126.40 " " $1,098.24 " $633.60 $577.28 $591.36 $563.20 " $1,056.00 " $915.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26756 26756 PR PRQ SKEL FIXJ DSTL PHLNGL FX FNGR/THMB EA "1,930.00" " $1,737.00 " $772.00 " $1,544.00 " " $1,080.80 " " $1,351.00 " " $1,235.20 " " $1,544.00 " " $1,505.40 " $868.50 $791.30 $810.60 $772.00 " $1,447.50 " " $1,254.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26765 26765 PR OPEN TX DISTAL PHALANGEAL FRACTURE EACH "2,361.00" " $2,124.90 " $944.40 " $1,888.80 " " $1,322.16 " " $1,652.70 " " $1,511.04 " " $1,888.80 " " $1,841.58 " " $1,062.45 " $968.01 $991.62 $944.40 " $1,770.75 " " $1,534.65 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26770 26770 PR CLTX IPHAL JT DISLC W/MANJ W/O ANES "1,192.00" " $1,072.80 " $476.80 $953.60 $667.52 $834.40 $762.88 $953.60 $929.76 $536.40 $488.72 $500.64 $476.80 $894.00 $774.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26775 26775 PR CLTX IPHAL JT DISLC W/MANJ REQ ANES "1,783.00" " $1,604.70 " $713.20 " $1,426.40 " $998.48 " $1,248.10 " " $1,141.12 " " $1,426.40 " " $1,390.74 " $802.35 $731.03 $748.86 $713.20 " $1,337.25 " " $1,158.95 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26951 26951 PR AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR "2,672.00" " $2,404.80 " " $1,068.80 " " $2,137.60 " " $1,496.32 " " $1,870.40 " " $1,710.08 " " $2,137.60 " " $2,084.16 " " $1,202.40 " " $1,095.52 " " $1,122.24 " " $1,068.80 " " $2,004.00 " " $1,736.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26952 26952 PR AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP "2,896.00" " $2,606.40 " " $1,158.40 " " $2,316.80 " " $1,621.76 " " $2,027.20 " " $1,853.44 " " $2,316.80 " " $2,258.88 " " $1,303.20 " " $1,187.36 " " $1,216.32 " " $1,158.40 " " $2,172.00 " " $1,882.40 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26989.1 26989 PR CL MANIPULATION FINGERS UNDER ANESTHESIA 677.00 $609.30 $270.80 $541.60 $379.12 $473.90 $433.28 $541.60 $528.06 $304.65 $277.57 $284.34 $270.80 $507.75 $440.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 26990 26990 PR I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA "2,790.00" " $2,511.00 " " $1,116.00 " " $2,232.00 " " $1,562.40 " " $1,953.00 " " $1,785.60 " " $2,232.00 " " $2,176.20 " " $1,255.50 " " $1,143.90 " " $1,171.80 " " $1,116.00 " " $2,092.50 " " $1,813.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27043 27043 PR EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3CM/> "1,888.00" " $1,699.20 " $755.20 " $1,510.40 " " $1,057.28 " " $1,321.60 " " $1,208.32 " " $1,510.40 " " $1,472.64 " $849.60 $774.08 $792.96 $755.20 " $1,416.00 " " $1,227.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27047 27047 PR EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM "2,200.00" " $1,980.00 " $880.00 " $1,760.00 " " $1,232.00 " " $1,540.00 " " $1,408.00 " " $1,760.00 " " $1,716.00 " $990.00 $902.00 $924.00 $880.00 " $1,650.00 " " $1,430.00 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27096 27096 PR INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA 716.00 $644.40 $286.40 $572.80 $400.96 $501.20 $458.24 $572.80 $558.48 $322.20 $293.56 $300.72 $286.40 $537.00 $465.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27130 27130 PR ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT "7,252.00" " $6,526.80 " " $2,900.80 " " $5,801.60 " " $4,061.12 " " $5,076.40 " " $4,641.28 " " $5,801.60 " " $5,656.56 " " $3,263.40 " " $2,973.32 " " $3,045.84 " " $2,900.80 " " $5,439.00 " " $4,713.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27134 27134 PR REVJ TOT HIP ARTHRP BTH W/WO AGRFT/ALGRFT "11,647.00" " $10,482.30 " " $4,658.80 " " $9,317.60 " " $6,522.32 " " $8,152.90 " " $7,454.08 " " $9,317.60 " " $9,084.66 " " $5,241.15 " " $4,775.27 " " $4,891.74 " " $4,658.80 " " $8,735.25 " " $7,570.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27138 27138 PR REVJ TOT HIP ARTHRP FEM ONLY W/WO ALGRFT "8,488.00" " $7,639.20 " " $3,395.20 " " $6,790.40 " " $4,753.28 " " $5,941.60 " " $5,432.32 " " $6,790.40 " " $6,620.64 " " $3,819.60 " " $3,480.08 " " $3,564.96 " " $3,395.20 " " $6,366.00 " " $5,517.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27197 27197 PR CLSD TX PELVIC RING FX W/O MANIPULATION 666.00 $599.40 $266.40 $532.80 $372.96 $466.20 $426.24 $532.80 $519.48 $299.70 $273.06 $279.72 $266.40 $499.50 $432.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27200 27200 PR CLOSED TREATMENT COCCYGEAL FRACTURE 810.00 $729.00 $324.00 $648.00 $453.60 $567.00 $518.40 $648.00 $631.80 $364.50 $332.10 $340.20 $324.00 $607.50 $526.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27220 27220 PR CLTX ACETABULUM HIP/SOCKT FX W/O MANJ "2,069.00" " $1,862.10 " $827.60 " $1,655.20 " " $1,158.64 " " $1,448.30 " " $1,324.16 " " $1,655.20 " " $1,613.82 " $931.05 $848.29 $868.98 $827.60 " $1,551.75 " " $1,344.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27235 27235 PR PRQ SKEL FIXJ FEMORAL FX PROX END NECK "5,278.00" " $4,750.20 " " $2,111.20 " " $4,222.40 " " $2,955.68 " " $3,694.60 " " $3,377.92 " " $4,222.40 " " $4,116.84 " " $2,375.10 " " $2,163.98 " " $2,216.76 " " $2,111.20 " " $3,958.50 " " $3,430.70 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27236 27236 PR OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT "6,193.00" " $5,573.70 " " $2,477.20 " " $4,954.40 " " $3,468.08 " " $4,335.10 " " $3,963.52 " " $4,954.40 " " $4,830.54 " " $2,786.85 " " $2,539.13 " " $2,601.06 " " $2,477.20 " " $4,644.75 " " $4,025.45 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27245 27245 PR TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLTSCREW "6,754.00" " $6,078.60 " " $2,701.60 " " $5,403.20 " " $3,782.24 " " $4,727.80 " " $4,322.56 " " $5,403.20 " " $5,268.12 " " $3,039.30 " " $2,769.14 " " $2,836.68 " " $2,701.60 " " $5,065.50 " " $4,390.10 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27266 27266 PR CLTX POST HIP ARTHRP DISLC REQ ANES "2,815.00" " $2,533.50 " " $1,126.00 " " $2,252.00 " " $1,576.40 " " $1,970.50 " " $1,801.60 " " $2,252.00 " " $2,195.70 " " $1,266.75 " " $1,154.15 " " $1,182.30 " " $1,126.00 " " $2,111.25 " " $1,829.75 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27310 27310 PR ARTHRT KNE W/EXPL DRG/RMVL FB "3,987.00" " $3,588.30 " " $1,594.80 " " $3,189.60 " " $2,232.72 " " $2,790.90 " " $2,551.68 " " $3,189.60 " " $3,109.86 " " $1,794.15 " " $1,634.67 " " $1,674.54 " " $1,594.80 " " $2,990.25 " " $2,591.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27327 27327 PR EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM "1,728.00" " $1,555.20 " $691.20 " $1,382.40 " $967.68 " $1,209.60 " " $1,105.92 " " $1,382.40 " " $1,347.84 " $777.60 $708.48 $725.76 $691.20 " $1,296.00 " " $1,123.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27328 27328 PR EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM "2,228.00" " $2,005.20 " $891.20 " $1,782.40 " " $1,247.68 " " $1,559.60 " " $1,425.92 " " $1,782.40 " " $1,737.84 " " $1,002.60 " $913.48 $935.76 $891.20 " $1,671.00 " " $1,448.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27337 27337 PR EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/> "1,848.00" " $1,663.20 " $739.20 " $1,478.40 " " $1,034.88 " " $1,293.60 " " $1,182.72 " " $1,478.40 " " $1,441.44 " $831.60 $757.68 $776.16 $739.20 " $1,386.00 " " $1,201.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27340 27340 PR EXCISION PREPATELLAR BURSA "1,751.00" " $1,575.90 " $700.40 " $1,400.80 " $980.56 " $1,225.70 " " $1,120.64 " " $1,400.80 " " $1,365.78 " $787.95 $717.91 $735.42 $700.40 " $1,313.25 " " $1,138.15 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27355 27355 PR EXCISION/CURETTAGE CYST/TUMOR FEMUR "3,117.00" " $2,805.30 " " $1,246.80 " " $2,493.60 " " $1,745.52 " " $2,181.90 " " $1,994.88 " " $2,493.60 " " $2,431.26 " " $1,402.65 " " $1,277.97 " " $1,309.14 " " $1,246.80 " " $2,337.75 " " $2,026.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27380 27380 PR SUTURE INFRAPATELLAR TENDON PRIMARY "2,656.00" " $2,390.40 " " $1,062.40 " " $2,124.80 " " $1,487.36 " " $1,859.20 " " $1,699.84 " " $2,124.80 " " $2,071.68 " " $1,195.20 " " $1,088.96 " " $1,115.52 " " $1,062.40 " " $1,992.00 " " $1,726.40 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27385 27385 PR SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY "3,525.00" " $3,172.50 " " $1,410.00 " " $2,820.00 " " $1,974.00 " " $2,467.50 " " $2,256.00 " " $2,820.00 " " $2,749.50 " " $1,586.25 " " $1,445.25 " " $1,480.50 " " $1,410.00 " " $2,643.75 " " $2,291.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27415 27415 PR OSTEOCHONDRAL ALLOGRAFT KNEE OPEN "6,983.00" " $6,284.70 " " $2,793.20 " " $5,586.40 " " $3,910.48 " " $4,888.10 " " $4,469.12 " " $5,586.40 " " $5,446.74 " " $3,142.35 " " $2,863.03 " " $2,932.86 " " $2,793.20 " " $5,237.25 " " $4,538.95 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27422 27422 PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL "4,856.00" " $4,370.40 " " $1,942.40 " " $3,884.80 " " $2,719.36 " " $3,399.20 " " $3,107.84 " " $3,884.80 " " $3,787.68 " " $2,185.20 " " $1,990.96 " " $2,039.52 " " $1,942.40 " " $3,642.00 " " $3,156.40 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27447 27447 PR ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS "8,005.00" " $7,204.50 " " $3,202.00 " " $6,404.00 " " $4,482.80 " " $5,603.50 " " $5,123.20 " " $6,404.00 " " $6,243.90 " " $3,602.25 " " $3,282.05 " " $3,362.10 " " $3,202.00 " " $6,003.75 " " $5,203.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27507 27507 PR OPTX FEM SHFT FX W/PLATE/SCREWS W/WO CERCLAGE "5,119.00" " $4,607.10 " " $2,047.60 " " $4,095.20 " " $2,866.64 " " $3,583.30 " " $3,276.16 " " $4,095.20 " " $3,992.82 " " $2,303.55 " " $2,098.79 " " $2,149.98 " " $2,047.60 " " $3,839.25 " " $3,327.35 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27508 27508 PR CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ "2,287.00" " $2,058.30 " $914.80 " $1,829.60 " " $1,280.72 " " $1,600.90 " " $1,463.68 " " $1,829.60 " " $1,783.86 " " $1,029.15 " $937.67 $960.54 $914.80 " $1,715.25 " " $1,486.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27520 27520 PR CLOSED TX PATELLAR FRACTURE W/O MANIPULATION "1,352.00" " $1,216.80 " $540.80 " $1,081.60 " $757.12 $946.40 $865.28 " $1,081.60 " " $1,054.56 " $608.40 $554.32 $567.84 $540.80 " $1,014.00 " $878.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27524 27524 PR OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR "3,997.00" " $3,597.30 " " $1,598.80 " " $3,197.60 " " $2,238.32 " " $2,797.90 " " $2,558.08 " " $3,197.60 " " $3,117.66 " " $1,798.65 " " $1,638.77 " " $1,678.74 " " $1,598.80 " " $2,997.75 " " $2,598.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27530 27530 PR CLTX TIBIAL FX PROXIMAL W/O MANIPULATION "1,664.00" " $1,497.60 " $665.60 " $1,331.20 " $931.84 " $1,164.80 " " $1,064.96 " " $1,331.20 " " $1,297.92 " $748.80 $682.24 $698.88 $665.60 " $1,248.00 " " $1,081.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27535 27535 PR OPEN TX TIBIAL FRACTURE PROXIMAL UNICONDYLAR "4,417.00" " $3,975.30 " " $1,766.80 " " $3,533.60 " " $2,473.52 " " $3,091.90 " " $2,826.88 " " $3,533.60 " " $3,445.26 " " $1,987.65 " " $1,810.97 " " $1,855.14 " " $1,766.80 " " $3,312.75 " " $2,871.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27538 27538 PR CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MAN "1,807.00" " $1,626.30 " $722.80 " $1,445.60 " " $1,011.92 " " $1,264.90 " " $1,156.48 " " $1,445.60 " " $1,409.46 " $813.15 $740.87 $758.94 $722.80 " $1,355.25 " " $1,174.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27560 27560 PR CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA "1,678.00" " $1,510.20 " $671.20 " $1,342.40 " $939.68 " $1,174.60 " " $1,073.92 " " $1,342.40 " " $1,308.84 " $755.10 $687.98 $704.76 $671.20 " $1,258.50 " " $1,090.70 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27599 27599 PR UNLISTED PROCEDURE FEMUR/KNEE "3,024.00" " $2,721.60 " " $1,209.60 " " $2,419.20 " " $1,693.44 " " $2,116.80 " " $1,935.36 " " $2,419.20 " " $2,358.72 " " $1,360.80 " " $1,239.84 " " $1,270.08 " " $1,209.60 " " $2,268.00 " " $1,965.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27600 27600 PR DCMPRN FASCT LEG ANT&/LAT COMPARTMENTS ONLY "1,920.00" " $1,728.00 " $768.00 " $1,536.00 " " $1,075.20 " " $1,344.00 " " $1,228.80 " " $1,536.00 " " $1,497.60 " $864.00 $787.20 $806.40 $768.00 " $1,440.00 " " $1,248.00 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27601 27601 PR DCMPRN FASCT LEG POST COMPARTMENT ONLY "2,130.00" " $1,917.00 " $852.00 " $1,704.00 " " $1,192.80 " " $1,491.00 " " $1,363.20 " " $1,704.00 " " $1,661.40 " $958.50 $873.30 $894.60 $852.00 " $1,597.50 " " $1,384.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27606 27606 PR TENOTOMY PRQ ACHILLES TENDON SPX GENERAL ANES "1,489.00" " $1,340.10 " $595.60 " $1,191.20 " $833.84 " $1,042.30 " $952.96 " $1,191.20 " " $1,161.42 " $670.05 $610.49 $625.38 $595.60 " $1,116.75 " $967.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27610 27610 PR ARTHROTOMY ANKLE W/EXPL DRAINAGE/REMOVAL FB "3,902.00" " $3,511.80 " " $1,560.80 " " $3,121.60 " " $2,185.12 " " $2,731.40 " " $2,497.28 " " $3,121.60 " " $3,043.56 " " $1,755.90 " " $1,599.82 " " $1,638.84 " " $1,560.80 " " $2,926.50 " " $2,536.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27618 27618 PR EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM "1,799.00" " $1,619.10 " $719.60 " $1,439.20 " " $1,007.44 " " $1,259.30 " " $1,151.36 " " $1,439.20 " " $1,403.22 " $809.55 $737.59 $755.58 $719.60 " $1,349.25 " " $1,169.35 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27620 27620 PR ARTHRT ANKLE W/EXPL W/WO BX W/WO RMVL LOOSE/FB "2,443.00" " $2,198.70 " $977.20 " $1,954.40 " " $1,368.08 " " $1,710.10 " " $1,563.52 " " $1,954.40 " " $1,905.54 " " $1,099.35 " " $1,001.63 " " $1,026.06 " $977.20 " $1,832.25 " " $1,587.95 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27630 27630 PR EXCISION LESION TENDON SHEATH/CAPSULE LEG&/ANK "1,888.00" " $1,699.20 " $755.20 " $1,510.40 " " $1,057.28 " " $1,321.60 " " $1,208.32 " " $1,510.40 " " $1,472.64 " $849.60 $774.08 $792.96 $755.20 " $1,416.00 " " $1,227.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27635 27635 PR EXCISION/CURETTAGE BONE CYST/TUMOR TIBIA/FIBULA "2,754.00" " $2,478.60 " " $1,101.60 " " $2,203.20 " " $1,542.24 " " $1,927.80 " " $1,762.56 " " $2,203.20 " " $2,148.12 " " $1,239.30 " " $1,129.14 " " $1,156.68 " " $1,101.60 " " $2,065.50 " " $1,790.10 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27650 27650 PR REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON "3,534.00" " $3,180.60 " " $1,413.60 " " $2,827.20 " " $1,979.04 " " $2,473.80 " " $2,261.76 " " $2,827.20 " " $2,756.52 " " $1,590.30 " " $1,448.94 " " $1,484.28 " " $1,413.60 " " $2,650.50 " " $2,297.10 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27658 27658 PR REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH "1,970.00" " $1,773.00 " $788.00 " $1,576.00 " " $1,103.20 " " $1,379.00 " " $1,260.80 " " $1,576.00 " " $1,536.60 " $886.50 $807.70 $827.40 $788.00 " $1,477.50 " " $1,280.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27676 27676 PR REPAIR DISLOCATING PERONEAL TENDON W/FIB OSTEOT "2,294.00" " $2,064.60 " $917.60 " $1,835.20 " " $1,284.64 " " $1,605.80 " " $1,468.16 " " $1,835.20 " " $1,789.32 " " $1,032.30 " $940.54 $963.48 $917.60 " $1,720.50 " " $1,491.10 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27687 27687 PR GASTROCNEMIUS RECESSION "2,606.00" " $2,345.40 " " $1,042.40 " " $2,084.80 " " $1,459.36 " " $1,824.20 " " $1,667.84 " " $2,084.80 " " $2,032.68 " " $1,172.70 " " $1,068.46 " " $1,094.52 " " $1,042.40 " " $1,954.50 " " $1,693.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27690 27690 PR TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING SUPFC "3,497.00" " $3,147.30 " " $1,398.80 " " $2,797.60 " " $1,958.32 " " $2,447.90 " " $2,238.08 " " $2,797.60 " " $2,727.66 " " $1,573.65 " " $1,433.77 " " $1,468.74 " " $1,398.80 " " $2,622.75 " " $2,273.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27692 27692 PR TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING EA TDN 626.00 $563.40 $250.40 $500.80 $350.56 $438.20 $400.64 $500.80 $488.28 $281.70 $256.66 $262.92 $250.40 $469.50 $406.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27695 27695 PR RPR PRIMARY DISRUPTED LIGAMENT ANKLE COLLATERAL "2,493.00" " $2,243.70 " $997.20 " $1,994.40 " " $1,396.08 " " $1,745.10 " " $1,595.52 " " $1,994.40 " " $1,944.54 " " $1,121.85 " " $1,022.13 " " $1,047.06 " $997.20 " $1,869.75 " " $1,620.45 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27698 27698 PR REPAIR SECONDARY DISRUPTED LIGAMENT ANKLE COLTRL "3,627.00" " $3,264.30 " " $1,450.80 " " $2,901.60 " " $2,031.12 " " $2,538.90 " " $2,321.28 " " $2,901.60 " " $2,829.06 " " $1,632.15 " " $1,487.07 " " $1,523.34 " " $1,450.80 " " $2,720.25 " " $2,357.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27724 27724 PR RPR NON/MAL TIBIA W/ILIAC/OTH AGRFT "7,095.00" " $6,385.50 " " $2,838.00 " " $5,676.00 " " $3,973.20 " " $4,966.50 " " $4,540.80 " " $5,676.00 " " $5,534.10 " " $3,192.75 " " $2,908.95 " " $2,979.90 " " $2,838.00 " " $5,321.25 " " $4,611.75 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27750 27750 PR CLTX TIBIAL SHAFT FX W/O MANIPULATION "1,587.00" " $1,428.30 " $634.80 " $1,269.60 " $888.72 " $1,110.90 " " $1,015.68 " " $1,269.60 " " $1,237.86 " $714.15 $650.67 $666.54 $634.80 " $1,190.25 " " $1,031.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27760 27760 PR CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION "1,342.00" " $1,207.80 " $536.80 " $1,073.60 " $751.52 $939.40 $858.88 " $1,073.60 " " $1,046.76 " $603.90 $550.22 $563.64 $536.80 " $1,006.50 " $872.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27766 27766 PR OPEN TREATMENT MEDIAL MALLEOLUS FRACTURE "3,082.00" " $2,773.80 " " $1,232.80 " " $2,465.60 " " $1,725.92 " " $2,157.40 " " $1,972.48 " " $2,465.60 " " $2,403.96 " " $1,386.90 " " $1,263.62 " " $1,294.44 " " $1,232.80 " " $2,311.50 " " $2,003.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27767 27767 PR CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANJ "1,079.00" $971.10 $431.60 $863.20 $604.24 $755.30 $690.56 $863.20 $841.62 $485.55 $442.39 $453.18 $431.60 $809.25 $701.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27780 27780 PR CLTX PROX FIBULA/SHFT FX W/O MANJ "1,163.00" " $1,046.70 " $465.20 $930.40 $651.28 $814.10 $744.32 $930.40 $907.14 $523.35 $476.83 $488.46 $465.20 $872.25 $755.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27784 27784 PR OPEN TREATMENT PROXIMAL FIBULA/SHAFT FRACTURE "2,806.00" " $2,525.40 " " $1,122.40 " " $2,244.80 " " $1,571.36 " " $1,964.20 " " $1,795.84 " " $2,244.80 " " $2,188.68 " " $1,262.70 " " $1,150.46 " " $1,178.52 " " $1,122.40 " " $2,104.50 " " $1,823.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27786 27786 PR CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ "1,318.00" " $1,186.20 " $527.20 " $1,054.40 " $738.08 $922.60 $843.52 " $1,054.40 " " $1,028.04 " $593.10 $540.38 $553.56 $527.20 $988.50 $856.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27788 27788 PR CLTX DSTL FIBULAR FX LAT MALLS W/MANJ "1,566.00" " $1,409.40 " $626.40 " $1,252.80 " $876.96 " $1,096.20 " " $1,002.24 " " $1,252.80 " " $1,221.48 " $704.70 $642.06 $657.72 $626.40 " $1,174.50 " " $1,017.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27792 27792 PR OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS "3,339.00" " $3,005.10 " " $1,335.60 " " $2,671.20 " " $1,869.84 " " $2,337.30 " " $2,136.96 " " $2,671.20 " " $2,604.42 " " $1,502.55 " " $1,368.99 " " $1,402.38 " " $1,335.60 " " $2,504.25 " " $2,170.35 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27808 27808 PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ "1,436.00" " $1,292.40 " $574.40 " $1,148.80 " $804.16 " $1,005.20 " $919.04 " $1,148.80 " " $1,120.08 " $646.20 $588.76 $603.12 $574.40 " $1,077.00 " $933.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27810 27810 PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ "2,219.00" " $1,997.10 " $887.60 " $1,775.20 " " $1,242.64 " " $1,553.30 " " $1,420.16 " " $1,775.20 " " $1,730.82 " $998.55 $909.79 $931.98 $887.60 " $1,664.25 " " $1,442.35 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27814 27814 PR OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE "3,991.00" " $3,591.90 " " $1,596.40 " " $3,192.80 " " $2,234.96 " " $2,793.70 " " $2,554.24 " " $3,192.80 " " $3,112.98 " " $1,795.95 " " $1,636.31 " " $1,676.22 " " $1,596.40 " " $2,993.25 " " $2,594.15 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27818 27818 PR CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION "2,297.00" " $2,067.30 " $918.80 " $1,837.60 " " $1,286.32 " " $1,607.90 " " $1,470.08 " " $1,837.60 " " $1,791.66 " " $1,033.65 " $941.77 $964.74 $918.80 " $1,722.75 " " $1,493.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27822 27822 PR OPEN TX TRIMALLEOLAR ANKLE FX W/O FIXJ PST LIP "4,536.00" " $4,082.40 " " $1,814.40 " " $3,628.80 " " $2,540.16 " " $3,175.20 " " $2,903.04 " " $3,628.80 " " $3,538.08 " " $2,041.20 " " $1,859.76 " " $1,905.12 " " $1,814.40 " " $3,402.00 " " $2,948.40 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27824 27824 PR CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ "1,212.00" " $1,090.80 " $484.80 $969.60 $678.72 $848.40 $775.68 $969.60 $945.36 $545.40 $496.92 $509.04 $484.80 $909.00 $787.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27829 27829 PR OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION "2,706.00" " $2,435.40 " " $1,082.40 " " $2,164.80 " " $1,515.36 " " $1,894.20 " " $1,731.84 " " $2,164.80 " " $2,110.68 " " $1,217.70 " " $1,109.46 " " $1,136.52 " " $1,082.40 " " $2,029.50 " " $1,758.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 27840 27840 PR CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA "1,401.00" " $1,260.90 " $560.40 " $1,120.80 " $784.56 $980.70 $896.64 " $1,120.80 " " $1,092.78 " $630.45 $574.41 $588.42 $560.40 " $1,050.75 " $910.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28008 28008 PR FASCIOTOMY FOOT&/TOE "1,454.00" " $1,308.60 " $581.60 " $1,163.20 " $814.24 " $1,017.80 " $930.56 " $1,163.20 " " $1,134.12 " $654.30 $596.14 $610.68 $581.60 " $1,090.50 " $945.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28010 28010 PR TENOTOMY PERCUTANEOUS TOE SINGLE TENDON 911.00 $819.90 $364.40 $728.80 $510.16 $637.70 $583.04 $728.80 $710.58 $409.95 $373.51 $382.62 $364.40 $683.25 $592.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28011 28011 PR TENOTOMY PERCUTANEOUS TOE MULTIPLE TENDON "1,136.00" " $1,022.40 " $454.40 $908.80 $636.16 $795.20 $727.04 $908.80 $886.08 $511.20 $465.76 $477.12 $454.40 $852.00 $738.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28022 28022 PR ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT "1,534.00" " $1,380.60 " $613.60 " $1,227.20 " $859.04 " $1,073.80 " $981.76 " $1,227.20 " " $1,196.52 " $690.30 $628.94 $644.28 $613.60 " $1,150.50 " $997.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28039 28039 PR EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/> 987.00 $888.30 $394.80 $789.60 $552.72 $690.90 $631.68 $789.60 $769.86 $444.15 $404.67 $414.54 $394.80 $740.25 $641.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28043 28043 PR EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM "1,050.00" $945.00 $420.00 $840.00 $588.00 $735.00 $672.00 $840.00 $819.00 $472.50 $430.50 $441.00 $420.00 $787.50 $682.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28045 28045 PR EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM "1,438.00" " $1,294.20 " $575.20 " $1,150.40 " $805.28 " $1,006.60 " $920.32 " $1,150.40 " " $1,121.64 " $647.10 $589.58 $603.96 $575.20 " $1,078.50 " $934.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28080 28080 PR EXCISION INTERDIGITAL MORTON NEUROMA SINGLE EACH "1,751.00" " $1,575.90 " $700.40 " $1,400.80 " $980.56 " $1,225.70 " " $1,120.64 " " $1,400.80 " " $1,365.78 " $787.95 $717.91 $735.42 $700.40 " $1,313.25 " " $1,138.15 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28090 28090 PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT "1,841.00" " $1,656.90 " $736.40 " $1,472.80 " " $1,030.96 " " $1,288.70 " " $1,178.24 " " $1,472.80 " " $1,435.98 " $828.45 $754.81 $773.22 $736.40 " $1,380.75 " " $1,196.65 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28092 28092 PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT TOE EA "1,342.00" " $1,207.80 " $536.80 " $1,073.60 " $751.52 $939.40 $858.88 " $1,073.60 " " $1,046.76 " $603.90 $550.22 $563.64 $536.80 " $1,006.50 " $872.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28100 28100 PR EXCISION/CURETTAGE CYST/TUMOR TALUS/CALCANEUS "2,672.00" " $2,404.80 " " $1,068.80 " " $2,137.60 " " $1,496.32 " " $1,870.40 " " $1,710.08 " " $2,137.60 " " $2,084.16 " " $1,202.40 " " $1,095.52 " " $1,122.24 " " $1,068.80 " " $2,004.00 " " $1,736.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28104 28104 PR EXC/CURTG BONE CYST/B9 TUMORTARSAL/METATARSAL "2,470.00" " $2,223.00 " $988.00 " $1,976.00 " " $1,383.20 " " $1,729.00 " " $1,580.80 " " $1,976.00 " " $1,926.60 " " $1,111.50 " " $1,012.70 " " $1,037.40 " $988.00 " $1,852.50 " " $1,605.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28108 28108 PR EXC/CURTG CST/B9 TUM PHALANGES FOOT "1,588.00" " $1,429.20 " $635.20 " $1,270.40 " $889.28 " $1,111.60 " " $1,016.32 " " $1,270.40 " " $1,238.64 " $714.60 $651.08 $666.96 $635.20 " $1,191.00 " " $1,032.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28110 28110 PR OSTECTOMY PRTL 5TH METAR HEAD SPX "1,485.00" " $1,336.50 " $594.00 " $1,188.00 " $831.60 " $1,039.50 " $950.40 " $1,188.00 " " $1,158.30 " $668.25 $608.85 $623.70 $594.00 " $1,113.75 " $965.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28111 28111 PR OSTECTOMY COMPLETE 1ST METATARSAL HEAD "1,724.00" " $1,551.60 " $689.60 " $1,379.20 " $965.44 " $1,206.80 " " $1,103.36 " " $1,379.20 " " $1,344.72 " $775.80 $706.84 $724.08 $689.60 " $1,293.00 " " $1,120.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28112 28112 PR OSTECTOMY COMPLETE OTHER METATARSAL HEAD 2/3/4 "1,511.00" " $1,359.90 " $604.40 " $1,208.80 " $846.16 " $1,057.70 " $967.04 " $1,208.80 " " $1,178.58 " $679.95 $619.51 $634.62 $604.40 " $1,133.25 " $982.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28113 28113 PR OSTECTOMY COMPLETE 5TH METATARSAL HEAD "1,770.00" " $1,593.00 " $708.00 " $1,416.00 " $991.20 " $1,239.00 " " $1,132.80 " " $1,416.00 " " $1,380.60 " $796.50 $725.70 $743.40 $708.00 " $1,327.50 " " $1,150.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28120 28120 PR PARTIAL EXCISION BONE TALUS/CALCANEUS "2,270.00" " $2,043.00 " $908.00 " $1,816.00 " " $1,271.20 " " $1,589.00 " " $1,452.80 " " $1,816.00 " " $1,770.60 " " $1,021.50 " $930.70 $953.40 $908.00 " $1,702.50 " " $1,475.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28122 28122 PR PRTL EXC B1 TARSAL/METAR B1 XCP TALUS/CALCANEUS "2,402.00" " $2,161.80 " $960.80 " $1,921.60 " " $1,345.12 " " $1,681.40 " " $1,537.28 " " $1,921.60 " " $1,873.56 " " $1,080.90 " $984.82 " $1,008.84 " $960.80 " $1,801.50 " " $1,561.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28124 28124 PR PARTICAL EXCISION BONE PHALANX TOE "1,740.00" " $1,566.00 " $696.00 " $1,392.00 " $974.40 " $1,218.00 " " $1,113.60 " " $1,392.00 " " $1,357.20 " $783.00 $713.40 $730.80 $696.00 " $1,305.00 " " $1,131.00 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28126 28126 PR RESECTION PARTIAL/COMPLETE PHALANGEAL BASE EACH "1,226.00" " $1,103.40 " $490.40 $980.80 $686.56 $858.20 $784.64 $980.80 $956.28 $551.70 $502.66 $514.92 $490.40 $919.50 $796.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28190 28190 PR REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS 838.00 $754.20 $335.20 $670.40 $469.28 $586.60 $536.32 $670.40 $653.64 $377.10 $343.58 $351.96 $335.20 $628.50 $544.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28192 28192 PR REMOVAL FOREIGN BODY FOOT DEEP "1,561.00" " $1,404.90 " $624.40 " $1,248.80 " $874.16 " $1,092.70 " $999.04 " $1,248.80 " " $1,217.58 " $702.45 $640.01 $655.62 $624.40 " $1,170.75 " " $1,014.65 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28200 28200 PR RPR TDN FLXR FOOT 1/2 W/O FREE GRAFG EACH TENDON "1,679.00" " $1,511.10 " $671.60 " $1,343.20 " $940.24 " $1,175.30 " " $1,074.56 " " $1,343.20 " " $1,309.62 " $755.55 $688.39 $705.18 $671.60 " $1,259.25 " " $1,091.35 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28232 28232 PR TX OPEN TENDON FLEXOR TOE 1 TENDON SPX "1,115.00" " $1,003.50 " $446.00 $892.00 $624.40 $780.50 $713.60 $892.00 $869.70 $501.75 $457.15 $468.30 $446.00 $836.25 $724.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28238 28238 PR RCNSTJ PST TIBL TDN W/EXC ACCESSORY TARSL NAVCLR "2,518.00" " $2,266.20 " " $1,007.20 " " $2,014.40 " " $1,410.08 " " $1,762.60 " " $1,611.52 " " $2,014.40 " " $1,964.04 " " $1,133.10 " " $1,032.38 " " $1,057.56 " " $1,007.20 " " $1,888.50 " " $1,636.70 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28270 28270 PR CAPSUL MTTARPHLNGL JT W/WO TENORRHAPHY EA JT SPX "1,473.00" " $1,325.70 " $589.20 " $1,178.40 " $824.88 " $1,031.10 " $942.72 " $1,178.40 " " $1,148.94 " $662.85 $603.93 $618.66 $589.20 " $1,104.75 " $957.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28272 28272 PR CAPSULOTOMY IPHAL JOINT EACH JOINT SPX "1,064.00" $957.60 $425.60 $851.20 $595.84 $744.80 $680.96 $851.20 $829.92 $478.80 $436.24 $446.88 $425.60 $798.00 $691.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28285 28285 PR CORRECTION HAMMERTOE "2,181.00" " $1,962.90 " $872.40 " $1,744.80 " " $1,221.36 " " $1,526.70 " " $1,395.84 " " $1,744.80 " " $1,701.18 " $981.45 $894.21 $916.02 $872.40 " $1,635.75 " " $1,417.65 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28288 28288 PR OSTC PRTL EXOSTC/CONDYLC METAR HEAD "2,181.00" " $1,962.90 " $872.40 " $1,744.80 " " $1,221.36 " " $1,526.70 " " $1,395.84 " " $1,744.80 " " $1,701.18 " $981.45 $894.21 $916.02 $872.40 " $1,635.75 " " $1,417.65 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28289 28289 PR HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/O IMPLT "2,672.00" " $2,404.80 " " $1,068.80 " " $2,137.60 " " $1,496.32 " " $1,870.40 " " $1,710.08 " " $2,137.60 " " $2,084.16 " " $1,202.40 " " $1,095.52 " " $1,122.24 " " $1,068.80 " " $2,004.00 " " $1,736.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28291 28291 PR HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/IMPLT "3,389.00" " $3,050.10 " " $1,355.60 " " $2,711.20 " " $1,897.84 " " $2,372.30 " " $2,168.96 " " $2,711.20 " " $2,643.42 " " $1,525.05 " " $1,389.49 " " $1,423.38 " " $1,355.60 " " $2,541.75 " " $2,202.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28292 28292 PR CORRJ HALLUX VALGUS W/SESMDC W/RESCJ PROX PHAL "2,728.00" " $2,455.20 " " $1,091.20 " " $2,182.40 " " $1,527.68 " " $1,909.60 " " $1,745.92 " " $2,182.40 " " $2,127.84 " " $1,227.60 " " $1,118.48 " " $1,145.76 " " $1,091.20 " " $2,046.00 " " $1,773.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28295 28295 PR CORRJ HALLUX VALGUS W/SESMDC W/PROX METAR OSTEOT "3,713.00" " $3,341.70 " " $1,485.20 " " $2,970.40 " " $2,079.28 " " $2,599.10 " " $2,376.32 " " $2,970.40 " " $2,896.14 " " $1,670.85 " " $1,522.33 " " $1,559.46 " " $1,485.20 " " $2,784.75 " " $2,413.45 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28296 28296 PR CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT "3,676.00" " $3,308.40 " " $1,470.40 " " $2,940.80 " " $2,058.56 " " $2,573.20 " " $2,352.64 " " $2,940.80 " " $2,867.28 " " $1,654.20 " " $1,507.16 " " $1,543.92 " " $1,470.40 " " $2,757.00 " " $2,389.40 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28298 28298 PR CORRJ HALLUX VALGUS W/SESMDC W/PROX PHLNX OSTEOT "2,610.00" " $2,349.00 " " $1,044.00 " " $2,088.00 " " $1,461.60 " " $1,827.00 " " $1,670.40 " " $2,088.00 " " $2,035.80 " " $1,174.50 " " $1,070.10 " " $1,096.20 " " $1,044.00 " " $1,957.50 " " $1,696.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28302 28302 PR OSTEOTOMY TALUS "3,953.00" " $3,557.70 " " $1,581.20 " " $3,162.40 " " $2,213.68 " " $2,767.10 " " $2,529.92 " " $3,162.40 " " $3,083.34 " " $1,778.85 " " $1,620.73 " " $1,660.26 " " $1,581.20 " " $2,964.75 " " $2,569.45 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28315 28315 PR SESAMOIDECTOMY FIRST TOE SPX "1,639.00" " $1,475.10 " $655.60 " $1,311.20 " $917.84 " $1,147.30 " " $1,048.96 " " $1,311.20 " " $1,278.42 " $737.55 $671.99 $688.38 $655.60 " $1,229.25 " " $1,065.35 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28400 28400 PR CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION "1,108.00" $997.20 $443.20 $886.40 $620.48 $775.60 $709.12 $886.40 $864.24 $498.60 $454.28 $465.36 $443.20 $831.00 $720.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28405 28405 PR CLOSED TX CALCANEAL FRACTURE W/MANIPULATION "1,496.00" " $1,346.40 " $598.40 " $1,196.80 " $837.76 " $1,047.20 " $957.44 " $1,196.80 " " $1,166.88 " $673.20 $613.36 $628.32 $598.40 " $1,122.00 " $972.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28430 28430 PR CLOSED TX TALUS FRACTURE W/O MANIPULATION "1,066.00" $959.40 $426.40 $852.80 $596.96 $746.20 $682.24 $852.80 $831.48 $479.70 $437.06 $447.72 $426.40 $799.50 $692.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28450 28450 PR TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ 927.00 $834.30 $370.80 $741.60 $519.12 $648.90 $593.28 $741.60 $723.06 $417.15 $380.07 $389.34 $370.80 $695.25 $602.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28470 28470 PR CLOSED TX METATARSAL FRACTURE W/O MANIPULATION 873.00 $785.70 $349.20 $698.40 $488.88 $611.10 $558.72 $698.40 $680.94 $392.85 $357.93 $366.66 $349.20 $654.75 $567.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28485 28485 PR OPEN TREATMENT METATARSAL FRACTURE EACH "2,366.00" " $2,129.40 " $946.40 " $1,892.80 " " $1,324.96 " " $1,656.20 " " $1,514.24 " " $1,892.80 " " $1,845.48 " " $1,064.70 " $970.06 $993.72 $946.40 " $1,774.50 " " $1,537.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28490 28490 PR CLTX FX GRT TOE PHLX/PHLG W/O MANJ 587.00 $528.30 $234.80 $469.60 $328.72 $410.90 $375.68 $469.60 $457.86 $264.15 $240.67 $246.54 $234.80 $440.25 $381.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28495 28495 PR CLTX FX GRT TOE PHLX/PHLG W/MANJ 752.00 $676.80 $300.80 $601.60 $421.12 $526.40 $481.28 $601.60 $586.56 $338.40 $308.32 $315.84 $300.80 $564.00 $488.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28505 28505 PR OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES "2,074.00" " $1,866.60 " $829.60 " $1,659.20 " " $1,161.44 " " $1,451.80 " " $1,327.36 " " $1,659.20 " " $1,617.72 " $933.30 $850.34 $871.08 $829.60 " $1,555.50 " " $1,348.10 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28510 28510 PR CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ 484.00 $435.60 $193.60 $387.20 $271.04 $338.80 $309.76 $387.20 $377.52 $217.80 $198.44 $203.28 $193.60 $363.00 $314.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28515 28515 PR CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ 596.00 $536.40 $238.40 $476.80 $333.76 $417.20 $381.44 $476.80 $464.88 $268.20 $244.36 $250.32 $238.40 $447.00 $387.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28530 28530 PR CLOSED TREATMENT SESAMOID FRACTURE 485.00 $436.50 $194.00 $388.00 $271.60 $339.50 $310.40 $388.00 $378.30 $218.25 $198.85 $203.70 $194.00 $363.75 $315.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28605 28605 PR CLOSED TX TARSOMETATARSAL DISLOCATION W/ANES 905.00 $814.50 $362.00 $724.00 $506.80 $633.50 $579.20 $724.00 $705.90 $407.25 $371.05 $380.10 $362.00 $678.75 $588.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28630 28630 PR CLTX METATARSOPHLNGL JT DISLC W/O ANES 715.00 $643.50 $286.00 $572.00 $400.40 $500.50 $457.60 $572.00 $557.70 $321.75 $293.15 $300.30 $286.00 $536.25 $464.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28660 28660 PR CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES 521.00 $468.90 $208.40 $416.80 $291.76 $364.70 $333.44 $416.80 $406.38 $234.45 $213.61 $218.82 $208.40 $390.75 $338.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28725 28725 PR ARTHRODESIS SUBTALAR "2,673.00" " $2,405.70 " " $1,069.20 " " $2,138.40 " " $1,496.88 " " $1,871.10 " " $1,710.72 " " $2,138.40 " " $2,084.94 " " $1,202.85 " " $1,095.93 " " $1,122.66 " " $1,069.20 " " $2,004.75 " " $1,737.45 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28730 28730 PR ARTHRD MIDTARSL/TARSOMETATARSAL MULT/TRANSVRS "3,154.00" " $2,838.60 " " $1,261.60 " " $2,523.20 " " $1,766.24 " " $2,207.80 " " $2,018.56 " " $2,523.20 " " $2,460.12 " " $1,419.30 " " $1,293.14 " " $1,324.68 " " $1,261.60 " " $2,365.50 " " $2,050.10 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28740 28740 PR ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT "2,642.00" " $2,377.80 " " $1,056.80 " " $2,113.60 " " $1,479.52 " " $1,849.40 " " $1,690.88 " " $2,113.60 " " $2,060.76 " " $1,188.90 " " $1,083.22 " " $1,109.64 " " $1,056.80 " " $1,981.50 " " $1,717.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28750 28750 PR ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT "3,099.00" " $2,789.10 " " $1,239.60 " " $2,479.20 " " $1,735.44 " " $2,169.30 " " $1,983.36 " " $2,479.20 " " $2,417.22 " " $1,394.55 " " $1,270.59 " " $1,301.58 " " $1,239.60 " " $2,324.25 " " $2,014.35 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28805 28805 PR AMPUTATION FOOT TRANSMETARSAL "2,700.00" " $2,430.00 " " $1,080.00 " " $2,160.00 " " $1,512.00 " " $1,890.00 " " $1,728.00 " " $2,160.00 " " $2,106.00 " " $1,215.00 " " $1,107.00 " " $1,134.00 " " $1,080.00 " " $2,025.00 " " $1,755.00 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28810 28810 PR AMPUTATION METATARSAL W/TOE SINGLE "2,125.00" " $1,912.50 " $850.00 " $1,700.00 " " $1,190.00 " " $1,487.50 " " $1,360.00 " " $1,700.00 " " $1,657.50 " $956.25 $871.25 $892.50 $850.00 " $1,593.75 " " $1,381.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28820 28820 PR AMPUTATION TOE METATARSOPHALANGEAL JOINT "1,691.00" " $1,521.90 " $676.40 " $1,352.80 " $946.96 " $1,183.70 " " $1,082.24 " " $1,352.80 " " $1,318.98 " $760.95 $693.31 $710.22 $676.40 " $1,268.25 " " $1,099.15 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28825 28825 PR AMPUTATION TOE INTERPHALANGEAL JOINT "1,791.00" " $1,611.90 " $716.40 " $1,432.80 " " $1,002.96 " " $1,253.70 " " $1,146.24 " " $1,432.80 " " $1,396.98 " $805.95 $734.31 $752.22 $716.40 " $1,343.25 " " $1,164.15 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28899 28899 PR UNLISTED PROCEDURE FOOT/TOES "1,331.00" " $1,197.90 " $532.40 " $1,064.80 " $745.36 $931.70 $851.84 " $1,064.80 " " $1,038.18 " $598.95 $545.71 $559.02 $532.40 $998.25 $865.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 28899.12 28899 "PR IMPLANT ARTHROPLASTY, LESSER MTPJ" "1,781.00" " $1,602.90 " $712.40 " $1,424.80 " $997.36 " $1,246.70 " " $1,139.84 " " $1,424.80 " " $1,389.18 " $801.45 $730.21 $748.02 $712.40 " $1,335.75 " " $1,157.65 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29065 29065 PR APPLICATION CAST SHOULDER HAND LONG ARM 462.00 $415.80 $184.80 $369.60 $258.72 $323.40 $295.68 $369.60 $360.36 $207.90 $189.42 $194.04 $184.80 $346.50 $300.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29075 29075 PR APPLICATION CAST ELBOW FINGER SHORT ARM 521.00 $468.90 $208.40 $416.80 $291.76 $364.70 $333.44 $416.80 $406.38 $234.45 $213.61 $218.82 $208.40 $390.75 $338.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29085 29085 PR APPLICATION CAST HAND & LOWER FOREARM GAUNTLET 439.00 $395.10 $175.60 $351.20 $245.84 $307.30 $280.96 $351.20 $342.42 $197.55 $179.99 $184.38 $175.60 $329.25 $285.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29105 29105 PR APPLICATION LONG ARM SPLINT SHOULDER HAND 329.00 $296.10 $131.60 $263.20 $184.24 $230.30 $210.56 $263.20 $256.62 $148.05 $134.89 $138.18 $131.60 $246.75 $213.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29125 29125 PR APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC 296.00 $266.40 $118.40 $236.80 $165.76 $207.20 $189.44 $236.80 $230.88 $133.20 $121.36 $124.32 $118.40 $222.00 $192.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29126 29126 PR APPLICATION SHORT ARM SPLINT DYNAMIC 322.00 $289.80 $128.80 $257.60 $180.32 $225.40 $206.08 $257.60 $251.16 $144.90 $132.02 $135.24 $128.80 $241.50 $209.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29130 29130 PR APPLICATION FINGER SPLINT STATIC 182.00 $163.80 $72.80 $145.60 $101.92 $127.40 $116.48 $145.60 $141.96 $81.90 $74.62 $76.44 $72.80 $136.50 $118.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29131 29131 PR APPLICATION FINGER SPLINT DYNAMIC 230.00 $207.00 $92.00 $184.00 $128.80 $161.00 $147.20 $184.00 $179.40 $103.50 $94.30 $96.60 $92.00 $172.50 $149.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29240 29240 PR STRAPPING SHOULDER 115.00 $103.50 $46.00 $92.00 $64.40 $80.50 $73.60 $92.00 $89.70 $51.75 $47.15 $48.30 $46.00 $86.25 $74.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29260 29260 PR STRAPPING ELBOW/WRIST 125.00 $112.50 $50.00 $100.00 $70.00 $87.50 $80.00 $100.00 $97.50 $56.25 $51.25 $52.50 $50.00 $93.75 $81.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29345 29345 PR APPLICATION LONG LEG CAST THIGH-TOE 478.00 $430.20 $191.20 $382.40 $267.68 $334.60 $305.92 $382.40 $372.84 $215.10 $195.98 $200.76 $191.20 $358.50 $310.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29405 29405 PR APPLICATION SHORT LEG CAST BELOW KNEE-TOE 387.00 $348.30 $154.80 $309.60 $216.72 $270.90 $247.68 $309.60 $301.86 $174.15 $158.67 $162.54 $154.80 $290.25 $251.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29425 29425 PR APPLICATION SHORT LEG CAST WALKING/AMBULATORY 455.00 $409.50 $182.00 $364.00 $254.80 $318.50 $291.20 $364.00 $354.90 $204.75 $186.55 $191.10 $182.00 $341.25 $295.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29505 29505 PR APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES 369.00 $332.10 $147.60 $295.20 $206.64 $258.30 $236.16 $295.20 $287.82 $166.05 $151.29 $154.98 $147.60 $276.75 $239.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29515 29515 PR APPLICATION SHORT LEG SPLINT CALF FOOT 272.00 $244.80 $108.80 $217.60 $152.32 $190.40 $174.08 $217.60 $212.16 $122.40 $111.52 $114.24 $108.80 $204.00 $176.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29540 29540 PR STRAPPING ANKLE &/FOOT 106.00 $95.40 $42.40 $84.80 $59.36 $74.20 $67.84 $84.80 $82.68 $47.70 $43.46 $44.52 $42.40 $79.50 $68.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29550 29550 PR STRAPPING TOES 103.00 $92.70 $41.20 $82.40 $57.68 $72.10 $65.92 $82.40 $80.34 $46.35 $42.23 $43.26 $41.20 $77.25 $66.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29580 29580 PR STRAPPING UNNA BOOT 255.00 $229.50 $102.00 $204.00 $142.80 $178.50 $163.20 $204.00 $198.90 $114.75 $104.55 $107.10 $102.00 $191.25 $165.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29581 29581 PR APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29700 29700 PR REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST 224.00 $201.60 $89.60 $179.20 $125.44 $156.80 $143.36 $179.20 $174.72 $100.80 $91.84 $94.08 $89.60 $168.00 $145.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29730 29730 PR WINDOWING CAST 211.00 $189.90 $84.40 $168.80 $118.16 $147.70 $135.04 $168.80 $164.58 $94.95 $86.51 $88.62 $84.40 $158.25 $137.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29740 29740 PR WEDGING CAST EXCEPT CLUBFOOT CASTS 400.00 $360.00 $160.00 $320.00 $224.00 $280.00 $256.00 $320.00 $312.00 $180.00 $164.00 $168.00 $160.00 $300.00 $260.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29806 29806 PR ARTHROSCOPY SHOULDER SURGICAL CAPSULORRHAPHY "5,570.00" " $5,013.00 " " $2,228.00 " " $4,456.00 " " $3,119.20 " " $3,899.00 " " $3,564.80 " " $4,456.00 " " $4,344.60 " " $2,506.50 " " $2,283.70 " " $2,339.40 " " $2,228.00 " " $4,177.50 " " $3,620.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29822 29822 PR SURGICAL ARTHROSCOPY SHOULDER LMTD DBRDMT 1/2 "3,404.00" " $3,063.60 " " $1,361.60 " " $2,723.20 " " $1,906.24 " " $2,382.80 " " $2,178.56 " " $2,723.20 " " $2,655.12 " " $1,531.80 " " $1,395.64 " " $1,429.68 " " $1,361.60 " " $2,553.00 " " $2,212.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29823 29823 PR SURGICAL ARTHROSCOPY SHOULDER XTNSV DBRDMT 3+ "4,592.00" " $4,132.80 " " $1,836.80 " " $3,673.60 " " $2,571.52 " " $3,214.40 " " $2,938.88 " " $3,673.60 " " $3,581.76 " " $2,066.40 " " $1,882.72 " " $1,928.64 " " $1,836.80 " " $3,444.00 " " $2,984.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29824 29824 PR ARTHROSCOPY SHOULDER DISTAL CLAVICULECTOMY "2,707.00" " $2,436.30 " " $1,082.80 " " $2,165.60 " " $1,515.92 " " $1,894.90 " " $1,732.48 " " $2,165.60 " " $2,111.46 " " $1,218.15 " " $1,109.87 " " $1,136.94 " " $1,082.80 " " $2,030.25 " " $1,759.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29826 29826 PR ARTHROSCOPY SHOULDER W/CORACOACRM LIGMNT RELEASE "1,482.00" " $1,333.80 " $592.80 " $1,185.60 " $829.92 " $1,037.40 " $948.48 " $1,185.60 " " $1,155.96 " $666.90 $607.62 $622.44 $592.80 " $1,111.50 " $963.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29827 29827 PR ARTHROSCOPY SHOULDER ROTATOR CUFF REPAIR "5,627.00" " $5,064.30 " " $2,250.80 " " $4,501.60 " " $3,151.12 " " $3,938.90 " " $3,601.28 " " $4,501.60 " " $4,389.06 " " $2,532.15 " " $2,307.07 " " $2,363.34 " " $2,250.80 " " $4,220.25 " " $3,657.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29828 29828 PR ARTHROSCOPY SHOULDER BICEPS TENODESIS "3,855.00" " $3,469.50 " " $1,542.00 " " $3,084.00 " " $2,158.80 " " $2,698.50 " " $2,467.20 " " $3,084.00 " " $3,006.90 " " $1,734.75 " " $1,580.55 " " $1,619.10 " " $1,542.00 " " $2,891.25 " " $2,505.75 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29873 29873 PR ARTHROSCOPY KNEE LATERAL RELEASE "3,371.00" " $3,033.90 " " $1,348.40 " " $2,696.80 " " $1,887.76 " " $2,359.70 " " $2,157.44 " " $2,696.80 " " $2,629.38 " " $1,516.95 " " $1,382.11 " " $1,415.82 " " $1,348.40 " " $2,528.25 " " $2,191.15 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29875 29875 PR ARTHROSCOPY KNEE SYNOVECTOMY LIMITED SPX "2,824.00" " $2,541.60 " " $1,129.60 " " $2,259.20 " " $1,581.44 " " $1,976.80 " " $1,807.36 " " $2,259.20 " " $2,202.72 " " $1,270.80 " " $1,157.84 " " $1,186.08 " " $1,129.60 " " $2,118.00 " " $1,835.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29876 29876 PR ARTHROSCOPY KNEE SYNOVECTOMY 2/>COMPARTMENTS "4,286.00" " $3,857.40 " " $1,714.40 " " $3,428.80 " " $2,400.16 " " $3,000.20 " " $2,743.04 " " $3,428.80 " " $3,343.08 " " $1,928.70 " " $1,757.26 " " $1,800.12 " " $1,714.40 " " $3,214.50 " " $2,785.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29877 29877 PR ARTHRS KNEE DEBRIDEMENT/SHAVING ARTCLR CRTLG "3,390.00" " $3,051.00 " " $1,356.00 " " $2,712.00 " " $1,898.40 " " $2,373.00 " " $2,169.60 " " $2,712.00 " " $2,644.20 " " $1,525.50 " " $1,389.90 " " $1,423.80 " " $1,356.00 " " $2,542.50 " " $2,203.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29879 29879 PR ARTHRS KNEE ABRASION ARTHRP/MLT DRLG/MICROFX "3,701.00" " $3,330.90 " " $1,480.40 " " $2,960.80 " " $2,072.56 " " $2,590.70 " " $2,368.64 " " $2,960.80 " " $2,886.78 " " $1,665.45 " " $1,517.41 " " $1,554.42 " " $1,480.40 " " $2,775.75 " " $2,405.65 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29880 29880 PR ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING "3,329.00" " $2,996.10 " " $1,331.60 " " $2,663.20 " " $1,864.24 " " $2,330.30 " " $2,130.56 " " $2,663.20 " " $2,596.62 " " $1,498.05 " " $1,364.89 " " $1,398.18 " " $1,331.60 " " $2,496.75 " " $2,163.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29881 29881 PR ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG "3,041.00" " $2,736.90 " " $1,216.40 " " $2,432.80 " " $1,702.96 " " $2,128.70 " " $1,946.24 " " $2,432.80 " " $2,371.98 " " $1,368.45 " " $1,246.81 " " $1,277.22 " " $1,216.40 " " $2,280.75 " " $1,976.65 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29882 29882 PR ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL/LATERAL "3,498.00" " $3,148.20 " " $1,399.20 " " $2,798.40 " " $1,958.88 " " $2,448.60 " " $2,238.72 " " $2,798.40 " " $2,728.44 " " $1,574.10 " " $1,434.18 " " $1,469.16 " " $1,399.20 " " $2,623.50 " " $2,273.70 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29883 29883 PR ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL&LATERAL "5,614.00" " $5,052.60 " " $2,245.60 " " $4,491.20 " " $3,143.84 " " $3,929.80 " " $3,592.96 " " $4,491.20 " " $4,378.92 " " $2,526.30 " " $2,301.74 " " $2,357.88 " " $2,245.60 " " $4,210.50 " " $3,649.10 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29884 29884 PR ARTHROSCOPY KNEE W/LYSIS ADHESIONS W/WO MANJ SPX "3,403.00" " $3,062.70 " " $1,361.20 " " $2,722.40 " " $1,905.68 " " $2,382.10 " " $2,177.92 " " $2,722.40 " " $2,654.34 " " $1,531.35 " " $1,395.23 " " $1,429.26 " " $1,361.20 " " $2,552.25 " " $2,211.95 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29888 29888 PR ARTHRS AIDED ANT CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ "5,453.00" " $4,907.70 " " $2,181.20 " " $4,362.40 " " $3,053.68 " " $3,817.10 " " $3,489.92 " " $4,362.40 " " $4,253.34 " " $2,453.85 " " $2,235.73 " " $2,290.26 " " $2,181.20 " " $4,089.75 " " $3,544.45 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 29999.69 29999 PR ARTHROSCOPIC EXCISION OF OSTEOPHYTE OF KNEE AFFILIATE ONLY "2,526.00" " $2,273.40 " " $1,010.40 " " $2,020.80 " " $1,414.56 " " $1,768.20 " " $1,616.64 " " $2,020.80 " " $1,970.28 " " $1,136.70 " " $1,035.66 " " $1,060.92 " " $1,010.40 " " $1,894.50 " " $1,641.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 30100 30100 PR BIOPSY INTRANASAL 398.00 $358.20 $159.20 $318.40 $222.88 $278.60 $254.72 $318.40 $310.44 $179.10 $163.18 $167.16 $159.20 $298.50 $258.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 30118 30118 PR EXCISION/DESTRUCTION INTRANASAL LESION XTRNL "2,069.00" " $1,862.10 " $827.60 " $1,655.20 " " $1,158.64 " " $1,448.30 " " $1,324.16 " " $1,655.20 " " $1,613.82 " $931.05 $848.29 $868.98 $827.60 " $1,551.75 " " $1,344.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 30130 30130 PR EXCISION INFERIOR TURBINATE PARTIAL/COMPLETE "1,307.00" " $1,176.30 " $522.80 " $1,045.60 " $731.92 $914.90 $836.48 " $1,045.60 " " $1,019.46 " $588.15 $535.87 $548.94 $522.80 $980.25 $849.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 30140 30140 PR SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL "1,809.00" " $1,628.10 " $723.60 " $1,447.20 " " $1,013.04 " " $1,266.30 " " $1,157.76 " " $1,447.20 " " $1,411.02 " $814.05 $741.69 $759.78 $723.60 " $1,356.75 " " $1,175.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 30300 30300 PR REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE 822.00 $739.80 $328.80 $657.60 $460.32 $575.40 $526.08 $657.60 $641.16 $369.90 $337.02 $345.24 $328.80 $616.50 $534.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 30520 30520 PR SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF "4,121.00" " $3,708.90 " " $1,648.40 " " $3,296.80 " " $2,307.76 " " $2,884.70 " " $2,637.44 " " $3,296.80 " " $3,214.38 " " $1,854.45 " " $1,689.61 " " $1,730.82 " " $1,648.40 " " $3,090.75 " " $2,678.65 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 30801 30801 PR ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC 637.00 $573.30 $254.80 $509.60 $356.72 $445.90 $407.68 $509.60 $496.86 $286.65 $261.17 $267.54 $254.80 $477.75 $414.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 30802 30802 PR ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL "1,008.00" $907.20 $403.20 $806.40 $564.48 $705.60 $645.12 $806.40 $786.24 $453.60 $413.28 $423.36 $403.20 $756.00 $655.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 308742600 87426 PB COVID 19 ANTIGEN 60.00 $54.00 $24.00 $48.00 $33.60 $42.00 $38.40 $48.00 $46.80 $27.00 $24.60 $25.20 $24.00 $45.00 $39.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 30901 30901 PR CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE 475.00 $427.50 $190.00 $380.00 $266.00 $332.50 $304.00 $380.00 $370.50 $213.75 $194.75 $199.50 $190.00 $356.25 $308.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 30905 30905 PR CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST "1,106.00" $995.40 $442.40 $884.80 $619.36 $774.20 $707.84 $884.80 $862.68 $497.70 $453.46 $464.52 $442.40 $829.50 $718.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 30906 30906 PR CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ "1,227.00" " $1,104.30 " $490.80 $981.60 $687.12 $858.90 $785.28 $981.60 $957.06 $552.15 $503.07 $515.34 $490.80 $920.25 $797.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 30930 30930 PR FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC 557.00 $501.30 $222.80 $445.60 $311.92 $389.90 $356.48 $445.60 $434.46 $250.65 $228.37 $233.94 $222.80 $417.75 $362.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 31020 31020 PR SINUSOTOMY MAXILLARY ANTROTOMY INTRANASAL "1,534.00" " $1,380.60 " $613.60 " $1,227.20 " $859.04 " $1,073.80 " $981.76 " $1,227.20 " " $1,196.52 " $690.30 $628.94 $644.28 $613.60 " $1,150.50 " $997.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 31201 31201 PR ETHMOIDECTOMY INTRANASAL TOTAL "3,095.00" " $2,785.50 " " $1,238.00 " " $2,476.00 " " $1,733.20 " " $2,166.50 " " $1,980.80 " " $2,476.00 " " $2,414.10 " " $1,392.75 " " $1,268.95 " " $1,299.90 " " $1,238.00 " " $2,321.25 " " $2,011.75 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 31231 31231 PR NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX 639.00 $575.10 $255.60 $511.20 $357.84 $447.30 $408.96 $511.20 $498.42 $287.55 $261.99 $268.38 $255.60 $479.25 $415.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 31237 31237 PR NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX 970.00 $873.00 $388.00 $776.00 $543.20 $679.00 $620.80 $776.00 $756.60 $436.50 $397.70 $407.40 $388.00 $727.50 $630.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 31238 31238 PR NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG "1,077.00" $969.30 $430.80 $861.60 $603.12 $753.90 $689.28 $861.60 $840.06 $484.65 $441.57 $452.34 $430.80 $807.75 $700.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 31240 31240 PR NASAL/SINUS NDSC SURG W/CONCHA BULLOSA RESECTION "1,010.00" $909.00 $404.00 $808.00 $565.60 $707.00 $646.40 $808.00 $787.80 $454.50 $414.10 $424.20 $404.00 $757.50 $656.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 31254 31254 PR NASAL/SINUS NDSC W/PARTIAL ETHMOIDECTOMY "1,766.00" " $1,589.40 " $706.40 " $1,412.80 " $988.96 " $1,236.20 " " $1,130.24 " " $1,412.80 " " $1,377.48 " $794.70 $724.06 $741.72 $706.40 " $1,324.50 " " $1,147.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 31255 31255 PR NASAL/SINUS NDSC W/TOTAL ETHOIDECTOMY "2,069.00" " $1,862.10 " $827.60 " $1,655.20 " " $1,158.64 " " $1,448.30 " " $1,324.16 " " $1,655.20 " " $1,613.82 " $931.05 $848.29 $868.98 $827.60 " $1,551.75 " " $1,344.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 31256 31256 PR NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY "2,005.00" " $1,804.50 " $802.00 " $1,604.00 " " $1,122.80 " " $1,403.50 " " $1,283.20 " " $1,604.00 " " $1,563.90 " $902.25 $822.05 $842.10 $802.00 " $1,503.75 " " $1,303.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 31267 31267 PR NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS "1,966.00" " $1,769.40 " $786.40 " $1,572.80 " " $1,100.96 " " $1,376.20 " " $1,258.24 " " $1,572.80 " " $1,533.48 " $884.70 $806.06 $825.72 $786.40 " $1,474.50 " " $1,277.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 31500 31500 PR INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE 639.00 $575.10 $255.60 $511.20 $357.84 $447.30 $408.96 $511.20 $498.42 $287.55 $261.99 $268.38 $255.60 $479.25 $415.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 31505 31505 PR LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX 397.00 $357.30 $158.80 $317.60 $222.32 $277.90 $254.08 $317.60 $309.66 $178.65 $162.77 $166.74 $158.80 $297.75 $258.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 31575 31575 PR LARYNGOSCOPY FLEXIBLE DIAGNOSTIC 480.00 $432.00 $192.00 $384.00 $268.80 $336.00 $307.20 $384.00 $374.40 $216.00 $196.80 $201.60 $192.00 $360.00 $312.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 31645 31645 PR BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE 1ST 996.00 $896.40 $398.40 $796.80 $557.76 $697.20 $637.44 $796.80 $776.88 $448.20 $408.36 $418.32 $398.40 $747.00 $647.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 32550 32550 PR INSERTION INDWELLING TUNNELED PLEURAL CATHETER "2,105.00" " $1,894.50 " $842.00 " $1,684.00 " " $1,178.80 " " $1,473.50 " " $1,347.20 " " $1,684.00 " " $1,641.90 " $947.25 $863.05 $884.10 $842.00 " $1,578.75 " " $1,368.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 32551 32551 PR TUBE THORACOSTOMY INCLUDES WATER SEAL 955.00 $859.50 $382.00 $764.00 $534.80 $668.50 $611.20 $764.00 $744.90 $429.75 $391.55 $401.10 $382.00 $716.25 $620.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 32560 32560 PR INSTLJ VIA CHEST TUBE/CATH AGENT FOR PLEURODESIS 651.00 $585.90 $260.40 $520.80 $364.56 $455.70 $416.64 $520.80 $507.78 $292.95 $266.91 $273.42 $260.40 $488.25 $423.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 32655 32655 PR THORACOSCOPY W/RESECTION BULLAE W/WO PLEURAL PX "4,609.00" " $4,148.10 " " $1,843.60 " " $3,687.20 " " $2,581.04 " " $3,226.30 " " $2,949.76 " " $3,687.20 " " $3,595.02 " " $2,074.05 " " $1,889.69 " " $1,935.78 " " $1,843.60 " " $3,456.75 " " $2,995.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 33286 33286 PR REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONITOR 472.00 $424.80 $188.80 $377.60 $264.32 $330.40 $302.08 $377.60 $368.16 $212.40 $193.52 $198.24 $188.80 $354.00 $306.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 34201 34201 PR EMBLC/THRMBC FEMORAL POPLITEAL AORTO-ILIAC ART "4,924.00" " $4,431.60 " " $1,969.60 " " $3,939.20 " " $2,757.44 " " $3,446.80 " " $3,151.36 " " $3,939.20 " " $3,840.72 " " $2,215.80 " " $2,018.84 " " $2,068.08 " " $1,969.60 " " $3,693.00 " " $3,200.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 35190 35190 PR RPR/TRAUMATIC AV FISTULA EXTREMITIES "3,692.00" " $3,322.80 " " $1,476.80 " " $2,953.60 " " $2,067.52 " " $2,584.40 " " $2,362.88 " " $2,953.60 " " $2,879.76 " " $1,661.40 " " $1,513.72 " " $1,550.64 " " $1,476.80 " " $2,769.00 " " $2,399.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36140 36140 PR INTRO OF NEEDLE OR INTRACATHETER UPR/LXTR ARTERY 893.00 $803.70 $357.20 $714.40 $500.08 $625.10 $571.52 $714.40 $696.54 $401.85 $366.13 $375.06 $357.20 $669.75 $580.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36200 36200 PR INTRODUCTION CATHETER AORTA "1,187.00" " $1,068.30 " $474.80 $949.60 $664.72 $830.90 $759.68 $949.60 $925.86 $534.15 $486.67 $498.54 $474.80 $890.25 $771.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36247 36247 PR SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH "2,301.00" " $2,070.90 " $920.40 " $1,840.80 " " $1,288.56 " " $1,610.70 " " $1,472.64 " " $1,840.80 " " $1,794.78 " " $1,035.45 " $943.41 $966.42 $920.40 " $1,725.75 " " $1,495.65 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36248 36248 PR SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH 564.00 $507.60 $225.60 $451.20 $315.84 $394.80 $360.96 $451.20 $439.92 $253.80 $231.24 $236.88 $225.60 $423.00 $366.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36415 36415 PR COLLECTION VENOUS BLOOD VENIPUNCTURE 26.00 $23.40 $10.40 $20.80 $14.56 $18.20 $16.64 $20.80 $20.28 $11.70 $10.66 $10.92 $10.40 $19.50 $16.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36425 36425 PR VENIPUNCTURE CUTDOWN AGE 1 YR/> 141.00 $126.90 $56.40 $112.80 $78.96 $98.70 $90.24 $112.80 $109.98 $63.45 $57.81 $59.22 $56.40 $105.75 $91.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36468 36468 PR INJECTIONS SCLEROSANT FOR SPIDER VEINS LIM/TRNK 423.00 $380.70 $169.20 $338.40 $236.88 $296.10 $270.72 $338.40 $329.94 $190.35 $173.43 $177.66 $169.20 $317.25 $274.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36470 36470 PR INJECTION SCLEROSANT SINGLE INCMPTNT VEIN 355.00 $319.50 $142.00 $284.00 $198.80 $248.50 $227.20 $284.00 $276.90 $159.75 $145.55 $149.10 $142.00 $266.25 $230.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36471 36471 PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS 606.00 $545.40 $242.40 $484.80 $339.36 $424.20 $387.84 $484.80 $472.68 $272.70 $248.46 $254.52 $242.40 $454.50 $393.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36475 36475 PR ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN "4,236.00" " $3,812.40 " " $1,694.40 " " $3,388.80 " " $2,372.16 " " $2,965.20 " " $2,711.04 " " $3,388.80 " " $3,304.08 " " $1,906.20 " " $1,736.76 " " $1,779.12 " " $1,694.40 " " $3,177.00 " " $2,753.40 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36476 36476 PR ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS 765.00 $688.50 $306.00 $612.00 $428.40 $535.50 $489.60 $612.00 $596.70 $344.25 $313.65 $321.30 $306.00 $573.75 $497.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36478 36478 PR ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN "3,600.00" " $3,240.00 " " $1,440.00 " " $2,880.00 " " $2,016.00 " " $2,520.00 " " $2,304.00 " " $2,880.00 " " $2,808.00 " " $1,620.00 " " $1,476.00 " " $1,512.00 " " $1,440.00 " " $2,700.00 " " $2,340.00 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36479 36479 PR ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS "1,637.00" " $1,473.30 " $654.80 " $1,309.60 " $916.72 " $1,145.90 " " $1,047.68 " " $1,309.60 " " $1,276.86 " $736.65 $671.17 $687.54 $654.80 " $1,227.75 " " $1,064.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36510 36510 PR CATHJ UMBILICAL VEIN DX/THER NB 550.00 $495.00 $220.00 $440.00 $308.00 $385.00 $352.00 $440.00 $429.00 $247.50 $225.50 $231.00 $220.00 $412.50 $357.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36556 36556 PR INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/> 930.00 $837.00 $372.00 $744.00 $520.80 $651.00 $595.20 $744.00 $725.40 $418.50 $381.30 $390.60 $372.00 $697.50 $604.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36558 36558 PR INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/> "2,027.00" " $1,824.30 " $810.80 " $1,621.60 " " $1,135.12 " " $1,418.90 " " $1,297.28 " " $1,621.60 " " $1,581.06 " $912.15 $831.07 $851.34 $810.80 " $1,520.25 " " $1,317.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36561 36561 PR INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/> "2,617.00" " $2,355.30 " " $1,046.80 " " $2,093.60 " " $1,465.52 " " $1,831.90 " " $1,674.88 " " $2,093.60 " " $2,041.26 " " $1,177.65 " " $1,072.97 " " $1,099.14 " " $1,046.80 " " $1,962.75 " " $1,701.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36569 36569 PR INSERTION PICC W/O IMG GDN 5 YR/> 930.00 $837.00 $372.00 $744.00 $520.80 $651.00 $595.20 $744.00 $725.40 $418.50 $381.30 $390.60 $372.00 $697.50 $604.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36571 36571 PR INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/> "3,063.00" " $2,756.70 " " $1,225.20 " " $2,450.40 " " $1,715.28 " " $2,144.10 " " $1,960.32 " " $2,450.40 " " $2,389.14 " " $1,378.35 " " $1,255.83 " " $1,286.46 " " $1,225.20 " " $2,297.25 " " $1,990.95 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36582 36582 PR RPLCMT COMPL TUN CTR VAD W/SUBQ PORT "2,552.00" " $2,296.80 " " $1,020.80 " " $2,041.60 " " $1,429.12 " " $1,786.40 " " $1,633.28 " " $2,041.60 " " $1,990.56 " " $1,148.40 " " $1,046.32 " " $1,071.84 " " $1,020.80 " " $1,914.00 " " $1,658.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36589 36589 PR RMVL TUN CVC W/O SUBQ PORT/PMP 731.00 $657.90 $292.40 $584.80 $409.36 $511.70 $467.84 $584.80 $570.18 $328.95 $299.71 $307.02 $292.40 $548.25 $475.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36590 36590 PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ 994.00 $894.60 $397.60 $795.20 $556.64 $695.80 $636.16 $795.20 $775.32 $447.30 $407.54 $417.48 $397.60 $745.50 $646.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36592 36592 PR COLLECT BLOOD FROM CATHETER VENOUS NOS 171.00 $153.90 $68.40 $136.80 $95.76 $119.70 $109.44 $136.80 $133.38 $76.95 $70.11 $71.82 $68.40 $128.25 $111.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36600 36600 PR ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36620 36620 PR ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX PRQ 517.00 $465.30 $206.80 $413.60 $289.52 $361.90 $330.88 $413.60 $403.26 $232.65 $211.97 $217.14 $206.80 $387.75 $336.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36821 36821 PR ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT "2,466.00" " $2,219.40 " $986.40 " $1,972.80 " " $1,380.96 " " $1,726.20 " " $1,578.24 " " $1,972.80 " " $1,923.48 " " $1,109.70 " " $1,011.06 " " $1,035.72 " $986.40 " $1,849.50 " " $1,602.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36830 36830 PR CRTJ ARVEN FSTL XCP DIR ARVEN ANAST NONAUTOG GRF "3,401.00" " $3,060.90 " " $1,360.40 " " $2,720.80 " " $1,904.56 " " $2,380.70 " " $2,176.64 " " $2,720.80 " " $2,652.78 " " $1,530.45 " " $1,394.41 " " $1,428.42 " " $1,360.40 " " $2,550.75 " " $2,210.65 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36832 36832 PR REVJ OPN ARVEN FSTL W/O THRMBC DIAL GRF "3,312.00" " $2,980.80 " " $1,324.80 " " $2,649.60 " " $1,854.72 " " $2,318.40 " " $2,119.68 " " $2,649.60 " " $2,583.36 " " $1,490.40 " " $1,357.92 " " $1,391.04 " " $1,324.80 " " $2,484.00 " " $2,152.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 36833 36833 PR REVJ OPN ARVEN FSTL W/THRMBC DIAL GRF "3,331.00" " $2,997.90 " " $1,332.40 " " $2,664.80 " " $1,865.36 " " $2,331.70 " " $2,131.84 " " $2,664.80 " " $2,598.18 " " $1,498.95 " " $1,365.71 " " $1,399.02 " " $1,332.40 " " $2,498.25 " " $2,165.15 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 37609 37609 PR LIGATION/BIOPSY TEMPORAL ARTERY "1,190.00" " $1,071.00 " $476.00 $952.00 $666.40 $833.00 $761.60 $952.00 $928.20 $535.50 $487.90 $499.80 $476.00 $892.50 $773.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 37618 37618 PR LIGATION MAJOR ARTERY EXTREMITY "1,850.00" " $1,665.00 " $740.00 " $1,480.00 " " $1,036.00 " " $1,295.00 " " $1,184.00 " " $1,480.00 " " $1,443.00 " $832.50 $758.50 $777.00 $740.00 " $1,387.50 " " $1,202.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 37761 37761 PR LIG PRFRATR VEIN SUBFSCAL OPEN INCL US GID 1 LEG "2,480.00" " $2,232.00 " $992.00 " $1,984.00 " " $1,388.80 " " $1,736.00 " " $1,587.20 " " $1,984.00 " " $1,934.40 " " $1,116.00 " " $1,016.80 " " $1,041.60 " $992.00 " $1,860.00 " " $1,612.00 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 37765 37765 PR STAB PHLEBT VARICOSE VEINS 1 XTR 10-20 STAB INCS "2,436.00" " $2,192.40 " $974.40 " $1,948.80 " " $1,364.16 " " $1,705.20 " " $1,559.04 " " $1,948.80 " " $1,900.08 " " $1,096.20 " $998.76 " $1,023.12 " $974.40 " $1,827.00 " " $1,583.40 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 37785 37785 PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG "1,426.00" " $1,283.40 " $570.40 " $1,140.80 " $798.56 $998.20 $912.64 " $1,140.80 " " $1,112.28 " $641.70 $584.66 $598.92 $570.40 " $1,069.50 " $926.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 37799 37799 PR UNLISTED PROCEDURE VASCULAR SURGERY 677.00 $609.30 $270.80 $541.60 $379.12 $473.90 $433.28 $541.60 $528.06 $304.65 $277.57 $284.34 $270.80 $507.75 $440.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 37799.12 37799 PR ENDOVENOUS MECHANICAL ABLATION OF BILAT GRTR SAPHENOUS VEIN 564.00 $507.60 $225.60 $451.20 $315.84 $394.80 $360.96 $451.20 $439.92 $253.80 $231.24 $236.88 $225.60 $423.00 $366.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 37799.13 37799 PR STAB PHLEBECTOMY 1 LEG <10 958.00 $862.20 $383.20 $766.40 $536.48 $670.60 $613.12 $766.40 $747.24 $431.10 $392.78 $402.36 $383.20 $718.50 $622.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 38100 38100 PR SPLENECTOMY TOTAL SEPARATE PROCEDURE "5,415.00" " $4,873.50 " " $2,166.00 " " $4,332.00 " " $3,032.40 " " $3,790.50 " " $3,465.60 " " $4,332.00 " " $4,223.70 " " $2,436.75 " " $2,220.15 " " $2,274.30 " " $2,166.00 " " $4,061.25 " " $3,519.75 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 38129 38129 PR UNLISTED LAPAROSCOPY PROCEDURE SPLEEN "1,441.00" " $1,296.90 " $576.40 " $1,152.80 " $806.96 " $1,008.70 " $922.24 " $1,152.80 " " $1,123.98 " $648.45 $590.81 $605.22 $576.40 " $1,080.75 " $936.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 38500 38500 PR BX/EXC LYMPH NODE OPEN SUPERFICIAL "1,292.00" " $1,162.80 " $516.80 " $1,033.60 " $723.52 $904.40 $826.88 " $1,033.60 " " $1,007.76 " $581.40 $529.72 $542.64 $516.80 $969.00 $839.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 38510 38510 PR BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE "2,118.00" " $1,906.20 " $847.20 " $1,694.40 " " $1,186.08 " " $1,482.60 " " $1,355.52 " " $1,694.40 " " $1,652.04 " $953.10 $868.38 $889.56 $847.20 " $1,588.50 " " $1,376.70 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 38525 38525 PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE "1,743.00" " $1,568.70 " $697.20 " $1,394.40 " $976.08 " $1,220.10 " " $1,115.52 " " $1,394.40 " " $1,359.54 " $784.35 $714.63 $732.06 $697.20 " $1,307.25 " " $1,132.95 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 38531 38531 PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES "1,915.00" " $1,723.50 " $766.00 " $1,532.00 " " $1,072.40 " " $1,340.50 " " $1,225.60 " " $1,532.00 " " $1,493.70 " $861.75 $785.15 $804.30 $766.00 " $1,436.25 " " $1,244.75 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 38747 38747 PR ABDL LMPHADEC REG CELIAC GSTR PORTAL PRIPNCRTC "1,591.00" " $1,431.90 " $636.40 " $1,272.80 " $890.96 " $1,113.70 " " $1,018.24 " " $1,272.80 " " $1,240.98 " $715.95 $652.31 $668.22 $636.40 " $1,193.25 " " $1,034.15 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 38792 38792 PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE 251.00 $225.90 $100.40 $200.80 $140.56 $175.70 $160.64 $200.80 $195.78 $112.95 $102.91 $105.42 $100.40 $188.25 $163.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 38900 38900 PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION 878.00 $790.20 $351.20 $702.40 $491.68 $614.60 $561.92 $702.40 $684.84 $395.10 $359.98 $368.76 $351.20 $658.50 $570.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 40654 40654 PR RPR LIP FULL THKNS >ONE-HALF VERT HEIGHT/COMPLE "3,319.00" " $2,987.10 " " $1,327.60 " " $2,655.20 " " $1,858.64 " " $2,323.30 " " $2,124.16 " " $2,655.20 " " $2,588.82 " " $1,493.55 " " $1,360.79 " " $1,393.98 " " $1,327.60 " " $2,489.25 " " $2,157.35 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 40800 40800 PR DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL 637.00 $573.30 $254.80 $509.60 $356.72 $445.90 $407.68 $509.60 $496.86 $286.65 $261.17 $267.54 $254.80 $477.75 $414.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 40806 40806 PR INCISION LABIAL FRENUM FRENOTOMY 470.00 $423.00 $188.00 $376.00 $263.20 $329.00 $300.80 $376.00 $366.60 $211.50 $192.70 $197.40 $188.00 $352.50 $305.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 40808 40808 PR BIOPSY VESTIBULE MOUTH 679.00 $611.10 $271.60 $543.20 $380.24 $475.30 $434.56 $543.20 $529.62 $305.55 $278.39 $285.18 $271.60 $509.25 $441.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 40812 40812 PR EXC LESION MUCOSA & SBMCSL VESTIBULE SMPL RPR 902.00 $811.80 $360.80 $721.60 $505.12 $631.40 $577.28 $721.60 $703.56 $405.90 $369.82 $378.84 $360.80 $676.50 $586.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 40820 40820 PR DSTRJ LES/SCAR VESTIBULE MOUTH PHYSICAL METHS 904.00 $813.60 $361.60 $723.20 $506.24 $632.80 $578.56 $723.20 $705.12 $406.80 $370.64 $379.68 $361.60 $678.00 $587.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 40830 40830 PR CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/< 863.00 $776.70 $345.20 $690.40 $483.28 $604.10 $552.32 $690.40 $673.14 $388.35 $353.83 $362.46 $345.20 $647.25 $560.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 41010 41010 PR INCISION LINGUAL FRENUM FRENOTOMY 711.00 $639.90 $284.40 $568.80 $398.16 $497.70 $455.04 $568.80 $554.58 $319.95 $291.51 $298.62 $284.40 $533.25 $462.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 41100 41100 PR BIOPSY TONGUE ANTERIOR TWO-THIRDS 639.00 $575.10 $255.60 $511.20 $357.84 $447.30 $408.96 $511.20 $498.42 $287.55 $261.99 $268.38 $255.60 $479.25 $415.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 41110 41110 PR EXCISION LESION TONGUE W/O CLOSURE 710.00 $639.00 $284.00 $568.00 $397.60 $497.00 $454.40 $568.00 $553.80 $319.50 $291.10 $298.20 $284.00 $532.50 $461.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 41115 41115 PR EXCISION LINGUAL FRENUM FRENECTOMY 836.00 $752.40 $334.40 $668.80 $468.16 $585.20 $535.04 $668.80 $652.08 $376.20 $342.76 $351.12 $334.40 $627.00 $543.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 41252 41252 PR RPR LAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX "1,498.00" " $1,348.20 " $599.20 " $1,198.40 " $838.88 " $1,048.60 " $958.72 " $1,198.40 " " $1,168.44 " $674.10 $614.18 $629.16 $599.20 " $1,123.50 " $973.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 41800 41800 PR DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS 594.00 $534.60 $237.60 $475.20 $332.64 $415.80 $380.16 $475.20 $463.32 $267.30 $243.54 $249.48 $237.60 $445.50 $386.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 42000 42000 PR DRAINAGE ABSCESS PALATE UVULA 684.00 $615.60 $273.60 $547.20 $383.04 $478.80 $437.76 $547.20 $533.52 $307.80 $280.44 $287.28 $273.60 $513.00 $444.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 42104 42104 PR EXC LESION PALATE UVULA W/O CLOSURE 666.00 $599.40 $266.40 $532.80 $372.96 $466.20 $426.24 $532.80 $519.48 $299.70 $273.06 $279.72 $266.40 $499.50 $432.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 42140 42140 PR UVULECTOMY EXCISION UVULA 938.00 $844.20 $375.20 $750.40 $525.28 $656.60 $600.32 $750.40 $731.64 $422.10 $384.58 $393.96 $375.20 $703.50 $609.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 42145 42145 PR PALATOPHARYNGOPLASTY "3,464.00" " $3,117.60 " " $1,385.60 " " $2,771.20 " " $1,939.84 " " $2,424.80 " " $2,216.96 " " $2,771.20 " " $2,701.92 " " $1,558.80 " " $1,420.24 " " $1,454.88 " " $1,385.60 " " $2,598.00 " " $2,251.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 42330 42330 PR SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL 755.00 $679.50 $302.00 $604.00 $422.80 $528.50 $483.20 $604.00 $588.90 $339.75 $309.55 $317.10 $302.00 $566.25 $490.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 42450 42450 PR EXISION OF SUBLINGUAL GLAND "2,390.00" " $2,151.00 " $956.00 " $1,912.00 " " $1,338.40 " " $1,673.00 " " $1,529.60 " " $1,912.00 " " $1,864.20 " " $1,075.50 " $979.90 " $1,003.80 " $956.00 " $1,792.50 " " $1,553.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 42699 42699 PR UNLISTED PX SALIVARY GLANDS/DUCTS 902.00 $811.80 $360.80 $721.60 $505.12 $631.40 $577.28 $721.60 $703.56 $405.90 $369.82 $378.84 $360.80 $676.50 $586.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 42800 42800 PR BIOPSY OROPHARYNX 609.00 $548.10 $243.60 $487.20 $341.04 $426.30 $389.76 $487.20 $475.02 $274.05 $249.69 $255.78 $243.60 $456.75 $395.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 42809 42809 PR REMOVAL FOREIGN BODY PHARYNX 699.00 $629.10 $279.60 $559.20 $391.44 $489.30 $447.36 $559.20 $545.22 $314.55 $286.59 $293.58 $279.60 $524.25 $454.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 42820 42820 PR TONSILLECTOMY & ADENOIDECTOMY "1,696.00" " $1,526.40 " $678.40 " $1,356.80 " $949.76 " $1,187.20 " " $1,085.44 " " $1,356.80 " " $1,322.88 " $763.20 $695.36 $712.32 $678.40 " $1,272.00 " " $1,102.40 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 42825 42825 PR TONSILLECTOMY PRIMARY/SECONDARY "1,733.00" " $1,559.70 " $693.20 " $1,386.40 " $970.48 " $1,213.10 " " $1,109.12 " " $1,386.40 " " $1,351.74 " $779.85 $710.53 $727.86 $693.20 " $1,299.75 " " $1,126.45 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 42830 42830 PR ADENOIDECTOMY PRIMARY "1,087.00" $978.30 $434.80 $869.60 $608.72 $760.90 $695.68 $869.60 $847.86 $489.15 $445.67 $456.54 $434.80 $815.25 $706.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 42999 42999 PR UNLISTED PROCEDURE PHARYNX ADENOIDS/TONSILS 690.00 $621.00 $276.00 $552.00 $386.40 $483.00 $441.60 $552.00 $538.20 $310.50 $282.90 $289.80 $276.00 $517.50 $448.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43200 43200 PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC "1,002.00" $901.80 $400.80 $801.60 $561.12 $701.40 $641.28 $801.60 $781.56 $450.90 $410.82 $420.84 $400.80 $751.50 $651.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43202 43202 PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY "4,132.00" " $3,718.80 " " $1,652.80 " " $3,305.60 " " $2,313.92 " " $2,892.40 " " $2,644.48 " " $3,305.60 " " $3,222.96 " " $1,859.40 " " $1,694.12 " " $1,735.44 " " $1,652.80 " " $3,099.00 " " $2,685.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43210 43210 PR EGD PARTIAL/COMPL ESOPHAGOGASTRIC FUNDOPLASTY "2,402.00" " $2,161.80 " $960.80 " $1,921.60 " " $1,345.12 " " $1,681.40 " " $1,537.28 " " $1,921.60 " " $1,873.56 " " $1,080.90 " $984.82 " $1,008.84 " $960.80 " $1,801.50 " " $1,561.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43235 43235 PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC "1,273.00" " $1,145.70 " $509.20 " $1,018.40 " $712.88 $891.10 $814.72 " $1,018.40 " $992.94 $572.85 $521.93 $534.66 $509.20 $954.75 $827.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43236 43236 PR ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION "1,376.00" " $1,238.40 " $550.40 " $1,100.80 " $770.56 $963.20 $880.64 " $1,100.80 " " $1,073.28 " $619.20 $564.16 $577.92 $550.40 " $1,032.00 " $894.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43239 43239 PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE "1,516.00" " $1,364.40 " $606.40 " $1,212.80 " $848.96 " $1,061.20 " $970.24 " $1,212.80 " " $1,182.48 " $682.20 $621.56 $636.72 $606.40 " $1,137.00 " $985.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43241 43241 PR EGD INTRALUMINAL TUBE/CATHETER INSERTION "1,091.00" $981.90 $436.40 $872.80 $610.96 $763.70 $698.24 $872.80 $850.98 $490.95 $447.31 $458.22 $436.40 $818.25 $709.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43244 43244 PR EGD BAND LIGATION ESOPHGEAL/GASTRIC VARICES "1,109.00" $998.10 $443.60 $887.20 $621.04 $776.30 $709.76 $887.20 $865.02 $499.05 $454.69 $465.78 $443.60 $831.75 $720.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43245 43245 PR EGD DILATION GASTRIC/DUODENAL STRICTURE "1,171.00" " $1,053.90 " $468.40 $936.80 $655.76 $819.70 $749.44 $936.80 $913.38 $526.95 $480.11 $491.82 $468.40 $878.25 $761.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43246 43246 PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE "1,175.00" " $1,057.50 " $470.00 $940.00 $658.00 $822.50 $752.00 $940.00 $916.50 $528.75 $481.75 $493.50 $470.00 $881.25 $763.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43247 43247 PR EGD FLEXIBLE FOREIGN BODY REMOVAL 769.00 $692.10 $307.60 $615.20 $430.64 $538.30 $492.16 $615.20 $599.82 $346.05 $315.29 $322.98 $307.60 $576.75 $499.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43248 43248 PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS "1,130.00" " $1,017.00 " $452.00 $904.00 $632.80 $791.00 $723.20 $904.00 $881.40 $508.50 $463.30 $474.60 $452.00 $847.50 $734.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43249 43249 PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM "2,426.00" " $2,183.40 " $970.40 " $1,940.80 " " $1,358.56 " " $1,698.20 " " $1,552.64 " " $1,940.80 " " $1,892.28 " " $1,091.70 " $994.66 " $1,018.92 " $970.40 " $1,819.50 " " $1,576.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43250 43250 PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS "1,231.00" " $1,107.90 " $492.40 $984.80 $689.36 $861.70 $787.84 $984.80 $960.18 $553.95 $504.71 $517.02 $492.40 $923.25 $800.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43251 43251 PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH "1,250.00" " $1,125.00 " $500.00 " $1,000.00 " $700.00 $875.00 $800.00 " $1,000.00 " $975.00 $562.50 $512.50 $525.00 $500.00 $937.50 $812.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43255 43255 PR EGD TRANSORAL CONTROL BLEEDING ANY METHOD "2,199.00" " $1,979.10 " $879.60 " $1,759.20 " " $1,231.44 " " $1,539.30 " " $1,407.36 " " $1,759.20 " " $1,715.22 " $989.55 $901.59 $923.58 $879.60 " $1,649.25 " " $1,429.35 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43270 43270 PR EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE "1,982.00" " $1,783.80 " $792.80 " $1,585.60 " " $1,109.92 " " $1,387.40 " " $1,268.48 " " $1,585.60 " " $1,545.96 " $891.90 $812.62 $832.44 $792.80 " $1,486.50 " " $1,288.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43279 43279 PR LAPS ESOPHAGOMYOTOMY W/FUNDOPLASTY IF PERFORMED "6,906.00" " $6,215.40 " " $2,762.40 " " $5,524.80 " " $3,867.36 " " $4,834.20 " " $4,419.84 " " $5,524.80 " " $5,386.68 " " $3,107.70 " " $2,831.46 " " $2,900.52 " " $2,762.40 " " $5,179.50 " " $4,488.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43280 43280 PR LAPS SURG ESOPG/GSTR FUNDOPLASTY "4,704.00" " $4,233.60 " " $1,881.60 " " $3,763.20 " " $2,634.24 " " $3,292.80 " " $3,010.56 " " $3,763.20 " " $3,669.12 " " $2,116.80 " " $1,928.64 " " $1,975.68 " " $1,881.60 " " $3,528.00 " " $3,057.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43281 43281 PR LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/O MESH "7,788.00" " $7,009.20 " " $3,115.20 " " $6,230.40 " " $4,361.28 " " $5,451.60 " " $4,984.32 " " $6,230.40 " " $6,074.64 " " $3,504.60 " " $3,193.08 " " $3,270.96 " " $3,115.20 " " $5,841.00 " " $5,062.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43282 43282 PR LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/MESH "8,593.00" " $7,733.70 " " $3,437.20 " " $6,874.40 " " $4,812.08 " " $6,015.10 " " $5,499.52 " " $6,874.40 " " $6,702.54 " " $3,866.85 " " $3,523.13 " " $3,609.06 " " $3,437.20 " " $6,444.75 " " $5,585.45 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43283 43283 PR LAPS ESOPHAGEAL LENGTHENING ADDL 685.00 $616.50 $274.00 $548.00 $383.60 $479.50 $438.40 $548.00 $534.30 $308.25 $280.85 $287.70 $274.00 $513.75 $445.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43284 43284 PR LAPS ESOPHGL SPHNCTR AGMNTJ PLMT DEV CRRPL "3,287.00" " $2,958.30 " " $1,314.80 " " $2,629.60 " " $1,840.72 " " $2,300.90 " " $2,103.68 " " $2,629.60 " " $2,563.86 " " $1,479.15 " " $1,347.67 " " $1,380.54 " " $1,314.80 " " $2,465.25 " " $2,136.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43327 43327 PR ESOPG/GSTR FUNDOPLASTY W/LAPAROTOMY "4,518.00" " $4,066.20 " " $1,807.20 " " $3,614.40 " " $2,530.08 " " $3,162.60 " " $2,891.52 " " $3,614.40 " " $3,524.04 " " $2,033.10 " " $1,852.38 " " $1,897.56 " " $1,807.20 " " $3,388.50 " " $2,936.70 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43332 43332 PR RPR PARAESOPH HIATAL HERNIA W/LAPT W/O MESH "5,342.00" " $4,807.80 " " $2,136.80 " " $4,273.60 " " $2,991.52 " " $3,739.40 " " $3,418.88 " " $4,273.60 " " $4,166.76 " " $2,403.90 " " $2,190.22 " " $2,243.64 " " $2,136.80 " " $4,006.50 " " $3,472.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43338 43338 PR ESOPHAGUS LENGTHENING 607.00 $546.30 $242.80 $485.60 $339.92 $424.90 $388.48 $485.60 $473.46 $273.15 $248.87 $254.94 $242.80 $455.25 $394.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43632 43632 PR GSTRCT PRTL DSTL W/GASTROJEJUNOSTOMY "9,120.00" " $8,208.00 " " $3,648.00 " " $7,296.00 " " $5,107.20 " " $6,384.00 " " $5,836.80 " " $7,296.00 " " $7,113.60 " " $4,104.00 " " $3,739.20 " " $3,830.40 " " $3,648.00 " " $6,840.00 " " $5,928.00 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43633 43633 PR GSTRCT PRTL DSTL W/ROUX-EN-Y RCNSTJ "8,755.00" " $7,879.50 " " $3,502.00 " " $7,004.00 " " $4,902.80 " " $6,128.50 " " $5,603.20 " " $7,004.00 " " $6,828.90 " " $3,939.75 " " $3,589.55 " " $3,677.10 " " $3,502.00 " " $6,566.25 " " $5,690.75 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43640 43640 PR VGTMY W/PYLORPLSTY W/WO GASTROST TRUNCAL/SLCTV "5,278.00" " $4,750.20 " " $2,111.20 " " $4,222.40 " " $2,955.68 " " $3,694.60 " " $3,377.92 " " $4,222.40 " " $4,116.84 " " $2,375.10 " " $2,163.98 " " $2,216.76 " " $2,111.20 " " $3,958.50 " " $3,430.70 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43659 43659 PR UNLISTED LAPAROSCOPIC PROCEDURE STOMACH "3,598.00" " $3,238.20 " " $1,439.20 " " $2,878.40 " " $2,014.88 " " $2,518.60 " " $2,302.72 " " $2,878.40 " " $2,806.44 " " $1,619.10 " " $1,475.18 " " $1,511.16 " " $1,439.20 " " $2,698.50 " " $2,338.70 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43752 43752 PR NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE 270.00 $243.00 $108.00 $216.00 $151.20 $189.00 $172.80 $216.00 $210.60 $121.50 $110.70 $113.40 $108.00 $202.50 $175.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43753 43753 PR GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE 203.00 $182.70 $81.20 $162.40 $113.68 $142.10 $129.92 $162.40 $158.34 $91.35 $83.23 $85.26 $81.20 $152.25 $131.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43761 43761 PR REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO 626.00 $563.40 $250.40 $500.80 $350.56 $438.20 $400.64 $500.80 $488.28 $281.70 $256.66 $262.92 $250.40 $469.50 $406.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43762 43762 PR PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC 809.00 $728.10 $323.60 $647.20 $453.04 $566.30 $517.76 $647.20 $631.02 $364.05 $331.69 $339.78 $323.60 $606.75 $525.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43800 43800 PR PYLOROPLASTY "3,968.00" " $3,571.20 " " $1,587.20 " " $3,174.40 " " $2,222.08 " " $2,777.60 " " $2,539.52 " " $3,174.40 " " $3,095.04 " " $1,785.60 " " $1,626.88 " " $1,666.56 " " $1,587.20 " " $2,976.00 " " $2,579.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43830 43830 PR GASTROSTOMY OPN W/O CONSTJ GSTR TUBE SPX "3,446.00" " $3,101.40 " " $1,378.40 " " $2,756.80 " " $1,929.76 " " $2,412.20 " " $2,205.44 " " $2,756.80 " " $2,687.88 " " $1,550.70 " " $1,412.86 " " $1,447.32 " " $1,378.40 " " $2,584.50 " " $2,239.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43840 43840 PR GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ "4,210.00" " $3,789.00 " " $1,684.00 " " $3,368.00 " " $2,357.60 " " $2,947.00 " " $2,694.40 " " $3,368.00 " " $3,283.80 " " $1,894.50 " " $1,726.10 " " $1,768.20 " " $1,684.00 " " $3,157.50 " " $2,736.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43860 43860 PR REVJ GSTR/JJ ANAST W/RCNSTJ W/O VGTMY "7,718.00" " $6,946.20 " " $3,087.20 " " $6,174.40 " " $4,322.08 " " $5,402.60 " " $4,939.52 " " $6,174.40 " " $6,020.04 " " $3,473.10 " " $3,164.38 " " $3,241.56 " " $3,087.20 " " $5,788.50 " " $5,016.70 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43870 43870 PR CLOSURE GASTROSTOMY SURG "3,070.00" " $2,763.00 " " $1,228.00 " " $2,456.00 " " $1,719.20 " " $2,149.00 " " $1,964.80 " " $2,456.00 " " $2,394.60 " " $1,381.50 " " $1,258.70 " " $1,289.40 " " $1,228.00 " " $2,302.50 " " $1,995.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 43999 43999 PR UNLISTED PROCEDURE STOMACH "5,857.00" " $5,271.30 " " $2,342.80 " " $4,685.60 " " $3,279.92 " " $4,099.90 " " $3,748.48 " " $4,685.60 " " $4,568.46 " " $2,635.65 " " $2,401.37 " " $2,459.94 " " $2,342.80 " " $4,392.75 " " $3,807.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44005 44005 PR ENTEROLSS FRING INTSTINAL ADHESION SPX "4,596.00" " $4,136.40 " " $1,838.40 " " $3,676.80 " " $2,573.76 " " $3,217.20 " " $2,941.44 " " $3,676.80 " " $3,584.88 " " $2,068.20 " " $1,884.36 " " $1,930.32 " " $1,838.40 " " $3,447.00 " " $2,987.40 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44015 44015 PR TUBE/NEEDLE CATH JEJUNOSTOMY ANY METHOD 902.00 $811.80 $360.80 $721.60 $505.12 $631.40 $577.28 $721.60 $703.56 $405.90 $369.82 $378.84 $360.80 $676.50 $586.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44020 44020 PR ENTEROTOMY SM INT OTH/THN DUO EXPL BX/FB RMVL "4,494.00" " $4,044.60 " " $1,797.60 " " $3,595.20 " " $2,516.64 " " $3,145.80 " " $2,876.16 " " $3,595.20 " " $3,505.32 " " $2,022.30 " " $1,842.54 " " $1,887.48 " " $1,797.60 " " $3,370.50 " " $2,921.10 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44050 44050 PR RDCTJ VOLVULUS INTUSSUSCEPTION INT HRNA LAPT "3,858.00" " $3,472.20 " " $1,543.20 " " $3,086.40 " " $2,160.48 " " $2,700.60 " " $2,469.12 " " $3,086.40 " " $3,009.24 " " $1,736.10 " " $1,581.78 " " $1,620.36 " " $1,543.20 " " $2,893.50 " " $2,507.70 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44120 44120 PR ENTRC RESCJ SMALL INTESTINE 1 RESCJ & ANAST "5,325.00" " $4,792.50 " " $2,130.00 " " $4,260.00 " " $2,982.00 " " $3,727.50 " " $3,408.00 " " $4,260.00 " " $4,153.50 " " $2,396.25 " " $2,183.25 " " $2,236.50 " " $2,130.00 " " $3,993.75 " " $3,461.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44121 44121 PR ENTERECTOMY RESCJ SMALL INTESTINE EA RESCJ & ANA "1,344.00" " $1,209.60 " $537.60 " $1,075.20 " $752.64 $940.80 $860.16 " $1,075.20 " " $1,048.32 " $604.80 $551.04 $564.48 $537.60 " $1,008.00 " $873.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44130 44130 PR ENTEROENTEROST ANAST INT W/WO CUTAN NTRSTM SPX "6,117.00" " $5,505.30 " " $2,446.80 " " $4,893.60 " " $3,425.52 " " $4,281.90 " " $3,914.88 " " $4,893.60 " " $4,771.26 " " $2,752.65 " " $2,507.97 " " $2,569.14 " " $2,446.80 " " $4,587.75 " " $3,976.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44139 44139 PR MOBLJ SPLENIC FLXR PFRMD CONJUNCT W/PRTL COLCT 570.00 $513.00 $228.00 $456.00 $319.20 $399.00 $364.80 $456.00 $444.60 $256.50 $233.70 $239.40 $228.00 $427.50 $370.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44140 44140 PR COLECTOMY PARTIAL W/ANASTOMOSIS "5,632.00" " $5,068.80 " " $2,252.80 " " $4,505.60 " " $3,153.92 " " $3,942.40 " " $3,604.48 " " $4,505.60 " " $4,392.96 " " $2,534.40 " " $2,309.12 " " $2,365.44 " " $2,252.80 " " $4,224.00 " " $3,660.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44141 44141 PR COLECTOMY PRTL W/SKIN LEVEL CECOST/COLOSTOMY "7,127.00" " $6,414.30 " " $2,850.80 " " $5,701.60 " " $3,991.12 " " $4,988.90 " " $4,561.28 " " $5,701.60 " " $5,559.06 " " $3,207.15 " " $2,922.07 " " $2,993.34 " " $2,850.80 " " $5,345.25 " " $4,632.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44143 44143 PR COLECTOMY PRTL W/END COLOSTOMY & CLSR DSTL SGMT "6,620.00" " $5,958.00 " " $2,648.00 " " $5,296.00 " " $3,707.20 " " $4,634.00 " " $4,236.80 " " $5,296.00 " " $5,163.60 " " $2,979.00 " " $2,714.20 " " $2,780.40 " " $2,648.00 " " $4,965.00 " " $4,303.00 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44144 44144 PR COLECTOMY PRTL W/COLOST/ILEOST & MUCOFISTULA "7,352.00" " $6,616.80 " " $2,940.80 " " $5,881.60 " " $4,117.12 " " $5,146.40 " " $4,705.28 " " $5,881.60 " " $5,734.56 " " $3,308.40 " " $3,014.32 " " $3,087.84 " " $2,940.80 " " $5,514.00 " " $4,778.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44145 44145 PR COLECTOMY PRTL W/COLOPROCTOSTOMY "7,053.00" " $6,347.70 " " $2,821.20 " " $5,642.40 " " $3,949.68 " " $4,937.10 " " $4,513.92 " " $5,642.40 " " $5,501.34 " " $3,173.85 " " $2,891.73 " " $2,962.26 " " $2,821.20 " " $5,289.75 " " $4,584.45 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44150 44150 PR COLCT TOT ABDL W/O PRCTECT W/ILEOST/ILEOPXTS "8,933.00" " $8,039.70 " " $3,573.20 " " $7,146.40 " " $5,002.48 " " $6,253.10 " " $5,717.12 " " $7,146.40 " " $6,967.74 " " $4,019.85 " " $3,662.53 " " $3,751.86 " " $3,573.20 " " $6,699.75 " " $5,806.45 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44160 44160 PR COLECTOMY PRTL W/RMVL TERMINAL ILEUM & ILEOCOLOS "5,805.00" " $5,224.50 " " $2,322.00 " " $4,644.00 " " $3,250.80 " " $4,063.50 " " $3,715.20 " " $4,644.00 " " $4,527.90 " " $2,612.25 " " $2,380.05 " " $2,438.10 " " $2,322.00 " " $4,353.75 " " $3,773.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44180 44180 PR LAPAROSCOPY ENTEROLYSIS SEPARATE PROCEDURE "3,430.00" " $3,087.00 " " $1,372.00 " " $2,744.00 " " $1,920.80 " " $2,401.00 " " $2,195.20 " " $2,744.00 " " $2,675.40 " " $1,543.50 " " $1,406.30 " " $1,440.60 " " $1,372.00 " " $2,572.50 " " $2,229.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44186 44186 PR LAPAROSCOPY SURGICAL JEJUNOSTOMY "2,994.00" " $2,694.60 " " $1,197.60 " " $2,395.20 " " $1,676.64 " " $2,095.80 " " $1,916.16 " " $2,395.20 " " $2,335.32 " " $1,347.30 " " $1,227.54 " " $1,257.48 " " $1,197.60 " " $2,245.50 " " $1,946.10 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44187 44187 PR LAPAROSCOPY SURG ILEOSTOMY/JEJUNOSTOMY NON-TUBE "5,567.00" " $5,010.30 " " $2,226.80 " " $4,453.60 " " $3,117.52 " " $3,896.90 " " $3,562.88 " " $4,453.60 " " $4,342.26 " " $2,505.15 " " $2,282.47 " " $2,338.14 " " $2,226.80 " " $4,175.25 " " $3,618.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44188 44188 PR LAPAROSCOPY SURG COLOSTOMY/SKN LVL CECOSTOMY "5,271.00" " $4,743.90 " " $2,108.40 " " $4,216.80 " " $2,951.76 " " $3,689.70 " " $3,373.44 " " $4,216.80 " " $4,111.38 " " $2,371.95 " " $2,161.11 " " $2,213.82 " " $2,108.40 " " $3,953.25 " " $3,426.15 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44202 44202 PR LAPS ENTERECT RESCJ 1 SMALL INTEST RESCJ & ANA "6,011.00" " $5,409.90 " " $2,404.40 " " $4,808.80 " " $3,366.16 " " $4,207.70 " " $3,847.04 " " $4,808.80 " " $4,688.58 " " $2,704.95 " " $2,464.51 " " $2,524.62 " " $2,404.40 " " $4,508.25 " " $3,907.15 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44204 44204 PR LAPAROSCOPY COLECTOMY PARTIAL W/ANASTOMOSIS "6,533.00" " $5,879.70 " " $2,613.20 " " $5,226.40 " " $3,658.48 " " $4,573.10 " " $4,181.12 " " $5,226.40 " " $5,095.74 " " $2,939.85 " " $2,678.53 " " $2,743.86 " " $2,613.20 " " $4,899.75 " " $4,246.45 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44205 44205 PR LAPS COLECTOMY PRTL W/RMVL TERMINAL ILEUM "6,192.00" " $5,572.80 " " $2,476.80 " " $4,953.60 " " $3,467.52 " " $4,334.40 " " $3,962.88 " " $4,953.60 " " $4,829.76 " " $2,786.40 " " $2,538.72 " " $2,600.64 " " $2,476.80 " " $4,644.00 " " $4,024.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44206 44206 PR LAPS COLECTOMY PRTL W/END CLST & CLSR DSTL SGM "7,177.00" " $6,459.30 " " $2,870.80 " " $5,741.60 " " $4,019.12 " " $5,023.90 " " $4,593.28 " " $5,741.60 " " $5,598.06 " " $3,229.65 " " $2,942.57 " " $3,014.34 " " $2,870.80 " " $5,382.75 " " $4,665.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44207 44207 PR LAPS COLECTOMY PRTL W/COLOPXTSTMY LW ANAST "7,944.00" " $7,149.60 " " $3,177.60 " " $6,355.20 " " $4,448.64 " " $5,560.80 " " $5,084.16 " " $6,355.20 " " $6,196.32 " " $3,574.80 " " $3,257.04 " " $3,336.48 " " $3,177.60 " " $5,958.00 " " $5,163.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44208 44208 PR LAPS COLECTMY PRTL W/COLOPXTSTMY LW ANAST W/CLST "11,019.00" " $9,917.10 " " $4,407.60 " " $8,815.20 " " $6,170.64 " " $7,713.30 " " $7,052.16 " " $8,815.20 " " $8,594.82 " " $4,958.55 " " $4,517.79 " " $4,627.98 " " $4,407.60 " " $8,264.25 " " $7,162.35 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44210 44210 PR LAPS COLECTOMY TOT W/O PRCTECT W/ILEOST/ILEOPXTS "9,030.00" " $8,127.00 " " $3,612.00 " " $7,224.00 " " $5,056.80 " " $6,321.00 " " $5,779.20 " " $7,224.00 " " $7,043.40 " " $4,063.50 " " $3,702.30 " " $3,792.60 " " $3,612.00 " " $6,772.50 " " $5,869.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44213 44213 PR LAPS MOBLJ SPLENIC FLXR PFRMD W/PRTL COLECTOMY 918.00 $826.20 $367.20 $734.40 $514.08 $642.60 $587.52 $734.40 $716.04 $413.10 $376.38 $385.56 $367.20 $688.50 $596.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44227 44227 PR LAPS CLSR NTRSTM LG/SM INT W/RESCJ & ANASTOMOSIS "6,805.00" " $6,124.50 " " $2,722.00 " " $5,444.00 " " $3,810.80 " " $4,763.50 " " $4,355.20 " " $5,444.00 " " $5,307.90 " " $3,062.25 " " $2,790.05 " " $2,858.10 " " $2,722.00 " " $5,103.75 " " $4,423.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44238 44238 PR UNLISTED LAPAROSCOPY PX INTESTINE XCP RECTUM "2,464.00" " $2,217.60 " $985.60 " $1,971.20 " " $1,379.84 " " $1,724.80 " " $1,576.96 " " $1,971.20 " " $1,921.92 " " $1,108.80 " " $1,010.24 " " $1,034.88 " $985.60 " $1,848.00 " " $1,601.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44238.15 44238 PR LAPAROSCOPIC SUTURE LARGE INTESTINE PERFORATION WO COLOSTOMY "5,557.00" " $5,001.30 " " $2,222.80 " " $4,445.60 " " $3,111.92 " " $3,889.90 " " $3,556.48 " " $4,445.60 " " $4,334.46 " " $2,500.65 " " $2,278.37 " " $2,333.94 " " $2,222.80 " " $4,167.75 " " $3,612.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44238.26 44238 PR LAP REPAIR OF PERFORATED INTESTINAL ULCER W OMENTAL FLAP "5,557.00" " $5,001.30 " " $2,222.80 " " $4,445.60 " " $3,111.92 " " $3,889.90 " " $3,556.48 " " $4,445.60 " " $4,334.46 " " $2,500.65 " " $2,278.37 " " $2,333.94 " " $2,222.80 " " $4,167.75 " " $3,612.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44238.27 44238 PR LAP REPAIR SMALL BOWEL PERFORATION AFFILIATE ONLY "5,557.00" " $5,001.30 " " $2,222.80 " " $4,445.60 " " $3,111.92 " " $3,889.90 " " $3,556.48 " " $4,445.60 " " $4,334.46 " " $2,500.65 " " $2,278.37 " " $2,333.94 " " $2,222.80 " " $4,167.75 " " $3,612.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44238.29 44238 PR LAP EXCISION BOWEL LESION(S) SINGLE ENTEROTOMY "5,557.00" " $5,001.30 " " $2,222.80 " " $4,445.60 " " $3,111.92 " " $3,889.90 " " $3,556.48 " " $4,445.60 " " $4,334.46 " " $2,500.65 " " $2,278.37 " " $2,333.94 " " $2,222.80 " " $4,167.75 " " $3,612.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44300 44300 PR PLACEMENT ENTEROSTOMY/CECOSTOMY TUBE OPEN "3,522.00" " $3,169.80 " " $1,408.80 " " $2,817.60 " " $1,972.32 " " $2,465.40 " " $2,254.08 " " $2,817.60 " " $2,747.16 " " $1,584.90 " " $1,444.02 " " $1,479.24 " " $1,408.80 " " $2,641.50 " " $2,289.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44310 44310 PR ILEOSTOMY/JEJUNOSTOMY NON-TUBE "5,282.00" " $4,753.80 " " $2,112.80 " " $4,225.60 " " $2,957.92 " " $3,697.40 " " $3,380.48 " " $4,225.60 " " $4,119.96 " " $2,376.90 " " $2,165.62 " " $2,218.44 " " $2,112.80 " " $3,961.50 " " $3,433.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44312 44312 PR REVJ ILEOSTOMY SIMPLE RLS SUPERFICIAL SCAR SPX "2,952.00" " $2,656.80 " " $1,180.80 " " $2,361.60 " " $1,653.12 " " $2,066.40 " " $1,889.28 " " $2,361.60 " " $2,302.56 " " $1,328.40 " " $1,210.32 " " $1,239.84 " " $1,180.80 " " $2,214.00 " " $1,918.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44314 44314 PR REVJ ILEOSTOMY COMPLIC RCNSTJ IN-DEPTH SPX "4,540.00" " $4,086.00 " " $1,816.00 " " $3,632.00 " " $2,542.40 " " $3,178.00 " " $2,905.60 " " $3,632.00 " " $3,541.20 " " $2,043.00 " " $1,861.40 " " $1,906.80 " " $1,816.00 " " $3,405.00 " " $2,951.00 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44320 44320 PR COLOSTOMY/SKIN LEVEL CECOSTOMY "4,900.00" " $4,410.00 " " $1,960.00 " " $3,920.00 " " $2,744.00 " " $3,430.00 " " $3,136.00 " " $3,920.00 " " $3,822.00 " " $2,205.00 " " $2,009.00 " " $2,058.00 " " $1,960.00 " " $3,675.00 " " $3,185.00 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44372 44372 PR ENTEROSCOPY > 2ND PRTN W/PLMT PRQ TUBE "1,564.00" " $1,407.60 " $625.60 " $1,251.20 " $875.84 " $1,094.80 " " $1,000.96 " " $1,251.20 " " $1,219.92 " $703.80 $641.24 $656.88 $625.60 " $1,173.00 " " $1,016.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44373 44373 PR ENTEROSCOPY > 2ND PRTN CONV GSTRST TUBE "1,037.00" $933.30 $414.80 $829.60 $580.72 $725.90 $663.68 $829.60 $808.86 $466.65 $425.17 $435.54 $414.80 $777.75 $674.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44377 44377 PR ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE "1,552.00" " $1,396.80 " $620.80 " $1,241.60 " $869.12 " $1,086.40 " $993.28 " $1,241.60 " " $1,210.56 " $698.40 $636.32 $651.84 $620.80 " $1,164.00 " " $1,008.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44380 44380 PR ILEOSCOPY THRU STOMA DX W/COLLJ SPEC WHEN PRFMD 570.00 $513.00 $228.00 $456.00 $319.20 $399.00 $364.80 $456.00 $444.60 $256.50 $233.70 $239.40 $228.00 $427.50 $370.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44382 44382 PR ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE 706.00 $635.40 $282.40 $564.80 $395.36 $494.20 $451.84 $564.80 $550.68 $317.70 $289.46 $296.52 $282.40 $529.50 $458.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44386 44386 PR NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE "1,433.00" " $1,289.70 " $573.20 " $1,146.40 " $802.48 " $1,003.10 " $917.12 " $1,146.40 " " $1,117.74 " $644.85 $587.53 $601.86 $573.20 " $1,074.75 " $931.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44388 44388 PR COLONOSCOPY STOMA DX INCLUDING COLLJ SPEC SPX "1,115.00" " $1,003.50 " $446.00 $892.00 $624.40 $780.50 $713.60 $892.00 $869.70 $501.75 $457.15 $468.30 $446.00 $836.25 $724.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44394 44394 PR COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE "1,531.00" " $1,377.90 " $612.40 " $1,224.80 " $857.36 " $1,071.70 " $979.84 " $1,224.80 " " $1,194.18 " $688.95 $627.71 $643.02 $612.40 " $1,148.25 " $995.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44602 44602 PR ENTERORRHAPHY 1PERFORATION "6,749.00" " $6,074.10 " " $2,699.60 " " $5,399.20 " " $3,779.44 " " $4,724.30 " " $4,319.36 " " $5,399.20 " " $5,264.22 " " $3,037.05 " " $2,767.09 " " $2,834.58 " " $2,699.60 " " $5,061.75 " " $4,386.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44603 44603 PR ENTERORRHAPHY MULTIPLE PERFORATIONS "7,751.00" " $6,975.90 " " $3,100.40 " " $6,200.80 " " $4,340.56 " " $5,425.70 " " $4,960.64 " " $6,200.80 " " $6,045.78 " " $3,487.95 " " $3,177.91 " " $3,255.42 " " $3,100.40 " " $5,813.25 " " $5,038.15 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44604 44604 PR SUTR LG INTESTINE 1/MULT PERFORAT W/O COLOSTOMY "4,695.00" " $4,225.50 " " $1,878.00 " " $3,756.00 " " $2,629.20 " " $3,286.50 " " $3,004.80 " " $3,756.00 " " $3,662.10 " " $2,112.75 " " $1,924.95 " " $1,971.90 " " $1,878.00 " " $3,521.25 " " $3,051.75 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44615 44615 PR INTSTINAL STRICTUROPLASTY W/WO DILAT OBSTRCJ "4,867.00" " $4,380.30 " " $1,946.80 " " $3,893.60 " " $2,725.52 " " $3,406.90 " " $3,114.88 " " $3,893.60 " " $3,796.26 " " $2,190.15 " " $1,995.47 " " $2,044.14 " " $1,946.80 " " $3,650.25 " " $3,163.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44620 44620 PR CLOSURE ENTEROSTOMY LG/SMALL INTESTINE "4,158.00" " $3,742.20 " " $1,663.20 " " $3,326.40 " " $2,328.48 " " $2,910.60 " " $2,661.12 " " $3,326.40 " " $3,243.24 " " $1,871.10 " " $1,704.78 " " $1,746.36 " " $1,663.20 " " $3,118.50 " " $2,702.70 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44626 44626 PR CLSR NTRSTM LG/SM RESCJ & COLORECTAL ANASTOMOSIS "7,665.00" " $6,898.50 " " $3,066.00 " " $6,132.00 " " $4,292.40 " " $5,365.50 " " $4,905.60 " " $6,132.00 " " $5,978.70 " " $3,449.25 " " $3,142.65 " " $3,219.30 " " $3,066.00 " " $5,748.75 " " $4,982.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44661 44661 PR CLSR ENTEROVES FSTL W/INTESTINE&/BLADDER RESCJ "7,774.00" " $6,996.60 " " $3,109.60 " " $6,219.20 " " $4,353.44 " " $5,441.80 " " $4,975.36 " " $6,219.20 " " $6,063.72 " " $3,498.30 " " $3,187.34 " " $3,265.08 " " $3,109.60 " " $5,830.50 " " $5,053.10 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44800 44800 PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT "3,449.00" " $3,104.10 " " $1,379.60 " " $2,759.20 " " $1,931.44 " " $2,414.30 " " $2,207.36 " " $2,759.20 " " $2,690.22 " " $1,552.05 " " $1,414.09 " " $1,448.58 " " $1,379.60 " " $2,586.75 " " $2,241.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44820 44820 PR EXCISION LESION MESENTERY SEPARATE PROCEDURE "4,661.00" " $4,194.90 " " $1,864.40 " " $3,728.80 " " $2,610.16 " " $3,262.70 " " $2,983.04 " " $3,728.80 " " $3,635.58 " " $2,097.45 " " $1,911.01 " " $1,957.62 " " $1,864.40 " " $3,495.75 " " $3,029.65 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44950 44950 PR APPENDECTOMY "2,944.00" " $2,649.60 " " $1,177.60 " " $2,355.20 " " $1,648.64 " " $2,060.80 " " $1,884.16 " " $2,355.20 " " $2,296.32 " " $1,324.80 " " $1,207.04 " " $1,236.48 " " $1,177.60 " " $2,208.00 " " $1,913.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44955 44955 PR APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX 376.00 $338.40 $150.40 $300.80 $210.56 $263.20 $240.64 $300.80 $293.28 $169.20 $154.16 $157.92 $150.40 $282.00 $244.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44960 44960 PR APPENDEC RPTD APPENDIX ABSC/PRITONITIS "3,774.00" " $3,396.60 " " $1,509.60 " " $3,019.20 " " $2,113.44 " " $2,641.80 " " $2,415.36 " " $3,019.20 " " $2,943.72 " " $1,698.30 " " $1,547.34 " " $1,585.08 " " $1,509.60 " " $2,830.50 " " $2,453.10 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 44970 44970 PR LAPAROSCOPIC APPENDECTOMY "2,668.00" " $2,401.20 " " $1,067.20 " " $2,134.40 " " $1,494.08 " " $1,867.60 " " $1,707.52 " " $2,134.40 " " $2,081.04 " " $1,200.60 " " $1,093.88 " " $1,120.56 " " $1,067.20 " " $2,001.00 " " $1,734.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45100 45100 PR BX ANORECTAL WALL ANAL APPROACH "1,542.00" " $1,387.80 " $616.80 " $1,233.60 " $863.52 " $1,079.40 " $986.88 " $1,233.60 " " $1,202.76 " $693.90 $632.22 $647.64 $616.80 " $1,156.50 " " $1,002.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45111 45111 PR PRCTECT PRTL RESCJ RECTUM TABDL APPR "5,375.00" " $4,837.50 " " $2,150.00 " " $4,300.00 " " $3,010.00 " " $3,762.50 " " $3,440.00 " " $4,300.00 " " $4,192.50 " " $2,418.75 " " $2,203.75 " " $2,257.50 " " $2,150.00 " " $4,031.25 " " $3,493.75 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45130 45130 PR EXC RCT PROCIDENTIA W/ANAST PERINEAL APPROACH "4,959.00" " $4,463.10 " " $1,983.60 " " $3,967.20 " " $2,777.04 " " $3,471.30 " " $3,173.76 " " $3,967.20 " " $3,868.02 " " $2,231.55 " " $2,033.19 " " $2,082.78 " " $1,983.60 " " $3,719.25 " " $3,223.35 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45171 45171 PR EXC RCT TUM NOT INCL MUSCULARIS PROPRIA "2,596.00" " $2,336.40 " " $1,038.40 " " $2,076.80 " " $1,453.76 " " $1,817.20 " " $1,661.44 " " $2,076.80 " " $2,024.88 " " $1,168.20 " " $1,064.36 " " $1,090.32 " " $1,038.40 " " $1,947.00 " " $1,687.40 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45300 45300 PR PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX 381.00 $342.90 $152.40 $304.80 $213.36 $266.70 $243.84 $304.80 $297.18 $171.45 $156.21 $160.02 $152.40 $285.75 $247.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45308 45308 PR PROCTOSGMDSC RIGID RMVL 1 LESION CAUTERY 646.00 $581.40 $258.40 $516.80 $361.76 $452.20 $413.44 $516.80 $503.88 $290.70 $264.86 $271.32 $258.40 $484.50 $419.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45330 45330 PR SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD 504.00 $453.60 $201.60 $403.20 $282.24 $352.80 $322.56 $403.20 $393.12 $226.80 $206.64 $211.68 $201.60 $378.00 $327.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45331 45331 PR SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE 303.00 $272.70 $121.20 $242.40 $169.68 $212.10 $193.92 $242.40 $236.34 $136.35 $124.23 $127.26 $121.20 $227.25 $196.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45333 45333 PR SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS 819.00 $737.10 $327.60 $655.20 $458.64 $573.30 $524.16 $655.20 $638.82 $368.55 $335.79 $343.98 $327.60 $614.25 $532.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45334 45334 PR SIGMOIDOSCOPY FLX CONTROL BLEEDING 751.00 $675.90 $300.40 $600.80 $420.56 $525.70 $480.64 $600.80 $585.78 $337.95 $307.91 $315.42 $300.40 $563.25 $488.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45335 45335 PR SGMDSC FLX DIRED SBMCSL NJX ANY SBST 696.00 $626.40 $278.40 $556.80 $389.76 $487.20 $445.44 $556.80 $542.88 $313.20 $285.36 $292.32 $278.40 $522.00 $452.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45338 45338 PR SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ "1,183.00" " $1,064.70 " $473.20 $946.40 $662.48 $828.10 $757.12 $946.40 $922.74 $532.35 $485.03 $496.86 $473.20 $887.25 $768.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45340 45340 PR SIGMOIDOSCOPY FLX TNDSC BALO DILAT 940.00 $846.00 $376.00 $752.00 $526.40 $658.00 $601.60 $752.00 $733.20 $423.00 $385.40 $394.80 $376.00 $705.00 $611.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45350 45350 PR SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S) "1,104.00" $993.60 $441.60 $883.20 $618.24 $772.80 $706.56 $883.20 $861.12 $496.80 $452.64 $463.68 $441.60 $828.00 $717.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45378 45378 PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD "1,767.00" " $1,590.30 " $706.80 " $1,413.60 " $989.52 " $1,236.90 " " $1,130.88 " " $1,413.60 " " $1,378.26 " $795.15 $724.47 $742.14 $706.80 " $1,325.25 " " $1,148.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45379 45379 PR COLONOSCOPY FLX W/REMOVAL OF FOREIGN BODY(S) "1,780.00" " $1,602.00 " $712.00 " $1,424.00 " $996.80 " $1,246.00 " " $1,139.20 " " $1,424.00 " " $1,388.40 " $801.00 $729.80 $747.60 $712.00 " $1,335.00 " " $1,157.00 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45380 45380 PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE "1,638.00" " $1,474.20 " $655.20 " $1,310.40 " $917.28 " $1,146.60 " " $1,048.32 " " $1,310.40 " " $1,277.64 " $737.10 $671.58 $687.96 $655.20 " $1,228.50 " " $1,064.70 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45381 45381 PR COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST "2,323.00" " $2,090.70 " $929.20 " $1,858.40 " " $1,300.88 " " $1,626.10 " " $1,486.72 " " $1,858.40 " " $1,811.94 " " $1,045.35 " $952.43 $975.66 $929.20 " $1,742.25 " " $1,509.95 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45382 45382 PR COLSC FLEXIBLE W/CONTROL BLEEDING ANY METHOD "1,685.00" " $1,516.50 " $674.00 " $1,348.00 " $943.60 " $1,179.50 " " $1,078.40 " " $1,348.00 " " $1,314.30 " $758.25 $690.85 $707.70 $674.00 " $1,263.75 " " $1,095.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45384 45384 PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS "1,460.00" " $1,314.00 " $584.00 " $1,168.00 " $817.60 " $1,022.00 " $934.40 " $1,168.00 " " $1,138.80 " $657.00 $598.60 $613.20 $584.00 " $1,095.00 " $949.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45385 45385 PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ "2,484.00" " $2,235.60 " $993.60 " $1,987.20 " " $1,391.04 " " $1,738.80 " " $1,589.76 " " $1,987.20 " " $1,937.52 " " $1,117.80 " " $1,018.44 " " $1,043.28 " $993.60 " $1,863.00 " " $1,614.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45386 45386 PR COLSC FLEXIBLE W/TRANSENDOSCOPIC BALLOON DILAT "1,747.00" " $1,572.30 " $698.80 " $1,397.60 " $978.32 " $1,222.90 " " $1,118.08 " " $1,397.60 " " $1,362.66 " $786.15 $716.27 $733.74 $698.80 " $1,310.25 " " $1,135.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45390 45390 PR COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION "2,562.00" " $2,305.80 " " $1,024.80 " " $2,049.60 " " $1,434.72 " " $1,793.40 " " $1,639.68 " " $2,049.60 " " $1,998.36 " " $1,152.90 " " $1,050.42 " " $1,076.04 " " $1,024.80 " " $1,921.50 " " $1,665.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45398 45398 PR COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S) "1,877.00" " $1,689.30 " $750.80 " $1,501.60 " " $1,051.12 " " $1,313.90 " " $1,201.28 " " $1,501.60 " " $1,464.06 " $844.65 $769.57 $788.34 $750.80 " $1,407.75 " " $1,220.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45399 45399 PR UNLISTED PROCEDURE COLON "1,049.00" $944.10 $419.60 $839.20 $587.44 $734.30 $671.36 $839.20 $818.22 $472.05 $430.09 $440.58 $419.60 $786.75 $681.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45400 45400 PR LAPAROSCOPY PROCTOPEXY PROLAPSE "6,085.00" " $5,476.50 " " $2,434.00 " " $4,868.00 " " $3,407.60 " " $4,259.50 " " $3,894.40 " " $4,868.00 " " $4,746.30 " " $2,738.25 " " $2,494.85 " " $2,555.70 " " $2,434.00 " " $4,563.75 " " $3,955.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45560 45560 PR REPAIR RECTOCELE SEPARATE PROCEDURE "2,589.00" " $2,330.10 " " $1,035.60 " " $2,071.20 " " $1,449.84 " " $1,812.30 " " $1,656.96 " " $2,071.20 " " $2,019.42 " " $1,165.05 " " $1,061.49 " " $1,087.38 " " $1,035.60 " " $1,941.75 " " $1,682.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45900 45900 PR RDCTJ PROCIDENTIA UNDER ANES SEPARATE PROCEDURE 953.00 $857.70 $381.20 $762.40 $533.68 $667.10 $609.92 $762.40 $743.34 $428.85 $390.73 $400.26 $381.20 $714.75 $619.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45915 45915 PR RMVL FECAL IMPACTION/FB SPX UNDER ANES "1,042.00" $937.80 $416.80 $833.60 $583.52 $729.40 $666.88 $833.60 $812.76 $468.90 $427.22 $437.64 $416.80 $781.50 $677.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45990 45990 PR ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX 446.00 $401.40 $178.40 $356.80 $249.76 $312.20 $285.44 $356.80 $347.88 $200.70 $182.86 $187.32 $178.40 $334.50 $289.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 45999 45999 PR UNLISTED PROCEDURE RECTUM "4,048.00" " $3,643.20 " " $1,619.20 " " $3,238.40 " " $2,266.88 " " $2,833.60 " " $2,590.72 " " $3,238.40 " " $3,157.44 " " $1,821.60 " " $1,659.68 " " $1,700.16 " " $1,619.20 " " $3,036.00 " " $2,631.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46020 46020 PR PLACEMENT SETON "1,296.00" " $1,166.40 " $518.40 " $1,036.80 " $725.76 $907.20 $829.44 " $1,036.80 " " $1,010.88 " $583.20 $531.36 $544.32 $518.40 $972.00 $842.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46040 46040 PR I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX "1,787.00" " $1,608.30 " $714.80 " $1,429.60 " " $1,000.72 " " $1,250.90 " " $1,143.68 " " $1,429.60 " " $1,393.86 " $804.15 $732.67 $750.54 $714.80 " $1,340.25 " " $1,161.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46050 46050 PR I&D PERIANAL ABSCESS SUPERFICIAL 686.00 $617.40 $274.40 $548.80 $384.16 $480.20 $439.04 $548.80 $535.08 $308.70 $281.26 $288.12 $274.40 $514.50 $445.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46080 46080 PR SPHINCTEROTOMY ANAL DIVISION SPHINCTER SPX "1,002.00" $901.80 $400.80 $801.60 $561.12 $701.40 $641.28 $801.60 $781.56 $450.90 $410.82 $420.84 $400.80 $751.50 $651.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46083 46083 PR INCISION THROMBOSED HEMORRHOID EXTERNAL 777.00 $699.30 $310.80 $621.60 $435.12 $543.90 $497.28 $621.60 $606.06 $349.65 $318.57 $326.34 $310.80 $582.75 $505.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46200 46200 PR FISSURECTOMY INCL SPHINCTEROTOMY WHEN PERFORMED "1,411.00" " $1,269.90 " $564.40 " $1,128.80 " $790.16 $987.70 $903.04 " $1,128.80 " " $1,100.58 " $634.95 $578.51 $592.62 $564.40 " $1,058.25 " $917.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46220 46220 PR EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS 639.00 $575.10 $255.60 $511.20 $357.84 $447.30 $408.96 $511.20 $498.42 $287.55 $261.99 $268.38 $255.60 $479.25 $415.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46221 46221 PR HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS 861.00 $774.90 $344.40 $688.80 $482.16 $602.70 $551.04 $688.80 $671.58 $387.45 $353.01 $361.62 $344.40 $645.75 $559.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46230 46230 PR EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS 885.00 $796.50 $354.00 $708.00 $495.60 $619.50 $566.40 $708.00 $690.30 $398.25 $362.85 $371.70 $354.00 $663.75 $575.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46250 46250 PR HEMORRHOIDECTOMY XTRNL 2/> COLUMN/GROUP "1,587.00" " $1,428.30 " $634.80 " $1,269.60 " $888.72 " $1,110.90 " " $1,015.68 " " $1,269.60 " " $1,237.86 " $714.15 $650.67 $666.54 $634.80 " $1,190.25 " " $1,031.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46255 46255 PR HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP "1,886.00" " $1,697.40 " $754.40 " $1,508.80 " " $1,056.16 " " $1,320.20 " " $1,207.04 " " $1,508.80 " " $1,471.08 " $848.70 $773.26 $792.12 $754.40 " $1,414.50 " " $1,225.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46260 46260 PR HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO "1,861.00" " $1,674.90 " $744.40 " $1,488.80 " " $1,042.16 " " $1,302.70 " " $1,191.04 " " $1,488.80 " " $1,451.58 " $837.45 $763.01 $781.62 $744.40 " $1,395.75 " " $1,209.65 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46270 46270 PR SURG TX ANAL FISTULA SUBQ "1,492.00" " $1,342.80 " $596.80 " $1,193.60 " $835.52 " $1,044.40 " $954.88 " $1,193.60 " " $1,163.76 " $671.40 $611.72 $626.64 $596.80 " $1,119.00 " $969.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46275 46275 PR SURG TX ANAL FISTULA INTERSPHINCTERIC "2,137.00" " $1,923.30 " $854.80 " $1,709.60 " " $1,196.72 " " $1,495.90 " " $1,367.68 " " $1,709.60 " " $1,666.86 " $961.65 $876.17 $897.54 $854.80 " $1,602.75 " " $1,389.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46320 46320 PR EXC THROMBOSED HEMORRHOID XTRNL 645.00 $580.50 $258.00 $516.00 $361.20 $451.50 $412.80 $516.00 $503.10 $290.25 $264.45 $270.90 $258.00 $483.75 $419.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46505 46505 PR CHEMODENERVATION INTERNAL ANAL SPHINCTER "1,169.00" " $1,052.10 " $467.60 $935.20 $654.64 $818.30 $748.16 $935.20 $911.82 $526.05 $479.29 $490.98 $467.60 $876.75 $759.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46600 46600 PR ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD 380.00 $342.00 $152.00 $304.00 $212.80 $266.00 $243.20 $304.00 $296.40 $171.00 $155.80 $159.60 $152.00 $285.00 $247.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46604 46604 PR ANOSCOPY W/DILATION 984.00 $885.60 $393.60 $787.20 $551.04 $688.80 $629.76 $787.20 $767.52 $442.80 $403.44 $413.28 $393.60 $738.00 $639.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46606 46606 PR ANOSCOPY W/BX SINGLE/MULTIPLE 597.00 $537.30 $238.80 $477.60 $334.32 $417.90 $382.08 $477.60 $465.66 $268.65 $244.77 $250.74 $238.80 $447.75 $388.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46614 46614 PR ANOSCOPY CONTROL BLEEDING 589.00 $530.10 $235.60 $471.20 $329.84 $412.30 $376.96 $471.20 $459.42 $265.05 $241.49 $247.38 $235.60 $441.75 $382.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46900 46900 PR DSTRJ LESION ANUS SIMPLE CHEMICAL 795.00 $715.50 $318.00 $636.00 $445.20 $556.50 $508.80 $636.00 $620.10 $357.75 $325.95 $333.90 $318.00 $596.25 $516.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46910 46910 PR DSTRJ LESION ANUS SMPL ELTRDSICCATION 730.00 $657.00 $292.00 $584.00 $408.80 $511.00 $467.20 $584.00 $569.40 $328.50 $299.30 $306.60 $292.00 $547.50 $474.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46916 46916 PR DSTRJ LESION ANUS SIMPLE CRYOSURGERY 802.00 $721.80 $320.80 $641.60 $449.12 $561.40 $513.28 $641.60 $625.56 $360.90 $328.82 $336.84 $320.80 $601.50 $521.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46922 46922 PR DSTRJ LESION ANUS SIMPLE SURG EXCISION 913.00 $821.70 $365.20 $730.40 $511.28 $639.10 $584.32 $730.40 $712.14 $410.85 $374.33 $383.46 $365.20 $684.75 $593.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46930 46930 PR DESTRUCTION INTERNAL HEMORRHOID THERMAL ENERGY 800.00 $720.00 $320.00 $640.00 $448.00 $560.00 $512.00 $640.00 $624.00 $360.00 $328.00 $336.00 $320.00 $600.00 $520.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46945 46945 PR HRHC NTRNL LIG OTH THAN RBBR BAND 1 COL/GRP "1,098.00" $988.20 $439.20 $878.40 $614.88 $768.60 $702.72 $878.40 $856.44 $494.10 $450.18 $461.16 $439.20 $823.50 $713.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46946 46946 PR HRHC NTRNL LIG OTH THAN RBBR BAND 2/> COL/GRP "1,110.00" $999.00 $444.00 $888.00 $621.60 $777.00 $710.40 $888.00 $865.80 $499.50 $455.10 $466.20 $444.00 $832.50 $721.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 46999 46999 PR UNLISTED PROCEDURE ANUS 506.00 $455.40 $202.40 $404.80 $283.36 $354.20 $323.84 $404.80 $394.68 $227.70 $207.46 $212.52 $202.40 $379.50 $328.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 47100 47100 PR BIOPSY LIVER WEDGE "3,814.00" " $3,432.60 " " $1,525.60 " " $3,051.20 " " $2,135.84 " " $2,669.80 " " $2,440.96 " " $3,051.20 " " $2,974.92 " " $1,716.30 " " $1,563.74 " " $1,601.88 " " $1,525.60 " " $2,860.50 " " $2,479.10 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 47120 47120 PR HEPATECTOMY RESCJ PARTIAL LOBECTOMY "11,745.00" " $10,570.50 " " $4,698.00 " " $9,396.00 " " $6,577.20 " " $8,221.50 " " $7,516.80 " " $9,396.00 " " $9,161.10 " " $5,285.25 " " $4,815.45 " " $4,932.90 " " $4,698.00 " " $8,808.75 " " $7,634.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 47379 47379 PR UNLIS LAPAROSCOPIC PROCEDURE LIVER "2,663.00" " $2,396.70 " " $1,065.20 " " $2,130.40 " " $1,491.28 " " $1,864.10 " " $1,704.32 " " $2,130.40 " " $2,077.14 " " $1,198.35 " " $1,091.83 " " $1,118.46 " " $1,065.20 " " $1,997.25 " " $1,730.95 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 47562 47562 PR LAPAROSCOPY SURG CHOLECYSTECTOMY "3,008.00" " $2,707.20 " " $1,203.20 " " $2,406.40 " " $1,684.48 " " $2,105.60 " " $1,925.12 " " $2,406.40 " " $2,346.24 " " $1,353.60 " " $1,233.28 " " $1,263.36 " " $1,203.20 " " $2,256.00 " " $1,955.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 47563 47563 PR LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY "3,144.00" " $2,829.60 " " $1,257.60 " " $2,515.20 " " $1,760.64 " " $2,200.80 " " $2,012.16 " " $2,515.20 " " $2,452.32 " " $1,414.80 " " $1,289.04 " " $1,320.48 " " $1,257.60 " " $2,358.00 " " $2,043.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 47564 47564 PR LAPS SURG CHOLECSTC W/EXPL COMMON DUCT "4,496.00" " $4,046.40 " " $1,798.40 " " $3,596.80 " " $2,517.76 " " $3,147.20 " " $2,877.44 " " $3,596.80 " " $3,506.88 " " $2,023.20 " " $1,843.36 " " $1,888.32 " " $1,798.40 " " $3,372.00 " " $2,922.40 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 47579 47579 PR UNLISTED LAPAROSCOPY PROCEDURE BILIARY TRACT "2,208.00" " $1,987.20 " $883.20 " $1,766.40 " " $1,236.48 " " $1,545.60 " " $1,413.12 " " $1,766.40 " " $1,722.24 " $993.60 $905.28 $927.36 $883.20 " $1,656.00 " " $1,435.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 47600 47600 PR CHOLECYSTECTOMY "4,482.00" " $4,033.80 " " $1,792.80 " " $3,585.60 " " $2,509.92 " " $3,137.40 " " $2,868.48 " " $3,585.60 " " $3,495.96 " " $2,016.90 " " $1,837.62 " " $1,882.44 " " $1,792.80 " " $3,361.50 " " $2,913.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 47610 47610 PR CHOLECYSTECTOMY W/EXPLORATION COMMON DUCT "4,991.00" " $4,491.90 " " $1,996.40 " " $3,992.80 " " $2,794.96 " " $3,493.70 " " $3,194.24 " " $3,992.80 " " $3,892.98 " " $2,245.95 " " $2,046.31 " " $2,096.22 " " $1,996.40 " " $3,743.25 " " $3,244.15 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 48540 48540 PR INT ANAST PANCREATIC CYST GI TRACT ROUX-EN-Y "5,190.00" " $4,671.00 " " $2,076.00 " " $4,152.00 " " $2,906.40 " " $3,633.00 " " $3,321.60 " " $4,152.00 " " $4,048.20 " " $2,335.50 " " $2,127.90 " " $2,179.80 " " $2,076.00 " " $3,892.50 " " $3,373.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49000 49000 PR EXPLORATORY LAPAROTOMY CELIOTOMY W/WO BIOPSY SPX "3,609.00" " $3,248.10 " " $1,443.60 " " $2,887.20 " " $2,021.04 " " $2,526.30 " " $2,309.76 " " $2,887.20 " " $2,815.02 " " $1,624.05 " " $1,479.69 " " $1,515.78 " " $1,443.60 " " $2,706.75 " " $2,345.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49010 49010 PR EXPL RETROPERITONEUM W/WO BX SPX "3,661.00" " $3,294.90 " " $1,464.40 " " $2,928.80 " " $2,050.16 " " $2,562.70 " " $2,343.04 " " $2,928.80 " " $2,855.58 " " $1,647.45 " " $1,501.01 " " $1,537.62 " " $1,464.40 " " $2,745.75 " " $2,379.65 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49020 49020 PR DRAINAGE PERITON ABSCESS/LOCAL PERITONITIS OPEN "5,954.00" " $5,358.60 " " $2,381.60 " " $4,763.20 " " $3,334.24 " " $4,167.80 " " $3,810.56 " " $4,763.20 " " $4,644.12 " " $2,679.30 " " $2,441.14 " " $2,500.68 " " $2,381.60 " " $4,465.50 " " $3,870.10 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49083 49083 PR ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE 959.00 $863.10 $383.60 $767.20 $537.04 $671.30 $613.76 $767.20 $748.02 $431.55 $393.19 $402.78 $383.60 $719.25 $623.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49203 49203 PR EXCISION/DESTRUCTION OPEN ABDOMINAL TUMOR 5 CM/< "5,346.00" " $4,811.40 " " $2,138.40 " " $4,276.80 " " $2,993.76 " " $3,742.20 " " $3,421.44 " " $4,276.80 " " $4,169.88 " " $2,405.70 " " $2,191.86 " " $2,245.32 " " $2,138.40 " " $4,009.50 " " $3,474.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49205 49205 PR EXC/DESTRUCTION OPEN ABDOMINAL TUMORS >10.0 CM "7,887.00" " $7,098.30 " " $3,154.80 " " $6,309.60 " " $4,416.72 " " $5,520.90 " " $5,047.68 " " $6,309.60 " " $6,151.86 " " $3,549.15 " " $3,233.67 " " $3,312.54 " " $3,154.80 " " $5,915.25 " " $5,126.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49250 49250 PR UMBILECTOMY OMPHALECTOMY EXC UMBILICUS SPX "2,246.00" " $2,021.40 " $898.40 " $1,796.80 " " $1,257.76 " " $1,572.20 " " $1,437.44 " " $1,796.80 " " $1,751.88 " " $1,010.70 " $920.86 $943.32 $898.40 " $1,684.50 " " $1,459.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49255 49255 PR OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX "3,220.00" " $2,898.00 " " $1,288.00 " " $2,576.00 " " $1,803.20 " " $2,254.00 " " $2,060.80 " " $2,576.00 " " $2,511.60 " " $1,449.00 " " $1,320.20 " " $1,352.40 " " $1,288.00 " " $2,415.00 " " $2,093.00 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49320 49320 PR LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX "1,932.00" " $1,738.80 " $772.80 " $1,545.60 " " $1,081.92 " " $1,352.40 " " $1,236.48 " " $1,545.60 " " $1,506.96 " $869.40 $792.12 $811.44 $772.80 " $1,449.00 " " $1,255.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49321 49321 PR LAPAROSCOPY SURG W/BX SINGLE/MULTIPLE "1,898.00" " $1,708.20 " $759.20 " $1,518.40 " " $1,062.88 " " $1,328.60 " " $1,214.72 " " $1,518.40 " " $1,480.44 " $854.10 $778.18 $797.16 $759.20 " $1,423.50 " " $1,233.70 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49322 49322 PR LAPS SURG W/ASPIR CAVITY/CYST SINGLE/MULTIPLE "1,944.00" " $1,749.60 " $777.60 " $1,555.20 " " $1,088.64 " " $1,360.80 " " $1,244.16 " " $1,555.20 " " $1,516.32 " $874.80 $797.04 $816.48 $777.60 " $1,458.00 " " $1,263.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49329 49329 PR UNLISTED LAPAROSCOPIC PX ABD PERTONEUM & OMENTUM "2,731.00" " $2,457.90 " " $1,092.40 " " $2,184.80 " " $1,529.36 " " $1,911.70 " " $1,747.84 " " $2,184.80 " " $2,130.18 " " $1,228.95 " " $1,119.71 " " $1,147.02 " " $1,092.40 " " $2,048.25 " " $1,775.15 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49402 49402 PR REMOVAL PERITONEAL FOREIGN BODY FROM CAVITY "3,397.00" " $3,057.30 " " $1,358.80 " " $2,717.60 " " $1,902.32 " " $2,377.90 " " $2,174.08 " " $2,717.60 " " $2,649.66 " " $1,528.65 " " $1,392.77 " " $1,426.74 " " $1,358.80 " " $2,547.75 " " $2,208.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49407 49407 PR IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL "2,148.00" " $1,933.20 " $859.20 " $1,718.40 " " $1,202.88 " " $1,503.60 " " $1,374.72 " " $1,718.40 " " $1,675.44 " $966.60 $880.68 $902.16 $859.20 " $1,611.00 " " $1,396.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49418 49418 PR INSJ INTRAPERITONEAL CATHETER W/IMG GUID "2,717.00" " $2,445.30 " " $1,086.80 " " $2,173.60 " " $1,521.52 " " $1,901.90 " " $1,738.88 " " $2,173.60 " " $2,119.26 " " $1,222.65 " " $1,113.97 " " $1,141.14 " " $1,086.80 " " $2,037.75 " " $1,766.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49440 49440 PR INSERT GASTROSTOMY TUBE PERCUTANEOUS "1,929.00" " $1,736.10 " $771.60 " $1,543.20 " " $1,080.24 " " $1,350.30 " " $1,234.56 " " $1,543.20 " " $1,504.62 " $868.05 $790.89 $810.18 $771.60 " $1,446.75 " " $1,253.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49460 49460 PR OBSTRUCTIVE MATERIAL REMOVAL FROM GI TUBE "1,310.00" " $1,179.00 " $524.00 " $1,048.00 " $733.60 $917.00 $838.40 " $1,048.00 " " $1,021.80 " $589.50 $537.10 $550.20 $524.00 $982.50 $851.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49505 49505 PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE "2,513.00" " $2,261.70 " " $1,005.20 " " $2,010.40 " " $1,407.28 " " $1,759.10 " " $1,608.32 " " $2,010.40 " " $1,960.14 " " $1,130.85 " " $1,030.33 " " $1,055.46 " " $1,005.20 " " $1,884.75 " " $1,633.45 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49507 49507 PR RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED "2,552.00" " $2,296.80 " " $1,020.80 " " $2,041.60 " " $1,429.12 " " $1,786.40 " " $1,633.28 " " $2,041.60 " " $1,990.56 " " $1,148.40 " " $1,046.32 " " $1,071.84 " " $1,020.80 " " $1,914.00 " " $1,658.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49520 49520 PR RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE "2,557.00" " $2,301.30 " " $1,022.80 " " $2,045.60 " " $1,431.92 " " $1,789.90 " " $1,636.48 " " $2,045.60 " " $1,994.46 " " $1,150.65 " " $1,048.37 " " $1,073.94 " " $1,022.80 " " $1,917.75 " " $1,662.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49521 49521 PR RPR RECRT INGUN HERNIA ANY AGE INCARCERATED "3,440.00" " $3,096.00 " " $1,376.00 " " $2,752.00 " " $1,926.40 " " $2,408.00 " " $2,201.60 " " $2,752.00 " " $2,683.20 " " $1,548.00 " " $1,410.40 " " $1,444.80 " " $1,376.00 " " $2,580.00 " " $2,236.00 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49525 49525 PR RPR INGUN HERNIA SLIDING ANY AGE "2,964.00" " $2,667.60 " " $1,185.60 " " $2,371.20 " " $1,659.84 " " $2,074.80 " " $1,896.96 " " $2,371.20 " " $2,311.92 " " $1,333.80 " " $1,215.24 " " $1,244.88 " " $1,185.60 " " $2,223.00 " " $1,926.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49540 49540 PR REPAIR LUMBAR HERNIA "2,716.00" " $2,444.40 " " $1,086.40 " " $2,172.80 " " $1,520.96 " " $1,901.20 " " $1,738.24 " " $2,172.80 " " $2,118.48 " " $1,222.20 " " $1,113.56 " " $1,140.72 " " $1,086.40 " " $2,037.00 " " $1,765.40 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49550 49550 PR RPR 1ST FEM HRNA ANY AGE REDUCIBLE "2,601.00" " $2,340.90 " " $1,040.40 " " $2,080.80 " " $1,456.56 " " $1,820.70 " " $1,664.64 " " $2,080.80 " " $2,028.78 " " $1,170.45 " " $1,066.41 " " $1,092.42 " " $1,040.40 " " $1,950.75 " " $1,690.65 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49553 49553 PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED "2,906.00" " $2,615.40 " " $1,162.40 " " $2,324.80 " " $1,627.36 " " $2,034.20 " " $1,859.84 " " $2,324.80 " " $2,266.68 " " $1,307.70 " " $1,191.46 " " $1,220.52 " " $1,162.40 " " $2,179.50 " " $1,888.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49560 49560 (IA) PR REPAIR FIRST ABDOMINAL WALL HERNIA "3,175.00" " $2,857.50 " " $1,270.00 " " $2,540.00 " " $1,778.00 " " $2,222.50 " " $2,032.00 " " $2,540.00 " " $2,476.50 " " $1,428.75 " " $1,301.75 " " $1,333.50 " " $1,270.00 " " $2,381.25 " " $2,063.75 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49561 49561 (IA) PR RPR 1ST INCAL/VNT HERNIA INCARCERATED "3,955.00" " $3,559.50 " " $1,582.00 " " $3,164.00 " " $2,214.80 " " $2,768.50 " " $2,531.20 " " $3,164.00 " " $3,084.90 " " $1,779.75 " " $1,621.55 " " $1,661.10 " " $1,582.00 " " $2,966.25 " " $2,570.75 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49565 49565 (IA) PR RPR RECRT INCAL/VNT HERNIA REDUCIBLE "3,560.00" " $3,204.00 " " $1,424.00 " " $2,848.00 " " $1,993.60 " " $2,492.00 " " $2,278.40 " " $2,848.00 " " $2,776.80 " " $1,602.00 " " $1,459.60 " " $1,495.20 " " $1,424.00 " " $2,670.00 " " $2,314.00 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49566 49566 (IA) PR RPR RECRT INCAL/VNT HERNIA INCARCERATED "4,064.00" " $3,657.60 " " $1,625.60 " " $3,251.20 " " $2,275.84 " " $2,844.80 " " $2,600.96 " " $3,251.20 " " $3,169.92 " " $1,828.80 " " $1,666.24 " " $1,706.88 " " $1,625.60 " " $3,048.00 " " $2,641.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49568 49568 (IA) PR IMPLANT MESH OPN HERNIA RPR/DEBRIDEMENT CLOSURE "1,269.00" " $1,142.10 " $507.60 " $1,015.20 " $710.64 $888.30 $812.16 " $1,015.20 " $989.82 $571.05 $520.29 $532.98 $507.60 $951.75 $824.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49570 49570 (IA) PR RPR EPIGASTRIC HERNIA REDUCIBLE SPX "2,219.00" " $1,997.10 " $887.60 " $1,775.20 " " $1,242.64 " " $1,553.30 " " $1,420.16 " " $1,775.20 " " $1,730.82 " $998.55 $909.79 $931.98 $887.60 " $1,664.25 " " $1,442.35 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49572 49572 (IA) PR RPR EPIGASTRIC HERNIA INCARCERATED "2,153.00" " $1,937.70 " $861.20 " $1,722.40 " " $1,205.68 " " $1,507.10 " " $1,377.92 " " $1,722.40 " " $1,679.34 " $968.85 $882.73 $904.26 $861.20 " $1,614.75 " " $1,399.45 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49585 49585 (IA) PR RPR UMBILICAL HRNA 5 YRS/> REDUCIBLE "2,532.00" " $2,278.80 " " $1,012.80 " " $2,025.60 " " $1,417.92 " " $1,772.40 " " $1,620.48 " " $2,025.60 " " $1,974.96 " " $1,139.40 " " $1,038.12 " " $1,063.44 " " $1,012.80 " " $1,899.00 " " $1,645.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49587 49587 (IA) PR RPR UMBILICAL HERNIA AGE 5 YRS/> INCARCERATED "2,292.00" " $2,062.80 " $916.80 " $1,833.60 " " $1,283.52 " " $1,604.40 " " $1,466.88 " " $1,833.60 " " $1,787.76 " " $1,031.40 " $939.72 $962.64 $916.80 " $1,719.00 " " $1,489.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49591 49591 PR RPR AA HERNIA 1ST < 3 CM REDUCIBLE "2,215.00" " $1,993.50 " $886.00 " $1,772.00 " " $1,240.40 " " $1,550.50 " " $1,417.60 " " $1,772.00 " " $1,727.70 " $996.75 $908.15 $930.30 $886.00 " $1,661.25 " " $1,439.75 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49592 49592 PR RPR AA HERNIA 1ST < 3 CM NCRC8/STRANGULATED "2,728.00" " $2,455.20 " " $1,091.20 " " $2,182.40 " " $1,527.68 " " $1,909.60 " " $1,745.92 " " $2,182.40 " " $2,127.84 " " $1,227.60 " " $1,118.48 " " $1,145.76 " " $1,091.20 " " $2,046.00 " " $1,773.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49593 49593 PR RPR AA HERNIA 1ST 3-10 CM REDUCIBLE "3,591.00" " $3,231.90 " " $1,436.40 " " $2,872.80 " " $2,010.96 " " $2,513.70 " " $2,298.24 " " $2,872.80 " " $2,800.98 " " $1,615.95 " " $1,472.31 " " $1,508.22 " " $1,436.40 " " $2,693.25 " " $2,334.15 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49594 49594 PR RPR AA HERNIA 1ST 3-10 CM NCRC8/STRANGULATED "3,445.00" " $3,100.50 " " $1,378.00 " " $2,756.00 " " $1,929.20 " " $2,411.50 " " $2,204.80 " " $2,756.00 " " $2,687.10 " " $1,550.25 " " $1,412.45 " " $1,446.90 " " $1,378.00 " " $2,583.75 " " $2,239.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49610 49610 PR RPR OMPHALOCELE GROSS TYP OPRATION 1ST STG "3,337.00" " $3,003.30 " " $1,334.80 " " $2,669.60 " " $1,868.72 " " $2,335.90 " " $2,135.68 " " $2,669.60 " " $2,602.86 " " $1,501.65 " " $1,368.17 " " $1,401.54 " " $1,334.80 " " $2,502.75 " " $2,169.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49613 49613 PR RPR AA HERNIA RECR < 3 CM REDUCIBLE "1,883.00" " $1,694.70 " $753.20 " $1,506.40 " " $1,054.48 " " $1,318.10 " " $1,205.12 " " $1,506.40 " " $1,468.74 " $847.35 $772.03 $790.86 $753.20 " $1,412.25 " " $1,223.95 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49614 49614 PR RPR AA HERNIA RECR < 3 CM NCRC8/STRANGULATED "2,912.00" " $2,620.80 " " $1,164.80 " " $2,329.60 " " $1,630.72 " " $2,038.40 " " $1,863.68 " " $2,329.60 " " $2,271.36 " " $1,310.40 " " $1,193.92 " " $1,223.04 " " $1,164.80 " " $2,184.00 " " $1,892.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49615 49615 PR RPR AA HERNIA RECR 3-10 CM REDUCIBLE "3,830.00" " $3,447.00 " " $1,532.00 " " $3,064.00 " " $2,144.80 " " $2,681.00 " " $2,451.20 " " $3,064.00 " " $2,987.40 " " $1,723.50 " " $1,570.30 " " $1,608.60 " " $1,532.00 " " $2,872.50 " " $2,489.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49616 49616 PR RPR AA HERNIA RECR 3-10 CM NCRC8/STRANGULATED "4,859.00" " $4,373.10 " " $1,943.60 " " $3,887.20 " " $2,721.04 " " $3,401.30 " " $3,109.76 " " $3,887.20 " " $3,790.02 " " $2,186.55 " " $1,992.19 " " $2,040.78 " " $1,943.60 " " $3,644.25 " " $3,158.35 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49623 49623 PR RMVL NONINFCT MESH/PROSTH AA/PARASTOMAL HRNA RPR "1,787.00" " $1,608.30 " $714.80 " $1,429.60 " " $1,000.72 " " $1,250.90 " " $1,143.68 " " $1,429.60 " " $1,393.86 " $804.15 $732.67 $750.54 $714.80 " $1,340.25 " " $1,161.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49650 49650 PR LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA "1,708.00" " $1,537.20 " $683.20 " $1,366.40 " $956.48 " $1,195.60 " " $1,093.12 " " $1,366.40 " " $1,332.24 " $768.60 $700.28 $717.36 $683.20 " $1,281.00 " " $1,110.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49651 49651 PR LAPS SURG RPR RECURRENT INGUINAL HERNIA "2,404.00" " $2,163.60 " $961.60 " $1,923.20 " " $1,346.24 " " $1,682.80 " " $1,538.56 " " $1,923.20 " " $1,875.12 " " $1,081.80 " $985.64 " $1,009.68 " $961.60 " $1,803.00 " " $1,562.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49652 49652 (IA) PR LAPS REPAIR HERNIA EXCEPT INCAL/INGUN REDUCIBLE "3,528.00" " $3,175.20 " " $1,411.20 " " $2,822.40 " " $1,975.68 " " $2,469.60 " " $2,257.92 " " $2,822.40 " " $2,751.84 " " $1,587.60 " " $1,446.48 " " $1,481.76 " " $1,411.20 " " $2,646.00 " " $2,293.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49653 49653 (IA) PR LAP RPR HRNA XCPT INCAL/INGUN NCRC8/STRANGULATED "4,299.00" " $3,869.10 " " $1,719.60 " " $3,439.20 " " $2,407.44 " " $3,009.30 " " $2,751.36 " " $3,439.20 " " $3,353.22 " " $1,934.55 " " $1,762.59 " " $1,805.58 " " $1,719.60 " " $3,224.25 " " $2,794.35 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49654 49654 (IA) PR LAPAROSCOPY REPAIR INCISIONAL HERNIA REDUCIBLE "3,925.00" " $3,532.50 " " $1,570.00 " " $3,140.00 " " $2,198.00 " " $2,747.50 " " $2,512.00 " " $3,140.00 " " $3,061.50 " " $1,766.25 " " $1,609.25 " " $1,648.50 " " $1,570.00 " " $2,943.75 " " $2,551.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49655 49655 (IA) PR LAPS RPR INCISIONAL HERNIA NCRC8/STRANGULATED "4,906.00" " $4,415.40 " " $1,962.40 " " $3,924.80 " " $2,747.36 " " $3,434.20 " " $3,139.84 " " $3,924.80 " " $3,826.68 " " $2,207.70 " " $2,011.46 " " $2,060.52 " " $1,962.40 " " $3,679.50 " " $3,188.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49656 49656 (IA) PR LAPS RPR RECURRENT INCISIONAL HERNIA REDUCIBLE "4,028.00" " $3,625.20 " " $1,611.20 " " $3,222.40 " " $2,255.68 " " $2,819.60 " " $2,577.92 " " $3,222.40 " " $3,141.84 " " $1,812.60 " " $1,651.48 " " $1,691.76 " " $1,611.20 " " $3,021.00 " " $2,618.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49657 49657 (IA) PR LAPS RPR RECURRENT INCAL HRNA NCRC8/STRANGULATED "5,340.00" " $4,806.00 " " $2,136.00 " " $4,272.00 " " $2,990.40 " " $3,738.00 " " $3,417.60 " " $4,272.00 " " $4,165.20 " " $2,403.00 " " $2,189.40 " " $2,242.80 " " $2,136.00 " " $4,005.00 " " $3,471.00 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49659 49659 PR UNLIS LAPS PX HRNAP HERNIORRHAPHY HERNIOTOMY "2,112.00" " $1,900.80 " $844.80 " $1,689.60 " " $1,182.72 " " $1,478.40 " " $1,351.68 " " $1,689.60 " " $1,647.36 " $950.40 $865.92 $887.04 $844.80 " $1,584.00 " " $1,372.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49905 49905 PR OMENTAL FLAP INTRA-ABDOMINAL "2,153.00" " $1,937.70 " $861.20 " $1,722.40 " " $1,205.68 " " $1,507.10 " " $1,377.92 " " $1,722.40 " " $1,679.34 " $968.85 $882.73 $904.26 $861.20 " $1,614.75 " " $1,399.45 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49999.1 49999 PR REMOVAL OF IMPLANTED MESH 475.00 $427.50 $190.00 $380.00 $266.00 $332.50 $304.00 $380.00 $370.50 $213.75 $194.75 $199.50 $190.00 $356.25 $308.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 49999.12 49999 PR REMOVAL OF FOREIGN BODY ABDOMEN BY INCISION "1,352.00" " $1,216.80 " $540.80 " $1,081.60 " $757.12 $946.40 $865.28 " $1,081.60 " " $1,054.56 " $608.40 $554.32 $567.84 $540.80 " $1,014.00 " $878.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 51102 51102 PR ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER "1,050.00" $945.00 $420.00 $840.00 $588.00 $735.00 $672.00 $840.00 $819.00 $472.50 $430.50 $441.00 $420.00 $787.50 $682.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 51550 51550 PR CYSTECTOMY PARTIAL SIMPLE "4,846.00" " $4,361.40 " " $1,938.40 " " $3,876.80 " " $2,713.76 " " $3,392.20 " " $3,101.44 " " $3,876.80 " " $3,779.88 " " $2,180.70 " " $1,986.86 " " $2,035.32 " " $1,938.40 " " $3,634.50 " " $3,149.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 51700 51700 PR BLDR IRRIGATION SMPL LAVAGE &/INSTLJ 469.00 $422.10 $187.60 $375.20 $262.64 $328.30 $300.16 $375.20 $365.82 $211.05 $192.29 $196.98 $187.60 $351.75 $304.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 51701 51701 PR INSJ NON-NDWELLG BLADDER CATHETER 304.00 $273.60 $121.60 $243.20 $170.24 $212.80 $194.56 $243.20 $237.12 $136.80 $124.64 $127.68 $121.60 $228.00 $197.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 51702 51702 PR INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE 364.00 $327.60 $145.60 $291.20 $203.84 $254.80 $232.96 $291.20 $283.92 $163.80 $149.24 $152.88 $145.60 $273.00 $236.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 51705 51705 PR CHANGE CYSTOSTOMY TUBE SIMPLE 491.00 $441.90 $196.40 $392.80 $274.96 $343.70 $314.24 $392.80 $382.98 $220.95 $201.31 $206.22 $196.40 $368.25 $319.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 51798 51798 PR MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP 97.00 $87.30 $38.80 $77.60 $54.32 $67.90 $62.08 $77.60 $75.66 $43.65 $39.77 $40.74 $38.80 $72.75 $63.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 51990 51990 PR LAPAROSCOPY URETHRAL SUSPENSION STRESS INCONT "3,624.00" " $3,261.60 " " $1,449.60 " " $2,899.20 " " $2,029.44 " " $2,536.80 " " $2,319.36 " " $2,899.20 " " $2,826.72 " " $1,630.80 " " $1,485.84 " " $1,522.08 " " $1,449.60 " " $2,718.00 " " $2,355.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 52000 52000 PR CYSTOURETHROSCOPY 959.00 $863.10 $383.60 $767.20 $537.04 $671.30 $613.76 $767.20 $748.02 $431.55 $393.19 $402.78 $383.60 $719.25 $623.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 52005 52005 PR CYSTO BLADDER W/URETERAL CATHETERIZATION "1,229.00" " $1,106.10 " $491.60 $983.20 $688.24 $860.30 $786.56 $983.20 $958.62 $553.05 $503.89 $516.18 $491.60 $921.75 $798.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 52204 52204 PR CYSTOURETHROSCOPY WITH BIOPSY "1,593.00" " $1,433.70 " $637.20 " $1,274.40 " $892.08 " $1,115.10 " " $1,019.52 " " $1,274.40 " " $1,242.54 " $716.85 $653.13 $669.06 $637.20 " $1,194.75 " " $1,035.45 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 52214 52214 PR CYSTO W/DESTRUCTION OF LESIONS "3,051.00" " $2,745.90 " " $1,220.40 " " $2,440.80 " " $1,708.56 " " $2,135.70 " " $1,952.64 " " $2,440.80 " " $2,379.78 " " $1,372.95 " " $1,250.91 " " $1,281.42 " " $1,220.40 " " $2,288.25 " " $1,983.15 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 52224 52224 PR CYSTO W/REMOVAL OF LESIONS SMALL "3,617.00" " $3,255.30 " " $1,446.80 " " $2,893.60 " " $2,025.52 " " $2,531.90 " " $2,314.88 " " $2,893.60 " " $2,821.26 " " $1,627.65 " " $1,482.97 " " $1,519.14 " " $1,446.80 " " $2,712.75 " " $2,351.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 52234 52234 PR CYSTO W/REMOVAL OF TUMORS SMALL "1,591.00" " $1,431.90 " $636.40 " $1,272.80 " $890.96 " $1,113.70 " " $1,018.24 " " $1,272.80 " " $1,240.98 " $715.95 $652.31 $668.22 $636.40 " $1,193.25 " " $1,034.15 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 52235 52235 PR CYSTOURETHROSCOPY W/DEST &/RMVL MED BLADDER TUM "2,122.00" " $1,909.80 " $848.80 " $1,697.60 " " $1,188.32 " " $1,485.40 " " $1,358.08 " " $1,697.60 " " $1,655.16 " $954.90 $870.02 $891.24 $848.80 " $1,591.50 " " $1,379.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 52240 52240 PR CYSTOURETHROSCOPY W/DEST &/RMVL TUMOR LARGE "3,139.00" " $2,825.10 " " $1,255.60 " " $2,511.20 " " $1,757.84 " " $2,197.30 " " $2,008.96 " " $2,511.20 " " $2,448.42 " " $1,412.55 " " $1,286.99 " " $1,318.38 " " $1,255.60 " " $2,354.25 " " $2,040.35 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 52281 52281 PR CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS "1,229.00" " $1,106.10 " $491.60 $983.20 $688.24 $860.30 $786.56 $983.20 $958.62 $553.05 $503.89 $516.18 $491.60 $921.75 $798.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 52287 52287 PR CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER "1,021.00" $918.90 $408.40 $816.80 $571.76 $714.70 $653.44 $816.80 $796.38 $459.45 $418.61 $428.82 $408.40 $765.75 $663.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 52310 52310 PR CYSTO W/SIMPLE REMOVAL STONE & STENT "1,093.00" $983.70 $437.20 $874.40 $612.08 $765.10 $699.52 $874.40 $852.54 $491.85 $448.13 $459.06 $437.20 $819.75 $710.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 52318 52318 PR LITHOLAPAXY COMP/LG > 2.5 CM "2,818.00" " $2,536.20 " " $1,127.20 " " $2,254.40 " " $1,578.08 " " $1,972.60 " " $1,803.52 " " $2,254.40 " " $2,198.04 " " $1,268.10 " " $1,155.38 " " $1,183.56 " " $1,127.20 " " $2,113.50 " " $1,831.70 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 52332 52332 PR CYSTO W/INSERT URETERAL STENT "1,880.00" " $1,692.00 " $752.00 " $1,504.00 " " $1,052.80 " " $1,316.00 " " $1,203.20 " " $1,504.00 " " $1,466.40 " $846.00 $770.80 $789.60 $752.00 " $1,410.00 " " $1,222.00 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 52351 52351 PR CYSTO W/URTROSCOPY&/PYELOSCOPY DX "1,797.00" " $1,617.30 " $718.80 " $1,437.60 " " $1,006.32 " " $1,257.90 " " $1,150.08 " " $1,437.60 " " $1,401.66 " $808.65 $736.77 $754.74 $718.80 " $1,347.75 " " $1,168.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 52352 52352 PR CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES "3,682.00" " $3,313.80 " " $1,472.80 " " $2,945.60 " " $2,061.92 " " $2,577.40 " " $2,356.48 " " $2,945.60 " " $2,871.96 " " $1,656.90 " " $1,509.62 " " $1,546.44 " " $1,472.80 " " $2,761.50 " " $2,393.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 52354 52354 PR CYSTO/PYELOSCOPY BX&/FULGURATION PELIVC LESION "2,561.00" " $2,304.90 " " $1,024.40 " " $2,048.80 " " $1,434.16 " " $1,792.70 " " $1,639.04 " " $2,048.80 " " $1,997.58 " " $1,152.45 " " $1,050.01 " " $1,075.62 " " $1,024.40 " " $1,920.75 " " $1,664.65 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 52356 52356 PR CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT "4,854.00" " $4,368.60 " " $1,941.60 " " $3,883.20 " " $2,718.24 " " $3,397.80 " " $3,106.56 " " $3,883.20 " " $3,786.12 " " $2,184.30 " " $1,990.14 " " $2,038.68 " " $1,941.60 " " $3,640.50 " " $3,155.10 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 52648 52648 PR LASER VAPORIZATION OF PROSTATE FOR URINE FLOW "6,198.00" " $5,578.20 " " $2,479.20 " " $4,958.40 " " $3,470.88 " " $4,338.60 " " $3,966.72 " " $4,958.40 " " $4,834.44 " " $2,789.10 " " $2,541.18 " " $2,603.16 " " $2,479.20 " " $4,648.50 " " $4,028.70 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 53899 53899 PR UNLISTED PROCEDURE URINARY SYSTEM "1,470.00" " $1,323.00 " $588.00 " $1,176.00 " $823.20 " $1,029.00 " $940.80 " $1,176.00 " " $1,146.60 " $661.50 $602.70 $617.40 $588.00 " $1,102.50 " $955.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 54050 54050 PR DSTRJ LESION PENIS SIMPLE CHEMICAL 480.00 $432.00 $192.00 $384.00 $268.80 $336.00 $307.20 $384.00 $374.40 $216.00 $196.80 $201.60 $192.00 $360.00 $312.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 54056 54056 PR DSTRJ LESION PENIS SIMPLE CRYOSURGERY 481.00 $432.90 $192.40 $384.80 $269.36 $336.70 $307.84 $384.80 $375.18 $216.45 $197.21 $202.02 $192.40 $360.75 $312.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 54065 54065 PR DSTRJ LESION PENIS EXTENSIVE 843.00 $758.70 $337.20 $674.40 $472.08 $590.10 $539.52 $674.40 $657.54 $379.35 $345.63 $354.06 $337.20 $632.25 $547.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 54100 54100 PR BIOPSY PENIS SEPARATE PROCEDURE 531.00 $477.90 $212.40 $424.80 $297.36 $371.70 $339.84 $424.80 $414.18 $238.95 $217.71 $223.02 $212.40 $398.25 $345.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 54150 54150 PR CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK 576.00 $518.40 $230.40 $460.80 $322.56 $403.20 $368.64 $460.80 $449.28 $259.20 $236.16 $241.92 $230.40 $432.00 $374.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 54161 54161 PR CIRCUMCISION AGE >28 DAYS 933.00 $839.70 $373.20 $746.40 $522.48 $653.10 $597.12 $746.40 $727.74 $419.85 $382.53 $391.86 $373.20 $699.75 $606.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 54163 54163 PR REPAIR INCOMPLETE CIRCUMCISION "1,145.00" " $1,030.50 " $458.00 $916.00 $641.20 $801.50 $732.80 $916.00 $893.10 $515.25 $469.45 $480.90 $458.00 $858.75 $744.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 54520 54520 PR ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH "1,776.00" " $1,598.40 " $710.40 " $1,420.80 " $994.56 " $1,243.20 " " $1,136.64 " " $1,420.80 " " $1,385.28 " $799.20 $728.16 $745.92 $710.40 " $1,332.00 " " $1,154.40 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 54530 54530 PR ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH "2,728.00" " $2,455.20 " " $1,091.20 " " $2,182.40 " " $1,527.68 " " $1,909.60 " " $1,745.92 " " $2,182.40 " " $2,127.84 " " $1,227.60 " " $1,118.48 " " $1,145.76 " " $1,091.20 " " $2,046.00 " " $1,773.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 54640 54640 PR ORCHIOPEXY INGUINAL APPROACH W/WO HERNIA RPR "2,624.00" " $2,361.60 " " $1,049.60 " " $2,099.20 " " $1,469.44 " " $1,836.80 " " $1,679.36 " " $2,099.20 " " $2,046.72 " " $1,180.80 " " $1,075.84 " " $1,102.08 " " $1,049.60 " " $1,968.00 " " $1,705.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 55000 55000 PR PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED 506.00 $455.40 $202.40 $404.80 $283.36 $354.20 $323.84 $404.80 $394.68 $227.70 $207.46 $212.52 $202.40 $379.50 $328.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 55040 55040 PR EXCISION HYDROCELE UNILATERAL "1,844.00" " $1,659.60 " $737.60 " $1,475.20 " " $1,032.64 " " $1,290.80 " " $1,180.16 " " $1,475.20 " " $1,438.32 " $829.80 $756.04 $774.48 $737.60 " $1,383.00 " " $1,198.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 55100 55100 PR DRAINAGE SCROTAL WALL ABSCESS 947.00 $852.30 $378.80 $757.60 $530.32 $662.90 $606.08 $757.60 $738.66 $426.15 $388.27 $397.74 $378.80 $710.25 $615.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 55110 55110 PR SCROTAL EXPLORATION "1,437.00" " $1,293.30 " $574.80 " $1,149.60 " $804.72 " $1,005.90 " $919.68 " $1,149.60 " " $1,120.86 " $646.65 $589.17 $603.54 $574.80 " $1,077.75 " $934.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 55250 55250 PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS "1,535.00" " $1,381.50 " $614.00 " $1,228.00 " $859.60 " $1,074.50 " $982.40 " $1,228.00 " " $1,197.30 " $690.75 $629.35 $644.70 $614.00 " $1,151.25 " $997.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 55500 55500 PR EXC HYDROCELE SPRMATIC CORD UNI SPX "1,909.00" " $1,718.10 " $763.60 " $1,527.20 " " $1,069.04 " " $1,336.30 " " $1,221.76 " " $1,527.20 " " $1,489.02 " $859.05 $782.69 $801.78 $763.60 " $1,431.75 " " $1,240.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 55700 55700 PR PROSTATE NEEDLE BIOPSY ANY APPROACH 990.00 $891.00 $396.00 $792.00 $554.40 $693.00 $633.60 $792.00 $772.20 $445.50 $405.90 $415.80 $396.00 $742.50 $643.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 55899 55899 PR UNLISTED PROCEDURE MALE GENITAL SYSTEM "4,201.00" " $3,780.90 " " $1,680.40 " " $3,360.80 " " $2,352.56 " " $2,940.70 " " $2,688.64 " " $3,360.80 " " $3,276.78 " " $1,890.45 " " $1,722.41 " " $1,764.42 " " $1,680.40 " " $3,150.75 " " $2,730.65 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 56405 56405 PR I&D VULVA/PERINEAL ABSCESS 560.00 $504.00 $224.00 $448.00 $313.60 $392.00 $358.40 $448.00 $436.80 $252.00 $229.60 $235.20 $224.00 $420.00 $364.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 56420 56420 PR I&D OF BARTHOLINS GLAND ABSCESS 481.00 $432.90 $192.40 $384.80 $269.36 $336.70 $307.84 $384.80 $375.18 $216.45 $197.21 $202.02 $192.40 $360.75 $312.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 56440 56440 PR MARSUPIALIZATION BARTHOLINS GLAND CYST 994.00 $894.60 $397.60 $795.20 $556.64 $695.80 $636.16 $795.20 $775.32 $447.30 $407.54 $417.48 $397.60 $745.50 $646.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 56441 56441 PR LYSIS LABIAL ADHESIONS 584.00 $525.60 $233.60 $467.20 $327.04 $408.80 $373.76 $467.20 $455.52 $262.80 $239.44 $245.28 $233.60 $438.00 $379.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 56501 56501 PR DESTRUCTION LESIONS VULVA SIMPLE 509.00 $458.10 $203.60 $407.20 $285.04 $356.30 $325.76 $407.20 $397.02 $229.05 $208.69 $213.78 $203.60 $381.75 $330.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 56515 56515 PR DESTRUCTION LESIONS VULVA EXTENSIVE 996.00 $896.40 $398.40 $796.80 $557.76 $697.20 $637.44 $796.80 $776.88 $448.20 $408.36 $418.32 $398.40 $747.00 $647.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 56605 56605 PR BIOPSY VULVA/PERINEUM 1 LESION SPX 377.00 $339.30 $150.80 $301.60 $211.12 $263.90 $241.28 $301.60 $294.06 $169.65 $154.57 $158.34 $150.80 $282.75 $245.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 56606 56606 PR BIOPSY VULVA/PERINEUM EACH ADDL LESION 224.00 $201.60 $89.60 $179.20 $125.44 $156.80 $143.36 $179.20 $174.72 $100.80 $91.84 $94.08 $89.60 $168.00 $145.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 56620 56620 PR VULVECTOMY SIMPLE PARTIAL "2,286.00" " $2,057.40 " $914.40 " $1,828.80 " " $1,280.16 " " $1,600.20 " " $1,463.04 " " $1,828.80 " " $1,783.08 " " $1,028.70 " $937.26 $960.12 $914.40 " $1,714.50 " " $1,485.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 56700 56700 PR PRTL HYMENECTOMY/REVJ HYMENAL RING 805.00 $724.50 $322.00 $644.00 $450.80 $563.50 $515.20 $644.00 $627.90 $362.25 $330.05 $338.10 $322.00 $603.75 $523.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 56740 56740 PR EXC BARTHOLINS GLAND/CYST "1,357.00" " $1,221.30 " $542.80 " $1,085.60 " $759.92 $949.90 $868.48 " $1,085.60 " " $1,058.46 " $610.65 $556.37 $569.94 $542.80 " $1,017.75 " $882.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 56810 56810 PR PERINEOPLASTY RPR PERINEUM NONOBSTETRICAL SPX "1,438.00" " $1,294.20 " $575.20 " $1,150.40 " $805.28 " $1,006.60 " $920.32 " $1,150.40 " " $1,121.64 " $647.10 $589.58 $603.96 $575.20 " $1,078.50 " $934.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 56820 56820 PR COLPOSCOPY VULVA 508.00 $457.20 $203.20 $406.40 $284.48 $355.60 $325.12 $406.40 $396.24 $228.60 $208.28 $213.36 $203.20 $381.00 $330.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 56821 56821 PR COLPOSCOPY VULVA W/BIOPSY 639.00 $575.10 $255.60 $511.20 $357.84 $447.30 $408.96 $511.20 $498.42 $287.55 $261.99 $268.38 $255.60 $479.25 $415.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57010 57010 PR COLPOTOMY W/DRAINAGE PELVIC ABSCESS "1,613.00" " $1,451.70 " $645.20 " $1,290.40 " $903.28 " $1,129.10 " " $1,032.32 " " $1,290.40 " " $1,258.14 " $725.85 $661.33 $677.46 $645.20 " $1,209.75 " " $1,048.45 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57022 57022 PR I&D VAGINAL HEMATOMA OBSTETRICAL/POSTPARTUM 853.00 $767.70 $341.20 $682.40 $477.68 $597.10 $545.92 $682.40 $665.34 $383.85 $349.73 $358.26 $341.20 $639.75 $554.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57023 57023 PR I&D VAGINAL HEMATOMA NON-OBSTETRICAL "1,074.00" $966.60 $429.60 $859.20 $601.44 $751.80 $687.36 $859.20 $837.72 $483.30 $440.34 $451.08 $429.60 $805.50 $698.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57061 57061 PR DESTRUCTION VAGINAL LESIONS SIMPLE 493.00 $443.70 $197.20 $394.40 $276.08 $345.10 $315.52 $394.40 $384.54 $221.85 $202.13 $207.06 $197.20 $369.75 $320.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57100 57100 PR BIOPSY VAGINAL MUCOSA SIMPLE 411.00 $369.90 $164.40 $328.80 $230.16 $287.70 $263.04 $328.80 $320.58 $184.95 $168.51 $172.62 $164.40 $308.25 $267.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57120 57120 PR COLPOCLEISIS LE FORT TYPE "2,474.00" " $2,226.60 " $989.60 " $1,979.20 " " $1,385.44 " " $1,731.80 " " $1,583.36 " " $1,979.20 " " $1,929.72 " " $1,113.30 " " $1,014.34 " " $1,039.08 " $989.60 " $1,855.50 " " $1,608.10 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57135 57135 PR EXCISION VAGINAL CYST/TUMOR "1,018.00" $916.20 $407.20 $814.40 $570.08 $712.60 $651.52 $814.40 $794.04 $458.10 $417.38 $427.56 $407.20 $763.50 $661.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57160 57160 PR FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI 302.00 $271.80 $120.80 $241.60 $169.12 $211.40 $193.28 $241.60 $235.56 $135.90 $123.82 $126.84 $120.80 $226.50 $196.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57170 57170 PR DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS 282.00 $253.80 $112.80 $225.60 $157.92 $197.40 $180.48 $225.60 $219.96 $126.90 $115.62 $118.44 $112.80 $211.50 $183.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57200 57200 PR COLPORRHAPHY SUTURE INJURY VAGINA "1,288.00" " $1,159.20 " $515.20 " $1,030.40 " $721.28 $901.60 $824.32 " $1,030.40 " " $1,004.64 " $579.60 $528.08 $540.96 $515.20 $966.00 $837.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57240 57240 PR ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYSTO "2,660.00" " $2,394.00 " " $1,064.00 " " $2,128.00 " " $1,489.60 " " $1,862.00 " " $1,702.40 " " $2,128.00 " " $2,074.80 " " $1,197.00 " " $1,090.60 " " $1,117.20 " " $1,064.00 " " $1,995.00 " " $1,729.00 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57250 57250 PR POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY "2,745.00" " $2,470.50 " " $1,098.00 " " $2,196.00 " " $1,537.20 " " $1,921.50 " " $1,756.80 " " $2,196.00 " " $2,141.10 " " $1,235.25 " " $1,125.45 " " $1,152.90 " " $1,098.00 " " $2,058.75 " " $1,784.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57260 57260 PR CMBND ANTERPOST COLPORRAPHY W/CYSTO "3,697.00" " $3,327.30 " " $1,478.80 " " $2,957.60 " " $2,070.32 " " $2,587.90 " " $2,366.08 " " $2,957.60 " " $2,883.66 " " $1,663.65 " " $1,515.77 " " $1,552.74 " " $1,478.80 " " $2,772.75 " " $2,403.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57267 57267 PR INSJ MESH/PROSTH PELVIC FLOOR DEFECT EACH SITE "1,173.00" " $1,055.70 " $469.20 $938.40 $656.88 $821.10 $750.72 $938.40 $914.94 $527.85 $480.93 $492.66 $469.20 $879.75 $762.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57268 57268 PR REPAIR ENTEROCELE VAGINAL APPROACH SPX "2,406.00" " $2,165.40 " $962.40 " $1,924.80 " " $1,347.36 " " $1,684.20 " " $1,539.84 " " $1,924.80 " " $1,876.68 " " $1,082.70 " $986.46 " $1,010.52 " $962.40 " $1,804.50 " " $1,563.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57280 57280 PR COLPOPEXY ABDOMINAL APPROACH "3,995.00" " $3,595.50 " " $1,598.00 " " $3,196.00 " " $2,237.20 " " $2,796.50 " " $2,556.80 " " $3,196.00 " " $3,116.10 " " $1,797.75 " " $1,637.95 " " $1,677.90 " " $1,598.00 " " $2,996.25 " " $2,596.75 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57282 57282 PR COLPOPEXY VAGINAL EXTRAPERITONEAL APPROACH "2,686.00" " $2,417.40 " " $1,074.40 " " $2,148.80 " " $1,504.16 " " $1,880.20 " " $1,719.04 " " $2,148.80 " " $2,095.08 " " $1,208.70 " " $1,101.26 " " $1,128.12 " " $1,074.40 " " $2,014.50 " " $1,745.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57285 57285 PR PARAVAGINAL DEFECT REPAIR VAGINAL APPROACH "2,643.00" " $2,378.70 " " $1,057.20 " " $2,114.40 " " $1,480.08 " " $1,850.10 " " $1,691.52 " " $2,114.40 " " $2,061.54 " " $1,189.35 " " $1,083.63 " " $1,110.06 " " $1,057.20 " " $1,982.25 " " $1,717.95 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57288 57288 PR SLING OPERATION STRESS INCONTINENCE "3,389.00" " $3,050.10 " " $1,355.60 " " $2,711.20 " " $1,897.84 " " $2,372.30 " " $2,168.96 " " $2,711.20 " " $2,643.42 " " $1,525.05 " " $1,389.49 " " $1,423.38 " " $1,355.60 " " $2,541.75 " " $2,202.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57295 57295 PR REVJ/RMVL PROSTHETIC VAGINAL GRAFT VAGINAL APP "2,158.00" " $1,942.20 " $863.20 " $1,726.40 " " $1,208.48 " " $1,510.60 " " $1,381.12 " " $1,726.40 " " $1,683.24 " $971.10 $884.78 $906.36 $863.20 " $1,618.50 " " $1,402.70 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57410 57410 PR PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL 434.00 $390.60 $173.60 $347.20 $243.04 $303.80 $277.76 $347.20 $338.52 $195.30 $177.94 $182.28 $173.60 $325.50 $282.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57415 57415 PR REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL 718.00 $646.20 $287.20 $574.40 $402.08 $502.60 $459.52 $574.40 $560.04 $323.10 $294.38 $301.56 $287.20 $538.50 $466.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57420 57420 PR COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT 547.00 $492.30 $218.80 $437.60 $306.32 $382.90 $350.08 $437.60 $426.66 $246.15 $224.27 $229.74 $218.80 $410.25 $355.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57421 57421 PR COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX 673.00 $605.70 $269.20 $538.40 $376.88 $471.10 $430.72 $538.40 $524.94 $302.85 $275.93 $282.66 $269.20 $504.75 $437.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57452 57452 PR COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA 470.00 $423.00 $188.00 $376.00 $263.20 $329.00 $300.80 $376.00 $366.60 $211.50 $192.70 $197.40 $188.00 $352.50 $305.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57454 57454 PR COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE 734.00 $660.60 $293.60 $587.20 $411.04 $513.80 $469.76 $587.20 $572.52 $330.30 $300.94 $308.28 $293.60 $550.50 $477.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57455 57455 PR COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX 666.00 $599.40 $266.40 $532.80 $372.96 $466.20 $426.24 $532.80 $519.48 $299.70 $273.06 $279.72 $266.40 $499.50 $432.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57456 57456 PR COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE 551.00 $495.90 $220.40 $440.80 $308.56 $385.70 $352.64 $440.80 $429.78 $247.95 $225.91 $231.42 $220.40 $413.25 $358.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57460 57460 PR COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX "1,392.00" " $1,252.80 " $556.80 " $1,113.60 " $779.52 $974.40 $890.88 " $1,113.60 " " $1,085.76 " $626.40 $570.72 $584.64 $556.80 " $1,044.00 " $904.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57461 57461 PR COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX "1,561.00" " $1,404.90 " $624.40 " $1,248.80 " $874.16 " $1,092.70 " $999.04 " $1,248.80 " " $1,217.58 " $702.45 $640.01 $655.62 $624.40 " $1,170.75 " " $1,014.65 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57500 57500 PR BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX 607.00 $546.30 $242.80 $485.60 $339.92 $424.90 $388.48 $485.60 $473.46 $273.15 $248.87 $254.94 $242.80 $455.25 $394.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57505 57505 PR ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C 431.00 $387.90 $172.40 $344.80 $241.36 $301.70 $275.84 $344.80 $336.18 $193.95 $176.71 $181.02 $172.40 $323.25 $280.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57510 57510 PR CAUTERY CERVIX ELECTRO/THERMAL 630.00 $567.00 $252.00 $504.00 $352.80 $441.00 $403.20 $504.00 $491.40 $283.50 $258.30 $264.60 $252.00 $472.50 $409.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57513 57513 PR CAUTERY CERVIX LASER ABLATION "1,275.00" " $1,147.50 " $510.00 " $1,020.00 " $714.00 $892.50 $816.00 " $1,020.00 " $994.50 $573.75 $522.75 $535.50 $510.00 $956.25 $828.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57522 57522 PR CONIZATION CERVIX W/WO D&C RPR ELTRD EXC "1,479.00" " $1,331.10 " $591.60 " $1,183.20 " $828.24 " $1,035.30 " $946.56 " $1,183.20 " " $1,153.62 " $665.55 $606.39 $621.18 $591.60 " $1,109.25 " $961.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57530 57530 PR TRACHELECTOMY CERVICECTOMY AMP CERVIX SPX "1,720.00" " $1,548.00 " $688.00 " $1,376.00 " $963.20 " $1,204.00 " " $1,100.80 " " $1,376.00 " " $1,341.60 " $774.00 $705.20 $722.40 $688.00 " $1,290.00 " " $1,118.00 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57555 57555 PR EXC CRV STUMP VAG APPR W/ANT &/POST REPAIR "2,990.00" " $2,691.00 " " $1,196.00 " " $2,392.00 " " $1,674.40 " " $2,093.00 " " $1,913.60 " " $2,392.00 " " $2,332.20 " " $1,345.50 " " $1,225.90 " " $1,255.80 " " $1,196.00 " " $2,242.50 " " $1,943.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 57800 57800 PR DILATION CERVICAL CANAL INSTRUMENTAL SPX 280.00 $252.00 $112.00 $224.00 $156.80 $196.00 $179.20 $224.00 $218.40 $126.00 $114.80 $117.60 $112.00 $210.00 $182.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58100 58100 PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX 538.00 $484.20 $215.20 $430.40 $301.28 $376.60 $344.32 $430.40 $419.64 $242.10 $220.58 $225.96 $215.20 $403.50 $349.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58110 58110 PR ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY 258.00 $232.20 $103.20 $206.40 $144.48 $180.60 $165.12 $206.40 $201.24 $116.10 $105.78 $108.36 $103.20 $193.50 $167.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58120 58120 PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC "1,269.00" " $1,142.10 " $507.60 " $1,015.20 " $710.64 $888.30 $812.16 " $1,015.20 " $989.82 $571.05 $520.29 $532.98 $507.60 $951.75 $824.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58145 58145 PR MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR "9,749.00" " $8,774.10 " " $3,899.60 " " $7,799.20 " " $5,459.44 " " $6,824.30 " " $6,239.36 " " $7,799.20 " " $7,604.22 " " $4,387.05 " " $3,997.09 " " $4,094.58 " " $3,899.60 " " $7,311.75 " " $6,336.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58150 58150 PR TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY "4,782.00" " $4,303.80 " " $1,912.80 " " $3,825.60 " " $2,677.92 " " $3,347.40 " " $3,060.48 " " $3,825.60 " " $3,729.96 " " $2,151.90 " " $1,960.62 " " $2,008.44 " " $1,912.80 " " $3,586.50 " " $3,108.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58180 58180 PR SUPRACERVICAL ABDL HYSTER W/WO RMVL TUBE OVARY "4,676.00" " $4,208.40 " " $1,870.40 " " $3,740.80 " " $2,618.56 " " $3,273.20 " " $2,992.64 " " $3,740.80 " " $3,647.28 " " $2,104.20 " " $1,917.16 " " $1,963.92 " " $1,870.40 " " $3,507.00 " " $3,039.40 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58210 58210 PR RAD ABDL HYSTERECTOMY W/BI PELVIC LMPHADENECTOMY "8,072.00" " $7,264.80 " " $3,228.80 " " $6,457.60 " " $4,520.32 " " $5,650.40 " " $5,166.08 " " $6,457.60 " " $6,296.16 " " $3,632.40 " " $3,309.52 " " $3,390.24 " " $3,228.80 " " $6,054.00 " " $5,246.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58260 58260 PR VAGINAL HYSTERECTOMY UTERUS 250 GM/< "4,028.00" " $3,625.20 " " $1,611.20 " " $3,222.40 " " $2,255.68 " " $2,819.60 " " $2,577.92 " " $3,222.40 " " $3,141.84 " " $1,812.60 " " $1,651.48 " " $1,691.76 " " $1,611.20 " " $3,021.00 " " $2,618.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58262 58262 PR VAG HYST 250 GM/< W/RMVL TUBE&/OVARY "5,016.00" " $4,514.40 " " $2,006.40 " " $4,012.80 " " $2,808.96 " " $3,511.20 " " $3,210.24 " " $4,012.80 " " $3,912.48 " " $2,257.20 " " $2,056.56 " " $2,106.72 " " $2,006.40 " " $3,762.00 " " $3,260.40 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58263 58263 PR VAG HYST 250 GM/< W/RMVL TUBE OVARY W/RPR NTRCL "4,906.00" " $4,415.40 " " $1,962.40 " " $3,924.80 " " $2,747.36 " " $3,434.20 " " $3,139.84 " " $3,924.80 " " $3,826.68 " " $2,207.70 " " $2,011.46 " " $2,060.52 " " $1,962.40 " " $3,679.50 " " $3,188.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58290 58290 PR VAGINAL HYSTERECTOMY UTERUS > 250 GM "5,215.00" " $4,693.50 " " $2,086.00 " " $4,172.00 " " $2,920.40 " " $3,650.50 " " $3,337.60 " " $4,172.00 " " $4,067.70 " " $2,346.75 " " $2,138.15 " " $2,190.30 " " $2,086.00 " " $3,911.25 " " $3,389.75 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58291 58291 PR VAG HYST > 250 GM RMVL TUBE&/OVARY "6,099.00" " $5,489.10 " " $2,439.60 " " $4,879.20 " " $3,415.44 " " $4,269.30 " " $3,903.36 " " $4,879.20 " " $4,757.22 " " $2,744.55 " " $2,500.59 " " $2,561.58 " " $2,439.60 " " $4,574.25 " " $3,964.35 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58300 58300 PR INSERTION INTRAUTERINE DEVICE IUD 446.00 $401.40 $178.40 $356.80 $249.76 $312.20 $285.44 $356.80 $347.88 $200.70 $182.86 $187.32 $178.40 $334.50 $289.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58301 58301 PR REMOVAL INTRAUTERINE DEVICE IUD 366.00 $329.40 $146.40 $292.80 $204.96 $256.20 $234.24 $292.80 $285.48 $164.70 $150.06 $153.72 $146.40 $274.50 $237.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58321 58321 PR ARTIFICIAL INSEMINATION INTRA-CERVICAL 284.00 $255.60 $113.60 $227.20 $159.04 $198.80 $181.76 $227.20 $221.52 $127.80 $116.44 $119.28 $113.60 $213.00 $184.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58322 58322 PR ARTIFICIAL INSEMINATION INTRA-UTERINE 388.00 $349.20 $155.20 $310.40 $217.28 $271.60 $248.32 $310.40 $302.64 $174.60 $159.08 $162.96 $155.20 $291.00 $252.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58340 58340 PR CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI 659.00 $593.10 $263.60 $527.20 $369.04 $461.30 $421.76 $527.20 $514.02 $296.55 $270.19 $276.78 $263.60 $494.25 $428.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58350 58350 PR CHROMOTUBATION OVIDUCT W/MATERIALS 453.00 $407.70 $181.20 $362.40 $253.68 $317.10 $289.92 $362.40 $353.34 $203.85 $185.73 $190.26 $181.20 $339.75 $294.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58353 58353 PR ENDOMETRIAL ABLTJ THERMAL W/O HYSTEROSCOPIC GUID "3,027.00" " $2,724.30 " " $1,210.80 " " $2,421.60 " " $1,695.12 " " $2,118.90 " " $1,937.28 " " $2,421.60 " " $2,361.06 " " $1,362.15 " " $1,241.07 " " $1,271.34 " " $1,210.80 " " $2,270.25 " " $1,967.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58541 58541 PR LAPAROSCOPY SUPRACERVICAL HYSTERECTOMY 250 GM/< "4,212.00" " $3,790.80 " " $1,684.80 " " $3,369.60 " " $2,358.72 " " $2,948.40 " " $2,695.68 " " $3,369.60 " " $3,285.36 " " $1,895.40 " " $1,726.92 " " $1,769.04 " " $1,684.80 " " $3,159.00 " " $2,737.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58542 58542 PR LAPS SUPRACRV HYSTERECT 250 GM/< RMVL TUBE/OVAR "4,534.00" " $4,080.60 " " $1,813.60 " " $3,627.20 " " $2,539.04 " " $3,173.80 " " $2,901.76 " " $3,627.20 " " $3,536.52 " " $2,040.30 " " $1,858.94 " " $1,904.28 " " $1,813.60 " " $3,400.50 " " $2,947.10 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58543 58543 PR LAPS SUPRACERVICAL HYSTERECTOMY >250 "4,202.00" " $3,781.80 " " $1,680.80 " " $3,361.60 " " $2,353.12 " " $2,941.40 " " $2,689.28 " " $3,361.60 " " $3,277.56 " " $1,890.90 " " $1,722.82 " " $1,764.84 " " $1,680.80 " " $3,151.50 " " $2,731.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58544 58544 PR LAPS SUPRACRV HYSTEREC >250 G RMVL TUBE/OVARY "4,580.00" " $4,122.00 " " $1,832.00 " " $3,664.00 " " $2,564.80 " " $3,206.00 " " $2,931.20 " " $3,664.00 " " $3,572.40 " " $2,061.00 " " $1,877.80 " " $1,923.60 " " $1,832.00 " " $3,435.00 " " $2,977.00 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58545 58545 PR LAPS MYOMECTOMY EXC 1-4 MYOMAS 250 GM/< "4,617.00" " $4,155.30 " " $1,846.80 " " $3,693.60 " " $2,585.52 " " $3,231.90 " " $2,954.88 " " $3,693.60 " " $3,601.26 " " $2,077.65 " " $1,892.97 " " $1,939.14 " " $1,846.80 " " $3,462.75 " " $3,001.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58550 58550 PR LAPS VAGINAL HYSTERECTOMY UTERUS 250 GM/< "3,793.00" " $3,413.70 " " $1,517.20 " " $3,034.40 " " $2,124.08 " " $2,655.10 " " $2,427.52 " " $3,034.40 " " $2,958.54 " " $1,706.85 " " $1,555.13 " " $1,593.06 " " $1,517.20 " " $2,844.75 " " $2,465.45 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58552 58552 PR LAPS W/VAG HYSTERECT 250 GM/&RMVL TUBE&/OVARIES "4,430.00" " $3,987.00 " " $1,772.00 " " $3,544.00 " " $2,480.80 " " $3,101.00 " " $2,835.20 " " $3,544.00 " " $3,455.40 " " $1,993.50 " " $1,816.30 " " $1,860.60 " " $1,772.00 " " $3,322.50 " " $2,879.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58554 58554 PR LAPS VAGINAL HYSTERECT > 250 GM RMVL TUBE&/OVAR "6,228.00" " $5,605.20 " " $2,491.20 " " $4,982.40 " " $3,487.68 " " $4,359.60 " " $3,985.92 " " $4,982.40 " " $4,857.84 " " $2,802.60 " " $2,553.48 " " $2,615.76 " " $2,491.20 " " $4,671.00 " " $4,048.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58555 58555 PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE 900.00 $810.00 $360.00 $720.00 $504.00 $630.00 $576.00 $720.00 $702.00 $405.00 $369.00 $378.00 $360.00 $675.00 $585.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58558 58558 PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C "1,559.00" " $1,403.10 " $623.60 " $1,247.20 " $873.04 " $1,091.30 " $997.76 " $1,247.20 " " $1,216.02 " $701.55 $639.19 $654.78 $623.60 " $1,169.25 " " $1,013.35 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58562 58562 PR HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY "1,683.00" " $1,514.70 " $673.20 " $1,346.40 " $942.48 " $1,178.10 " " $1,077.12 " " $1,346.40 " " $1,312.74 " $757.35 $690.03 $706.86 $673.20 " $1,262.25 " " $1,093.95 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58563 58563 PR HYSTEROSCOPY ENDOMETRIAL ABLATION "4,800.00" " $4,320.00 " " $1,920.00 " " $3,840.00 " " $2,688.00 " " $3,360.00 " " $3,072.00 " " $3,840.00 " " $3,744.00 " " $2,160.00 " " $1,968.00 " " $2,016.00 " " $1,920.00 " " $3,600.00 " " $3,120.00 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58565 58565 PR HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS "5,469.00" " $4,922.10 " " $2,187.60 " " $4,375.20 " " $3,062.64 " " $3,828.30 " " $3,500.16 " " $4,375.20 " " $4,265.82 " " $2,461.05 " " $2,242.29 " " $2,296.98 " " $2,187.60 " " $4,101.75 " " $3,554.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58570 58570 PR LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 GM/< "4,590.00" " $4,131.00 " " $1,836.00 " " $3,672.00 " " $2,570.40 " " $3,213.00 " " $2,937.60 " " $3,672.00 " " $3,580.20 " " $2,065.50 " " $1,881.90 " " $1,927.80 " " $1,836.00 " " $3,442.50 " " $2,983.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58571 58571 PR LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY "4,782.00" " $4,303.80 " " $1,912.80 " " $3,825.60 " " $2,677.92 " " $3,347.40 " " $3,060.48 " " $3,825.60 " " $3,729.96 " " $2,151.90 " " $1,960.62 " " $2,008.44 " " $1,912.80 " " $3,586.50 " " $3,108.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58573 58573 PR LAPAROSCOPY TOT HYSTERECTOMY >250 G W/TUBE/OVAR "6,053.00" " $5,447.70 " " $2,421.20 " " $4,842.40 " " $3,389.68 " " $4,237.10 " " $3,873.92 " " $4,842.40 " " $4,721.34 " " $2,723.85 " " $2,481.73 " " $2,542.26 " " $2,421.20 " " $4,539.75 " " $3,934.45 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58578 58578 PR UNLISTED LAPAROSCOPY PROCEDURE UTERUS "2,070.00" " $1,863.00 " $828.00 " $1,656.00 " " $1,159.20 " " $1,449.00 " " $1,324.80 " " $1,656.00 " " $1,614.60 " $931.50 $848.70 $869.40 $828.00 " $1,552.50 " " $1,345.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58579 58579 PR UNLISTED HYSTEROSCOPY PROCEDURE UTERUS "1,627.00" " $1,464.30 " $650.80 " $1,301.60 " $911.12 " $1,138.90 " " $1,041.28 " " $1,301.60 " " $1,269.06 " $732.15 $667.07 $683.34 $650.80 " $1,220.25 " " $1,057.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58600 58600 PR LIG/TRNSXJ FLP TUBE ABDL/VAG APPR UNI/BI "1,909.00" " $1,718.10 " $763.60 " $1,527.20 " " $1,069.04 " " $1,336.30 " " $1,221.76 " " $1,527.20 " " $1,489.02 " $859.05 $782.69 $801.78 $763.60 " $1,431.75 " " $1,240.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58605 58605 PR LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX "1,536.00" " $1,382.40 " $614.40 " $1,228.80 " $860.16 " $1,075.20 " $983.04 " $1,228.80 " " $1,198.08 " $691.20 $629.76 $645.12 $614.40 " $1,152.00 " $998.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58611 58611 PR LIG/TRNSXJ FALOPIAN TUBE CESAREAN DEL/ABDML SURG "1,028.00" $925.20 $411.20 $822.40 $575.68 $719.60 $657.92 $822.40 $801.84 $462.60 $421.48 $431.76 $411.20 $771.00 $668.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58660 58660 PR LAPAROSCOPY W/LYSIS OF ADHESIONS "3,378.00" " $3,040.20 " " $1,351.20 " " $2,702.40 " " $1,891.68 " " $2,364.60 " " $2,161.92 " " $2,702.40 " " $2,634.84 " " $1,520.10 " " $1,384.98 " " $1,418.76 " " $1,351.20 " " $2,533.50 " " $2,195.70 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58661 58661 PR LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES "3,817.00" " $3,435.30 " " $1,526.80 " " $3,053.60 " " $2,137.52 " " $2,671.90 " " $2,442.88 " " $3,053.60 " " $2,977.26 " " $1,717.65 " " $1,564.97 " " $1,603.14 " " $1,526.80 " " $2,862.75 " " $2,481.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58662 58662 PR LAPS FULG/EXC OVARY VISCERA/PERITONEAL SURFACE "3,428.00" " $3,085.20 " " $1,371.20 " " $2,742.40 " " $1,919.68 " " $2,399.60 " " $2,193.92 " " $2,742.40 " " $2,673.84 " " $1,542.60 " " $1,405.48 " " $1,439.76 " " $1,371.20 " " $2,571.00 " " $2,228.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58670 58670 PR LAPAROSCOPY FULGURATION OVIDUCTS "1,438.00" " $1,294.20 " $575.20 " $1,150.40 " $805.28 " $1,006.60 " $920.32 " $1,150.40 " " $1,121.64 " $647.10 $589.58 $603.96 $575.20 " $1,078.50 " $934.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58671 58671 PR LAPAROSCOPY W/PLMT OCCLUSION DEVICE OVIDUCTS "1,804.00" " $1,623.60 " $721.60 " $1,443.20 " " $1,010.24 " " $1,262.80 " " $1,154.56 " " $1,443.20 " " $1,407.12 " $811.80 $739.64 $757.68 $721.60 " $1,353.00 " " $1,172.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58679 58679 PR UNLISTED LAPAROSCOPY PROCEDURE OVIDUCT/OVARY "2,397.00" " $2,157.30 " $958.80 " $1,917.60 " " $1,342.32 " " $1,677.90 " " $1,534.08 " " $1,917.60 " " $1,869.66 " " $1,078.65 " $982.77 " $1,006.74 " $958.80 " $1,797.75 " " $1,558.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58679.6 58679 PR LAP OVARIAN DRILLING "3,174.00" " $2,856.60 " " $1,269.60 " " $2,539.20 " " $1,777.44 " " $2,221.80 " " $2,031.36 " " $2,539.20 " " $2,475.72 " " $1,428.30 " " $1,301.34 " " $1,333.08 " " $1,269.60 " " $2,380.50 " " $2,063.10 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58679.7 58679 PR LAP DRAIN OVARIAN CYST "1,618.00" " $1,456.20 " $647.20 " $1,294.40 " $906.08 " $1,132.60 " " $1,035.52 " " $1,294.40 " " $1,262.04 " $728.10 $663.38 $679.56 $647.20 " $1,213.50 " " $1,051.70 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58700 58700 PR SALPINGECTOMY COMPLETE/PARTIAL UNI/BI SPX "3,863.00" " $3,476.70 " " $1,545.20 " " $3,090.40 " " $2,163.28 " " $2,704.10 " " $2,472.32 " " $3,090.40 " " $3,013.14 " " $1,738.35 " " $1,583.83 " " $1,622.46 " " $1,545.20 " " $2,897.25 " " $2,510.95 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58720 58720 PR SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX "3,528.00" " $3,175.20 " " $1,411.20 " " $2,822.40 " " $1,975.68 " " $2,469.60 " " $2,257.92 " " $2,822.40 " " $2,751.84 " " $1,587.60 " " $1,446.48 " " $1,481.76 " " $1,411.20 " " $2,646.00 " " $2,293.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58805 58805 PR DRAINAGE OVARIAN CYST UNI/BI SPX ABDOMINAL "1,814.00" " $1,632.60 " $725.60 " $1,451.20 " " $1,015.84 " " $1,269.80 " " $1,160.96 " " $1,451.20 " " $1,414.92 " $816.30 $743.74 $761.88 $725.60 " $1,360.50 " " $1,179.10 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58900 58900 PR BIOPSY OVARY UNI/BI SEPARATE PROCEDURE "2,098.00" " $1,888.20 " $839.20 " $1,678.40 " " $1,174.88 " " $1,468.60 " " $1,342.72 " " $1,678.40 " " $1,636.44 " $944.10 $860.18 $881.16 $839.20 " $1,573.50 " " $1,363.70 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58940 58940 PR OOPHORECTOMY PARTIAL/TOTAL UNI/BI "2,428.00" " $2,185.20 " $971.20 " $1,942.40 " " $1,359.68 " " $1,699.60 " " $1,553.92 " " $1,942.40 " " $1,893.84 " " $1,092.60 " $995.48 " $1,019.76 " $971.20 " $1,821.00 " " $1,578.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58999 58999 PR UNLISTED PX FEMALE GENITAL SYSTEM NONOBSTETRICAL "1,218.00" " $1,096.20 " $487.20 $974.40 $682.08 $852.60 $779.52 $974.40 $950.04 $548.10 $499.38 $511.56 $487.20 $913.50 $791.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 58999.29 58999 PR VAGINAL EXPLORATION RELEASE VAGINAL BANDS "1,218.00" " $1,096.20 " $487.20 $974.40 $682.08 $852.60 $779.52 $974.40 $950.04 $548.10 $499.38 $511.56 $487.20 $913.50 $791.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59000 59000 PR AMNIOCENTESIS DIAGNOSIC 634.00 $570.60 $253.60 $507.20 $355.04 $443.80 $405.76 $507.20 $494.52 $285.30 $259.94 $266.28 $253.60 $475.50 $412.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59020 59020 PR FETAL CONTRACTION STRESS TEST 380.00 $342.00 $152.00 $304.00 $212.80 $266.00 $243.20 $304.00 $296.40 $171.00 $155.80 $159.60 $152.00 $285.00 $247.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59025 59025 PR FETAL NONSTRESS TEST 209.00 $188.10 $83.60 $167.20 $117.04 $146.30 $133.76 $167.20 $163.02 $94.05 $85.69 $87.78 $83.60 $156.75 $135.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59151 59151 PR LAPS TX ECTOPIC PREG W/SALPING&/OOPHORECTOMY "3,754.00" " $3,378.60 " " $1,501.60 " " $3,003.20 " " $2,102.24 " " $2,627.80 " " $2,402.56 " " $3,003.20 " " $2,928.12 " " $1,689.30 " " $1,539.14 " " $1,576.68 " " $1,501.60 " " $2,815.50 " " $2,440.10 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59160 59160 PR CURETTAGE POSTPARTUM "1,040.00" $936.00 $416.00 $832.00 $582.40 $728.00 $665.60 $832.00 $811.20 $468.00 $426.40 $436.80 $416.00 $780.00 $676.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59200 59200 PR INSERTION CERVICAL DILATOR SEPARATE PROCEDURE 396.00 $356.40 $158.40 $316.80 $221.76 $277.20 $253.44 $316.80 $308.88 $178.20 $162.36 $166.32 $158.40 $297.00 $257.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59300 59300 PR EPISIOTOMY/VAG RPR OTH/THN ATTENDING 757.00 $681.30 $302.80 $605.60 $423.92 $529.90 $484.48 $605.60 $590.46 $340.65 $310.37 $317.94 $302.80 $567.75 $492.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59320 59320 PR CERCLAGE CERVIX PREGNANCY VAGINAL "1,016.00" $914.40 $406.40 $812.80 $568.96 $711.20 $650.24 $812.80 $792.48 $457.20 $416.56 $426.72 $406.40 $762.00 $660.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59350 59350 PR HYSTERORRHAPHY RUPTURED UTERUS "1,815.00" " $1,633.50 " $726.00 " $1,452.00 " " $1,016.40 " " $1,270.50 " " $1,161.60 " " $1,452.00 " " $1,415.70 " $816.75 $744.15 $762.30 $726.00 " $1,361.25 " " $1,179.75 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59400 59400 PR OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM "5,563.00" " $5,006.70 " " $2,225.20 " " $4,450.40 " " $3,115.28 " " $3,894.10 " " $3,560.32 " " $4,450.40 " " $4,339.14 " " $2,503.35 " " $2,280.83 " " $2,336.46 " " $2,225.20 " " $4,172.25 " " $3,615.95 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59409 59409 PR VAGINAL DELIVERY ONLY "3,364.00" " $3,027.60 " " $1,345.60 " " $2,691.20 " " $1,883.84 " " $2,354.80 " " $2,152.96 " " $2,691.20 " " $2,623.92 " " $1,513.80 " " $1,379.24 " " $1,412.88 " " $1,345.60 " " $2,523.00 " " $2,186.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59410 59410 PR VAGINAL DELIVERY ONLY W/POSTPARTUM CARE "3,528.00" " $3,175.20 " " $1,411.20 " " $2,822.40 " " $1,975.68 " " $2,469.60 " " $2,257.92 " " $2,822.40 " " $2,751.84 " " $1,587.60 " " $1,446.48 " " $1,481.76 " " $1,411.20 " " $2,646.00 " " $2,293.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59412 59412 PR EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS 886.00 $797.40 $354.40 $708.80 $496.16 $620.20 $567.04 $708.80 $691.08 $398.70 $363.26 $372.12 $354.40 $664.50 $575.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59414 59414 PR DELIVERY PLACENTA SEPARATE PROCEDURE 577.00 $519.30 $230.80 $461.60 $323.12 $403.90 $369.28 $461.60 $450.06 $259.65 $236.57 $242.34 $230.80 $432.75 $375.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59425 59425 PR ANTEPARTUM CARE ONLY 4-6 VISITS "1,552.00" " $1,396.80 " $620.80 " $1,241.60 " $869.12 " $1,086.40 " $993.28 " $1,241.60 " " $1,210.56 " $698.40 $636.32 $651.84 $620.80 " $1,164.00 " " $1,008.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59426 59426 PR ANTEPARTUM CARE ONLY 7/> VISITS "2,640.00" " $2,376.00 " " $1,056.00 " " $2,112.00 " " $1,478.40 " " $1,848.00 " " $1,689.60 " " $2,112.00 " " $2,059.20 " " $1,188.00 " " $1,082.40 " " $1,108.80 " " $1,056.00 " " $1,980.00 " " $1,716.00 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59430 59430 PR POSTPARTUM CARE ONLY SEPARATE PROCEDURE 518.00 $466.20 $207.20 $414.40 $290.08 $362.60 $331.52 $414.40 $404.04 $233.10 $212.38 $217.56 $207.20 $388.50 $336.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59510 59510 PR OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM "6,122.00" " $5,509.80 " " $2,448.80 " " $4,897.60 " " $3,428.32 " " $4,285.40 " " $3,918.08 " " $4,897.60 " " $4,775.16 " " $2,754.90 " " $2,510.02 " " $2,571.24 " " $2,448.80 " " $4,591.50 " " $3,979.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59514 59514 PR CESAREAN DELIVERY ONLY "3,385.00" " $3,046.50 " " $1,354.00 " " $2,708.00 " " $1,895.60 " " $2,369.50 " " $2,166.40 " " $2,708.00 " " $2,640.30 " " $1,523.25 " " $1,387.85 " " $1,421.70 " " $1,354.00 " " $2,538.75 " " $2,200.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59515 59515 PR CESAREAN DELIVERY ONLY W/POSTPARTUM CARE "4,156.00" " $3,740.40 " " $1,662.40 " " $3,324.80 " " $2,327.36 " " $2,909.20 " " $2,659.84 " " $3,324.80 " " $3,241.68 " " $1,870.20 " " $1,703.96 " " $1,745.52 " " $1,662.40 " " $3,117.00 " " $2,701.40 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59610 59610 PR ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VB "6,563.00" " $5,906.70 " " $2,625.20 " " $5,250.40 " " $3,675.28 " " $4,594.10 " " $4,200.32 " " $5,250.40 " " $5,119.14 " " $2,953.35 " " $2,690.83 " " $2,756.46 " " $2,625.20 " " $4,922.25 " " $4,265.95 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59612 59612 PR VAGINAL DELIVERY AFTER CESAREAN DELIVERY "5,055.00" " $4,549.50 " " $2,022.00 " " $4,044.00 " " $2,830.80 " " $3,538.50 " " $3,235.20 " " $4,044.00 " " $3,942.90 " " $2,274.75 " " $2,072.55 " " $2,123.10 " " $2,022.00 " " $3,791.25 " " $3,285.75 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59614 59614 PR VAGINAL DELIVERY & POSTPARTUM CARE VBAC "5,735.00" " $5,161.50 " " $2,294.00 " " $4,588.00 " " $3,211.60 " " $4,014.50 " " $3,670.40 " " $4,588.00 " " $4,473.30 " " $2,580.75 " " $2,351.35 " " $2,408.70 " " $2,294.00 " " $4,301.25 " " $3,727.75 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59618 59618 PR ROUTINE OBSTETRICAL CARE ATTEMPTED VBAC "6,192.00" " $5,572.80 " " $2,476.80 " " $4,953.60 " " $3,467.52 " " $4,334.40 " " $3,962.88 " " $4,953.60 " " $4,829.76 " " $2,786.40 " " $2,538.72 " " $2,600.64 " " $2,476.80 " " $4,644.00 " " $4,024.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59620 59620 PR CESAREAN DELIVERY ATTEMPTED VBAC "3,838.00" " $3,454.20 " " $1,535.20 " " $3,070.40 " " $2,149.28 " " $2,686.60 " " $2,456.32 " " $3,070.40 " " $2,993.64 " " $1,727.10 " " $1,573.58 " " $1,611.96 " " $1,535.20 " " $2,878.50 " " $2,494.70 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59622 59622 PR CESAREAN DLVRY & POSTPARTUM CARE ATTEMPTED VBA "4,562.00" " $4,105.80 " " $1,824.80 " " $3,649.60 " " $2,554.72 " " $3,193.40 " " $2,919.68 " " $3,649.60 " " $3,558.36 " " $2,052.90 " " $1,870.42 " " $1,916.04 " " $1,824.80 " " $3,421.50 " " $2,965.30 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59812 59812 PR TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL "1,239.00" " $1,115.10 " $495.60 $991.20 $693.84 $867.30 $792.96 $991.20 $966.42 $557.55 $507.99 $520.38 $495.60 $929.25 $805.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59820 59820 PR TX MISSED ABORTION FIRST TRIMESTER SURGICAL "1,619.00" " $1,457.10 " $647.60 " $1,295.20 " $906.64 " $1,133.30 " " $1,036.16 " " $1,295.20 " " $1,262.82 " $728.55 $663.79 $679.98 $647.60 " $1,214.25 " " $1,052.35 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59821 59821 PR TX MISSED ABORTION SECOND TRIMESTER SURGICAL "1,921.00" " $1,728.90 " $768.40 " $1,536.80 " " $1,075.76 " " $1,344.70 " " $1,229.44 " " $1,536.80 " " $1,498.38 " $864.45 $787.61 $806.82 $768.40 " $1,440.75 " " $1,248.65 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59855 59855 PR INDUCED ABORT 1/> VAG SUPPOSITORIES DLVR FETUS "1,929.00" " $1,736.10 " $771.60 " $1,543.20 " " $1,080.24 " " $1,350.30 " " $1,234.56 " " $1,543.20 " " $1,504.62 " $868.05 $790.89 $810.18 $771.60 " $1,446.75 " " $1,253.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59856 59856 PR INDUCED ABORT 1/> VAG SUPP DLVR FETUS D&C &/EVAC "3,145.00" " $2,830.50 " " $1,258.00 " " $2,516.00 " " $1,761.20 " " $2,201.50 " " $2,012.80 " " $2,516.00 " " $2,453.10 " " $1,415.25 " " $1,289.45 " " $1,320.90 " " $1,258.00 " " $2,358.75 " " $2,044.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59870 59870 PR UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE "2,450.00" " $2,205.00 " $980.00 " $1,960.00 " " $1,372.00 " " $1,715.00 " " $1,568.00 " " $1,960.00 " " $1,911.00 " " $1,102.50 " " $1,004.50 " " $1,029.00 " $980.00 " $1,837.50 " " $1,592.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 59899 59899 PR UNLISTED PROCEDURE MATERNITY CARE & DELIVERY "3,501.00" " $3,150.90 " " $1,400.40 " " $2,800.80 " " $1,960.56 " " $2,450.70 " " $2,240.64 " " $2,800.80 " " $2,730.78 " " $1,575.45 " " $1,435.41 " " $1,470.42 " " $1,400.40 " " $2,625.75 " " $2,275.65 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 60210 60210 PR PRTL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY "3,387.00" " $3,048.30 " " $1,354.80 " " $2,709.60 " " $1,896.72 " " $2,370.90 " " $2,167.68 " " $2,709.60 " " $2,641.86 " " $1,524.15 " " $1,388.67 " " $1,422.54 " " $1,354.80 " " $2,540.25 " " $2,201.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 60212 60212 PR PRTL THYROID LOBEC UNI W/CONTRATLAT STOT LOBEC "4,749.00" " $4,274.10 " " $1,899.60 " " $3,799.20 " " $2,659.44 " " $3,324.30 " " $3,039.36 " " $3,799.20 " " $3,704.22 " " $2,137.05 " " $1,947.09 " " $1,994.58 " " $1,899.60 " " $3,561.75 " " $3,086.85 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 60220 60220 PR TOTAL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY "3,305.00" " $2,974.50 " " $1,322.00 " " $2,644.00 " " $1,850.80 " " $2,313.50 " " $2,115.20 " " $2,644.00 " " $2,577.90 " " $1,487.25 " " $1,355.05 " " $1,388.10 " " $1,322.00 " " $2,478.75 " " $2,148.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 60240 60240 PR THYROIDECTOMY TOTAL/COMPLETE "4,634.00" " $4,170.60 " " $1,853.60 " " $3,707.20 " " $2,595.04 " " $3,243.80 " " $2,965.76 " " $3,707.20 " " $3,614.52 " " $2,085.30 " " $1,899.94 " " $1,946.28 " " $1,853.60 " " $3,475.50 " " $3,012.10 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 60252 60252 PR THYROIDECTOMY TOTAL/SUBTOTAL LMTD NECK DISSECT "6,851.00" " $6,165.90 " " $2,740.40 " " $5,480.80 " " $3,836.56 " " $4,795.70 " " $4,384.64 " " $5,480.80 " " $5,343.78 " " $3,082.95 " " $2,808.91 " " $2,877.42 " " $2,740.40 " " $5,138.25 " " $4,453.15 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 60500 60500 PR PARATHYROIDECTOMY/EXPLORATION PARATHYROIDS "5,021.00" " $4,518.90 " " $2,008.40 " " $4,016.80 " " $2,811.76 " " $3,514.70 " " $3,213.44 " " $4,016.80 " " $3,916.38 " " $2,259.45 " " $2,058.61 " " $2,108.82 " " $2,008.40 " " $3,765.75 " " $3,263.65 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 60650 60650 PR LAPAROSCOPY ADRENALECTOMY PRTL/COMPL TABDL "5,844.00" " $5,259.60 " " $2,337.60 " " $4,675.20 " " $3,272.64 " " $4,090.80 " " $3,740.16 " " $4,675.20 " " $4,558.32 " " $2,629.80 " " $2,396.04 " " $2,454.48 " " $2,337.60 " " $4,383.00 " " $3,798.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 609047102 90471 PR ADMIN VACC INITIAL SEASONAL AFFILIATE ONLY 11.00 $9.90 $4.40 $8.80 $6.16 $7.70 $7.04 $8.80 $8.58 $4.95 $4.51 $4.62 $4.40 $8.25 $7.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 609047202 90472 PR ADMIN VACC EA ADDL SEASONAL AFFILIATE ONLY 11.00 $9.90 $4.40 $8.80 $6.16 $7.70 $7.04 $8.80 $8.58 $4.95 $4.51 $4.62 $4.40 $8.25 $7.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 609047302 90473 PR ADMIN VACC INIT INTRANASAL/ORAL SEASONAL AFFILIATE ONLY 33.00 $29.70 $13.20 $26.40 $18.48 $23.10 $21.12 $26.40 $25.74 $14.85 $13.53 $13.86 $13.20 $24.75 $21.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 62270 62270 PR SPINAL PUNCTURE LUMBAR DIAGNOSTIC 474.00 $426.60 $189.60 $379.20 $265.44 $331.80 $303.36 $379.20 $369.72 $213.30 $194.34 $199.08 $189.60 $355.50 $308.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 62321 62321 PR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN 974.00 $876.60 $389.60 $779.20 $545.44 $681.80 $623.36 $779.20 $759.72 $438.30 $399.34 $409.08 $389.60 $730.50 $633.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 62323 62323 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN "1,445.00" " $1,300.50 " $578.00 " $1,156.00 " $809.20 " $1,011.50 " $924.80 " $1,156.00 " " $1,127.10 " $650.25 $592.45 $606.90 $578.00 " $1,083.75 " $939.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 63030 63030 PR LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC LUMBR "6,430.00" " $5,787.00 " " $2,572.00 " " $5,144.00 " " $3,600.80 " " $4,501.00 " " $4,115.20 " " $5,144.00 " " $5,015.40 " " $2,893.50 " " $2,636.30 " " $2,700.60 " " $2,572.00 " " $4,822.50 " " $4,179.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 63035 63035 PR LAMNOTMY W/DCMPRSN NRV EACH ADDL CRVCL/LMBR "1,806.00" " $1,625.40 " $722.40 " $1,444.80 " " $1,011.36 " " $1,264.20 " " $1,155.84 " " $1,444.80 " " $1,408.68 " $812.70 $740.46 $758.52 $722.40 " $1,354.50 " " $1,173.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 63042 63042 PR LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC LUMBAR "7,626.00" " $6,863.40 " " $3,050.40 " " $6,100.80 " " $4,270.56 " " $5,338.20 " " $4,880.64 " " $6,100.80 " " $5,948.28 " " $3,431.70 " " $3,126.66 " " $3,202.92 " " $3,050.40 " " $5,719.50 " " $4,956.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 63047 63047 PR LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT LUMBAR "7,953.00" " $7,157.70 " " $3,181.20 " " $6,362.40 " " $4,453.68 " " $5,567.10 " " $5,089.92 " " $6,362.40 " " $6,203.34 " " $3,578.85 " " $3,260.73 " " $3,340.26 " " $3,181.20 " " $5,964.75 " " $5,169.45 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 63048 63048 PR LAM FACETECTOMY&FORAMTOMY 1 SGM EA CRV THRC/LMBR "2,312.00" " $2,080.80 " $924.80 " $1,849.60 " " $1,294.72 " " $1,618.40 " " $1,479.68 " " $1,849.60 " " $1,803.36 " " $1,040.40 " $947.92 $971.04 $924.80 " $1,734.00 " " $1,502.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 63688 63688 PR REVJ/RMVL IMPLANTED SPINAL NEUROSTIM GENERATOR "2,356.00" " $2,120.40 " $942.40 " $1,884.80 " " $1,319.36 " " $1,649.20 " " $1,507.84 " " $1,884.80 " " $1,837.68 " " $1,060.20 " $965.96 $989.52 $942.40 " $1,767.00 " " $1,531.40 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64400 64400 PR NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH 479.00 $431.10 $191.60 $383.20 $268.24 $335.30 $306.56 $383.20 $373.62 $215.55 $196.39 $201.18 $191.60 $359.25 $311.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64405 64405 PR INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV 519.00 $467.10 $207.60 $415.20 $290.64 $363.30 $332.16 $415.20 $404.82 $233.55 $212.79 $217.98 $207.60 $389.25 $337.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64420 64420 PR INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE 212.00 $190.80 $84.80 $169.60 $118.72 $148.40 $135.68 $169.60 $165.36 $95.40 $86.92 $89.04 $84.80 $159.00 $137.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64421 64421 PR MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES 106.00 $95.40 $42.40 $84.80 $59.36 $74.20 $67.84 $84.80 $82.68 $47.70 $43.46 $44.52 $42.40 $79.50 $68.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64425 64425 PR INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS 731.00 $657.90 $292.40 $584.80 $409.36 $511.70 $467.84 $584.80 $570.18 $328.95 $299.71 $307.02 $292.40 $548.25 $475.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64430 64430 PR INJECTION ANESTHETIC AGENT PUDENDAL NERVE 749.00 $674.10 $299.60 $599.20 $419.44 $524.30 $479.36 $599.20 $584.22 $337.05 $307.09 $314.58 $299.60 $561.75 $486.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64445 64445 PR INJECTION AA&/STRD SCIATIC NERVE W/IMG GDN 575.00 $517.50 $230.00 $460.00 $322.00 $402.50 $368.00 $460.00 $448.50 $258.75 $235.75 $241.50 $230.00 $431.25 $373.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64447 64447 PR INJECTION AA&/STRD FEMORAL NERVE W/IMG GDN "1,008.00" $907.20 $403.20 $806.40 $564.48 $705.60 $645.12 $806.40 $786.24 $453.60 $413.28 $423.36 $403.20 $756.00 $655.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64450 64450 PR INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH 346.00 $311.40 $138.40 $276.80 $193.76 $242.20 $221.44 $276.80 $269.88 $155.70 $141.86 $145.32 $138.40 $259.50 $224.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64451 64451 PR INJECTION AA&/STRD NERVES NRVTG SI JOINT W/IMG "14,853.00" " $13,367.70 " " $5,941.20 " " $11,882.40 " " $8,317.68 " " $10,397.10 " " $9,505.92 " " $11,882.40 " " $11,585.34 " " $6,683.85 " " $6,089.73 " " $6,238.26 " " $5,941.20 " " $11,139.75 " " $9,654.45 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64454 64454 PR INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG 150.00 $135.00 $60.00 $120.00 $84.00 $105.00 $96.00 $120.00 $117.00 $67.50 $61.50 $63.00 $60.00 $112.50 $97.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64455 64455 PR NJX AA&/STRD PLANTAR COMMON DIGITAL NERVES 333.00 $299.70 $133.20 $266.40 $186.48 $233.10 $213.12 $266.40 $259.74 $149.85 $136.53 $139.86 $133.20 $249.75 $216.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64479 64479 PR NJX AA&/STRD TFRML EPI CERVICAL/THORACIC 1 LEVEL "1,716.00" " $1,544.40 " $686.40 " $1,372.80 " $960.96 " $1,201.20 " " $1,098.24 " " $1,372.80 " " $1,338.48 " $772.20 $703.56 $720.72 $686.40 " $1,287.00 " " $1,115.40 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64480 64480 PR NJX AA&/STRD TFRML EPI CERVICAL/THORACIC EA ADDL 785.00 $706.50 $314.00 $628.00 $439.60 $549.50 $502.40 $628.00 $612.30 $353.25 $321.85 $329.70 $314.00 $588.75 $510.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64483 64483 PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL "1,395.00" " $1,255.50 " $558.00 " $1,116.00 " $781.20 $976.50 $892.80 " $1,116.00 " " $1,088.10 " $627.75 $571.95 $585.90 $558.00 " $1,046.25 " $906.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64484 64484 PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL EA ADDL 509.00 $458.10 $203.60 $407.20 $285.04 $356.30 $325.76 $407.20 $397.02 $229.05 $208.69 $213.78 $203.60 $381.75 $330.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64490 64490 PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL 852.00 $766.80 $340.80 $681.60 $477.12 $596.40 $545.28 $681.60 $664.56 $383.40 $349.32 $357.84 $340.80 $639.00 $553.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64491 64491 PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL 490.00 $441.00 $196.00 $392.00 $274.40 $343.00 $313.60 $392.00 $382.20 $220.50 $200.90 $205.80 $196.00 $367.50 $318.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64492 64492 PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL 509.00 $458.10 $203.60 $407.20 $285.04 $356.30 $325.76 $407.20 $397.02 $229.05 $208.69 $213.78 $203.60 $381.75 $330.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64493 64493 PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL 797.00 $717.30 $318.80 $637.60 $446.32 $557.90 $510.08 $637.60 $621.66 $358.65 $326.77 $334.74 $318.80 $597.75 $518.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64494 64494 PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL 405.00 $364.50 $162.00 $324.00 $226.80 $283.50 $259.20 $324.00 $315.90 $182.25 $166.05 $170.10 $162.00 $303.75 $263.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64495 64495 PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL 390.00 $351.00 $156.00 $312.00 $218.40 $273.00 $249.60 $312.00 $304.20 $175.50 $159.90 $163.80 $156.00 $292.50 $253.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64505 64505 PR INJECTION ANES AGENT SPHENOPALATINE GANGLION 451.00 $405.90 $180.40 $360.80 $252.56 $315.70 $288.64 $360.80 $351.78 $202.95 $184.91 $189.42 $180.40 $338.25 $293.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64520 64520 PR INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC 735.00 $661.50 $294.00 $588.00 $411.60 $514.50 $470.40 $588.00 $573.30 $330.75 $301.35 $308.70 $294.00 $551.25 $477.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64615 64615 PR CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE 984.00 $885.60 $393.60 $787.20 $551.04 $688.80 $629.76 $787.20 $767.52 $442.80 $403.44 $413.28 $393.60 $738.00 $639.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64624 64624 PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG 272.00 $244.80 $108.80 $217.60 $152.32 $190.40 $174.08 $217.60 $212.16 $122.40 $111.52 $114.24 $108.80 $204.00 $176.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64625 64625 PR RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN 361.00 $324.90 $144.40 $288.80 $202.16 $252.70 $231.04 $288.80 $281.58 $162.45 $148.01 $151.62 $144.40 $270.75 $234.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64633 64633 PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA 410.00 $369.00 $164.00 $328.00 $229.60 $287.00 $262.40 $328.00 $319.80 $184.50 $168.10 $172.20 $164.00 $307.50 $266.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64634 64634 PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA 128.00 $115.20 $51.20 $102.40 $71.68 $89.60 $81.92 $102.40 $99.84 $57.60 $52.48 $53.76 $51.20 $96.00 $83.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64635 64635 PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL 410.00 $369.00 $164.00 $328.00 $229.60 $287.00 $262.40 $328.00 $319.80 $184.50 $168.10 $172.20 $164.00 $307.50 $266.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64636 64636 PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL 111.00 $99.90 $44.40 $88.80 $62.16 $77.70 $71.04 $88.80 $86.58 $49.95 $45.51 $46.62 $44.40 $83.25 $72.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64640 64640 PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE 773.00 $695.70 $309.20 $618.40 $432.88 $541.10 $494.72 $618.40 $602.94 $347.85 $316.93 $324.66 $309.20 $579.75 $502.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64718 64718 PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW "3,592.00" " $3,232.80 " " $1,436.80 " " $2,873.60 " " $2,011.52 " " $2,514.40 " " $2,298.88 " " $2,873.60 " " $2,801.76 " " $1,616.40 " " $1,472.72 " " $1,508.64 " " $1,436.80 " " $2,694.00 " " $2,334.80 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64721 64721 PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE "2,817.00" " $2,535.30 " " $1,126.80 " " $2,253.60 " " $1,577.52 " " $1,971.90 " " $1,802.88 " " $2,253.60 " " $2,197.26 " " $1,267.65 " " $1,154.97 " " $1,183.14 " " $1,126.80 " " $2,112.75 " " $1,831.05 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64726 64726 PR DECOMPRESSION PLANTAR DIGITAL NERVE "1,294.00" " $1,164.60 " $517.60 " $1,035.20 " $724.64 $905.80 $828.16 " $1,035.20 " " $1,009.32 " $582.30 $530.54 $543.48 $517.60 $970.50 $841.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64782 64782 PR EXC NEUROMA HAND/FOOT XCP DIGITAL NERVE "1,730.00" " $1,557.00 " $692.00 " $1,384.00 " $968.80 " $1,211.00 " " $1,107.20 " " $1,384.00 " " $1,349.40 " $778.50 $709.30 $726.60 $692.00 " $1,297.50 " " $1,124.50 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 64999 64999 PR UNLISTED PROCEDURE NERVOUS SYSTEM 735.00 $661.50 $294.00 $588.00 $411.60 $514.50 $470.40 $588.00 $573.30 $330.75 $301.35 $308.70 $294.00 $551.25 $477.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 65205 65205 PR REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL 235.00 $211.50 $94.00 $188.00 $131.60 $164.50 $150.40 $188.00 $183.30 $105.75 $96.35 $98.70 $94.00 $176.25 $152.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 65210 65210 PR RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR 310.00 $279.00 $124.00 $248.00 $173.60 $217.00 $198.40 $248.00 $241.80 $139.50 $127.10 $130.20 $124.00 $232.50 $201.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 65220 65220 PR RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP 302.00 $271.80 $120.80 $241.60 $169.12 $211.40 $193.28 $241.60 $235.56 $135.90 $123.82 $126.84 $120.80 $226.50 $196.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 65222 65222 PR RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP 250.00 $225.00 $100.00 $200.00 $140.00 $175.00 $160.00 $200.00 $195.00 $112.50 $102.50 $105.00 $100.00 $187.50 $162.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 65435 65435 PR RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION 250.00 $225.00 $100.00 $200.00 $140.00 $175.00 $160.00 $200.00 $195.00 $112.50 $102.50 $105.00 $100.00 $187.50 $162.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 66821 66821 PR POST-CATARACT LASER SURGERY "1,398.00" " $1,258.20 " $559.20 " $1,118.40 " $782.88 $978.60 $894.72 " $1,118.40 " " $1,090.44 " $629.10 $573.18 $587.16 $559.20 " $1,048.50 " $908.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 66982 66982 PR XCAPSULAR CATARACT RMVL INSJ LENS PROSTH 1 STG "4,005.00" " $3,604.50 " " $1,602.00 " " $3,204.00 " " $2,242.80 " " $2,803.50 " " $2,563.20 " " $3,204.00 " " $3,123.90 " " $1,802.25 " " $1,642.05 " " $1,682.10 " " $1,602.00 " " $3,003.75 " " $2,603.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 66984 66984 PR CATARACT REMOVAL INSERTION OF LENS "3,085.00" " $2,776.50 " " $1,234.00 " " $2,468.00 " " $1,727.60 " " $2,159.50 " " $1,974.40 " " $2,468.00 " " $2,406.30 " " $1,388.25 " " $1,264.85 " " $1,295.70 " " $1,234.00 " " $2,313.75 " " $2,005.25 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 66999 66999 PR UNLISTED PROCEDURE ANTERIOR SEGMENT EYE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 67700 67700 PR BLEPHAROTOMY DRAINAGE ABSCESS EYELID "1,104.00" $993.60 $441.60 $883.20 $618.24 $772.80 $706.56 $883.20 $861.12 $496.80 $452.64 $463.68 $441.60 $828.00 $717.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 67820 67820 PR CORRECTION TRICHIASIS EPILATION FORCEPS ONLY 220.00 $198.00 $88.00 $176.00 $123.20 $154.00 $140.80 $176.00 $171.60 $99.00 $90.20 $92.40 $88.00 $165.00 $143.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 67850 67850 PR DESTRUCTION LESION LID MARGIN FETUSES 610.00 $549.00 $244.00 $488.00 $341.60 $427.00 $390.40 $488.00 $475.80 $274.50 $250.10 $256.20 $244.00 $457.50 $396.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 76815.22 76815 PR OB LIMITED 1 OR MORE FETUSES 610.00 $549.00 $244.00 $488.00 $341.60 $427.00 $390.40 $488.00 $475.80 $274.50 $250.10 $256.20 $244.00 $457.50 $396.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 76942 76942 PR US GUIDANCE NEEDLE PLACEMENT IMG S&I 278.00 $250.20 $111.20 $222.40 $155.68 $194.60 $177.92 $222.40 $216.84 $125.10 $113.98 $116.76 $111.20 $208.50 $180.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 76946 76946 PR US GUIDANCE AMNIOCENTESIS IMG S&I 375.00 $337.50 $150.00 $300.00 $210.00 $262.50 $240.00 $300.00 $292.50 $168.75 $153.75 $157.50 $150.00 $281.25 $243.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 77002 77002 PR FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON 483.00 $434.70 $193.20 $386.40 $270.48 $338.10 $309.12 $386.40 $376.74 $217.35 $198.03 $202.86 $193.20 $362.25 $313.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 81002 81002 PR URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP 14.00 $12.60 $5.60 $11.20 $7.84 $9.80 $8.96 $11.20 $10.92 $6.30 $5.74 $5.88 $5.60 $10.50 $9.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 81003 81003 PR URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY 28.00 $25.20 $11.20 $22.40 $15.68 $19.60 $17.92 $22.40 $21.84 $12.60 $11.48 $11.76 $11.20 $21.00 $18.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 81025 81025 PR GENERAL LAB 8102500 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 82272 82272 PR BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 82947 82947 PR GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 82962 82962 PR GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE 29.00 $26.10 $11.60 $23.20 $16.24 $20.30 $18.56 $23.20 $22.62 $13.05 $11.89 $12.18 $11.60 $21.75 $18.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 84132 84132 PR POTASSIUM SERUM PLASMA/WHOLE BLOOD 59.00 $53.10 $23.60 $47.20 $33.04 $41.30 $37.76 $47.20 $46.02 $26.55 $24.19 $24.78 $23.60 $44.25 $38.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 84295 84295 PR SODIUM SERUM PLASMA OR WHOLE BLOOD 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 84520 84520 PR ASSAY OF UREA NITROGEN QUANTITATIVE 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 85018 85018 PR BLOOD COUNT HEMOGLOBIN 32.00 $28.80 $12.80 $25.60 $17.92 $22.40 $20.48 $25.60 $24.96 $14.40 $13.12 $13.44 $12.80 $24.00 $20.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 85025 85025 PR BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC 96.00 $86.40 $38.40 $76.80 $53.76 $67.20 $61.44 $76.80 $74.88 $43.20 $39.36 $40.32 $38.40 $72.00 $62.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 85610 85610 PR PROTHROMBIN TIME 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 86580 86580 PR SKIN TEST TUBERCULOSIS INTRADERMAL 50.00 $45.00 $20.00 $40.00 $28.00 $35.00 $32.00 $40.00 $39.00 $22.50 $20.50 $21.00 $20.00 $37.50 $32.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 86769 86769 PR SARS-COV-2 COVID-19 ANTIBODY 81.00 $72.90 $32.40 $64.80 $45.36 $56.70 $51.84 $64.80 $63.18 $36.45 $33.21 $34.02 $32.40 $60.75 $52.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 87400 87400 PR IAAD IA INFLUENZA A/B EACH 67.00 $60.30 $26.80 $53.60 $37.52 $46.90 $42.88 $53.60 $52.26 $30.15 $27.47 $28.14 $26.80 $50.25 $43.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 87804 87804 PR IAADIADOO INFLUENZA 128.00 $115.20 $51.20 $102.40 $71.68 $89.60 $81.92 $102.40 $99.84 $57.60 $52.48 $53.76 $51.20 $96.00 $83.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 87880 87880 PR IAADIADOO STREPTOCOCCUS GROUP A 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90375 90375 PR RABIES IMMUNE GLOBULIN RIG HUMAN IM/SUBQ 653.00 $587.70 $261.20 $522.40 $365.68 $457.10 $417.92 $522.40 $509.34 $293.85 $267.73 $274.26 $261.20 $489.75 $424.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90380 90380 PR RSV MONOCLONAL ANTB SEASONAL DOSE 0.5ML IM USE 765.00 $688.50 $306.00 $612.00 $428.40 $535.50 $489.60 $612.00 $596.70 $344.25 $313.65 $321.30 $306.00 $573.75 $497.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90381 90381 PR RSV MONOCLONAL ANTB SEASONAL DOSE 1 ML IM USE 765.00 $688.50 $306.00 $612.00 $428.40 $535.50 $489.60 $612.00 $596.70 $344.25 $313.65 $321.30 $306.00 $573.75 $497.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90381 90381 PR RSV MONOCLONAL ANTB SEASONAL DOSE 1 ML IM USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90385 90385 PR RHO(D) IMMUNE GLOBULIN HUMAN MINI-DOSE IM 88.00 $79.20 $35.20 $70.40 $49.28 $61.60 $56.32 $70.40 $68.64 $39.60 $36.08 $36.96 $35.20 $66.00 $57.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90471 90471 PR IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE 20.83 $18.75 $8.33 $16.66 $11.66 $14.58 $13.33 $16.66 $16.25 $9.37 $8.54 $8.75 $8.33 $15.62 $13.54
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90471 90471 PR IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE 32.00 $28.80 $12.80 $25.60 $17.92 $22.40 $20.48 $25.60 $24.96 $14.40 $13.12 $13.44 $12.80 $24.00 $20.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90472 90472 PR IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE 27.00 $24.30 $10.80 $21.60 $15.12 $18.90 $17.28 $21.60 $21.06 $12.15 $11.07 $11.34 $10.80 $20.25 $17.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90473 90473 PR IM ADM INTRANSL/ORAL 1 VACCINE 30.00 $27.00 $12.00 $24.00 $16.80 $21.00 $19.20 $24.00 $23.40 $13.50 $12.30 $12.60 $12.00 $22.50 $19.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90474 90474 PR IM ADM INTRANSL/ORAL EA VACCINE 25.00 $22.50 $10.00 $20.00 $14.00 $17.50 $16.00 $20.00 $19.50 $11.25 $10.25 $10.50 $10.00 $18.75 $16.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90480 90480 PR IMM ADMN SARSCOV2 VACCINE SINGLE DOSE 66.00 $59.40 $26.40 $52.80 $36.96 $46.20 $42.24 $52.80 $51.48 $29.70 $27.06 $27.72 $26.40 $49.50 $42.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90620 90620 PR MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM 262.00 $235.80 $104.80 $209.60 $146.72 $183.40 $167.68 $209.60 $204.36 $117.90 $107.42 $110.04 $104.80 $196.50 $170.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90632 90632 PR HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE 131.00 $117.90 $52.40 $104.80 $73.36 $91.70 $83.84 $104.80 $102.18 $58.95 $53.71 $55.02 $52.40 $98.25 $85.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90633 90633 PR HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90633 90633 PR HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE 57.00 $51.30 $22.80 $45.60 $31.92 $39.90 $36.48 $45.60 $44.46 $25.65 $23.37 $23.94 $22.80 $42.75 $37.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90636 90636 PR HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM 180.00 $162.00 $72.00 $144.00 $100.80 $126.00 $115.20 $144.00 $140.40 $81.00 $73.80 $75.60 $72.00 $135.00 $117.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90647 90647 PR HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90647 90647 PR HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE 56.00 $50.40 $22.40 $44.80 $31.36 $39.20 $35.84 $44.80 $43.68 $25.20 $22.96 $23.52 $22.40 $42.00 $36.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90648 90648 PR HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90648 90648 PR HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90649 90649 PR 4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90649 90649 PR 4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE 270.00 $243.00 $108.00 $216.00 $151.20 $189.00 $172.80 $216.00 $210.60 $121.50 $110.70 $113.40 $108.00 $202.50 $175.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90651 90651 PR 9VHPV VACC 2/3 DOSE SCHED IM USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90651 90651 PR 9VHPV VACC 2/3 DOSE SCHED IM USE 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90655 90655 PR IIV3 VACC PRESRV FREE 0.25 ML DOSAGE IM USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90655 90655 PR IIV3 VACC PRESRV FREE 0.25 ML DOSAGE IM USE 35.00 $31.50 $14.00 $28.00 $19.60 $24.50 $22.40 $28.00 $27.30 $15.75 $14.35 $14.70 $14.00 $26.25 $22.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90656 90656 PR IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE 24.00 $21.60 $9.60 $19.20 $13.44 $16.80 $15.36 $19.20 $18.72 $10.80 $9.84 $10.08 $9.60 $18.00 $15.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90656 90656 PR IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90658 90658 PR IIV3 VACCINE SPLIT VIRUS 0.5 ML DOSAGE IM USE 24.00 $21.60 $9.60 $19.20 $13.44 $16.80 $15.36 $19.20 $18.72 $10.80 $9.84 $10.08 $9.60 $18.00 $15.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90658 90658 PR IIV3 VACCINE SPLIT VIRUS 0.5 ML DOSAGE IM USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90660 90660 PR LAIV3 VACCINE LIVE FOR INTRANASAL USE 52.00 $46.80 $20.80 $41.60 $29.12 $36.40 $33.28 $41.60 $40.56 $23.40 $21.32 $21.84 $20.80 $39.00 $33.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90660 90660 PR LAIV3 VACCINE LIVE FOR INTRANASAL USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90661 90661 PR CCIIV3 VACCINE PRESERVATIVE FREE 0.5 ML IM USE 37.00 $33.30 $14.80 $29.60 $20.72 $25.90 $23.68 $29.60 $28.86 $16.65 $15.17 $15.54 $14.80 $27.75 $24.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90662 90662 PR IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM 59.00 $53.10 $23.60 $47.20 $33.04 $41.30 $37.76 $47.20 $46.02 $26.55 $24.19 $24.78 $23.60 $44.25 $38.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90670 90670 PR PCV13 VACCINE FOR INTRAMUSCULAR USE 266.00 $239.40 $106.40 $212.80 $148.96 $186.20 $170.24 $212.80 $207.48 $119.70 $109.06 $111.72 $106.40 $199.50 $172.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90670 90670 PR PCV13 VACCINE FOR INTRAMUSCULAR USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90672 90672 PR LAIV4 VACCINE FOR INTRANASAL USE 50.00 $45.00 $20.00 $40.00 $28.00 $35.00 $32.00 $40.00 $39.00 $22.50 $20.50 $21.00 $20.00 $37.50 $32.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90672 90672 PR LAIV4 VACCINE FOR INTRANASAL USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90673 90673 PR RIV3 VACCINE PRESERVATIVE FREE FOR IM USE 63.00 $56.70 $25.20 $50.40 $35.28 $44.10 $40.32 $50.40 $49.14 $28.35 $25.83 $26.46 $25.20 $47.25 $40.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90675 90675 PR RABIES VACCINE INTRAMUSCULAR 495.00 $445.50 $198.00 $396.00 $277.20 $346.50 $316.80 $396.00 $386.10 $222.75 $202.95 $207.90 $198.00 $371.25 $321.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90677 90677 PR PCV20 VACCINE FOR INTRAMUSCULAR USE 495.00 $445.50 $198.00 $396.00 $277.20 $346.50 $316.80 $396.00 $386.10 $222.75 $202.95 $207.90 $198.00 $371.25 $321.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90677 90677 PR PCV20 VACCINE FOR INTRAMUSCULAR USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90678 90678 PR RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE 425.00 $382.50 $170.00 $340.00 $238.00 $297.50 $272.00 $340.00 $331.50 $191.25 $174.25 $178.50 $170.00 $318.75 $276.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90679 90679 PR RSV VACC PREF RECOMBINANT ADJUVANTED FOR IM USE 433.00 $389.70 $173.20 $346.40 $242.48 $303.10 $277.12 $346.40 $337.74 $194.85 $177.53 $181.86 $173.20 $324.75 $281.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90680 90680 PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE 119.00 $107.10 $47.60 $95.20 $66.64 $83.30 $76.16 $95.20 $92.82 $53.55 $48.79 $49.98 $47.60 $89.25 $77.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90680 90680 PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90681 90681 PR RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE 172.00 $154.80 $68.80 $137.60 $96.32 $120.40 $110.08 $137.60 $134.16 $77.40 $70.52 $72.24 $68.80 $129.00 $111.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90681 90681 PR RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90682 90682 PR RIV4 VACC RECOMBINANT DNA PRSRV ANTIBIO FREE IM 59.00 $53.10 $23.60 $47.20 $33.04 $41.30 $37.76 $47.20 $46.02 $26.55 $24.19 $24.78 $23.60 $44.25 $38.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90685 90685 PR IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE 28.00 $25.20 $11.20 $22.40 $15.68 $19.60 $17.92 $22.40 $21.84 $12.60 $11.48 $11.76 $11.20 $21.00 $18.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90685 90685 PR IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90686 90686 PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE 20.00 $18.00 $8.00 $16.00 $11.20 $14.00 $12.80 $16.00 $15.60 $9.00 $8.20 $8.40 $8.00 $15.00 $13.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90686 90686 PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90687 90687 PR IIV4 VACC SPLIT VIRUS 0.25 ML DOS FOR IM USE 20.00 $18.00 $8.00 $16.00 $11.20 $14.00 $12.80 $16.00 $15.60 $9.00 $8.20 $8.40 $8.00 $15.00 $13.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90687 90687 PR IIV4 VACC SPLIT VIRUS 0.25 ML DOS FOR IM USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90688 90688 PR IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90688 90688 PR IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE 20.00 $18.00 $8.00 $16.00 $11.20 $14.00 $12.80 $16.00 $15.60 $9.00 $8.20 $8.40 $8.00 $15.00 $13.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90691 90691 PR TYPHOID VACCINE VI CAPSULAR POLYSACCHARIDE IM 150.00 $135.00 $60.00 $120.00 $84.00 $105.00 $96.00 $120.00 $117.00 $67.50 $61.50 $63.00 $60.00 $112.50 $97.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90696 90696 PR DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE 102.00 $91.80 $40.80 $81.60 $57.12 $71.40 $65.28 $81.60 $79.56 $45.90 $41.82 $42.84 $40.80 $76.50 $66.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90696 90696 PR DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90698 90698 PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE 407.00 $366.30 $162.80 $325.60 $227.92 $284.90 $260.48 $325.60 $317.46 $183.15 $166.87 $170.94 $162.80 $305.25 $264.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90698 90698 PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90700 90700 PR DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90700 90700 PR DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM 39.00 $35.10 $15.60 $31.20 $21.84 $27.30 $24.96 $31.20 $30.42 $17.55 $15.99 $16.38 $15.60 $29.25 $25.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90702 90702 PR DT VACCINE YOUNGER THAN 7 YRS FOR IM USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90702 90702 PR DT VACCINE YOUNGER THAN 7 YRS FOR IM USE 48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90707 90707 PR MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ 121.00 $108.90 $48.40 $96.80 $67.76 $84.70 $77.44 $96.80 $94.38 $54.45 $49.61 $50.82 $48.40 $90.75 $78.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90707 90707 PR MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90710 90710 PR MEASLES MUMPS RUBELLA VARICELLA VACC LIVE SUBQ 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90710 90710 PR MEASLES MUMPS RUBELLA VARICELLA VACC LIVE SUBQ 294.00 $264.60 $117.60 $235.20 $164.64 $205.80 $188.16 $235.20 $229.32 $132.30 $120.54 $123.48 $117.60 $220.50 $191.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90713 90713 PR POLIOVIRUS VACCINE INACTIVATED SUBQ/IM 47.00 $42.30 $18.80 $37.60 $26.32 $32.90 $30.08 $37.60 $36.66 $21.15 $19.27 $19.74 $18.80 $35.25 $30.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90713 90713 PR POLIOVIRUS VACCINE INACTIVATED SUBQ/IM 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90714 90714 PR TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE 48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90714 90714 PR TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90715 90715 PR TDAP VACCINE 7 YRS/> IM 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90715 90715 PR TDAP VACCINE 7 YRS/> IM 74.00 $66.60 $29.60 $59.20 $41.44 $51.80 $47.36 $59.20 $57.72 $33.30 $30.34 $31.08 $29.60 $55.50 $48.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90716 90716 PR VAR VACCINE LIVE FOR SUBCUTANEOUS USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90716 90716 PR VAR VACCINE LIVE FOR SUBCUTANEOUS USE 197.00 $177.30 $78.80 $157.60 $110.32 $137.90 $126.08 $157.60 $153.66 $88.65 $80.77 $82.74 $78.80 $147.75 $128.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90723 90723 PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR 148.00 $133.20 $59.20 $118.40 $82.88 $103.60 $94.72 $118.40 $115.44 $66.60 $60.68 $62.16 $59.20 $111.00 $96.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90723 90723 PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90732 90732 PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE 147.00 $132.30 $58.80 $117.60 $82.32 $102.90 $94.08 $117.60 $114.66 $66.15 $60.27 $61.74 $58.80 $110.25 $95.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90733 90733 PR MPSV4 VACCINE GROUPS ACYW-135 SUBQ USE 199.00 $179.10 $79.60 $159.20 $111.44 $139.30 $127.36 $159.20 $155.22 $89.55 $81.59 $83.58 $79.60 $149.25 $129.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90733 90733 PR MPSV4 VACCINE GROUPS ACYW-135 SUBQ USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90734 90734 PR MCV4/MENACWY CONJ VACC GRPS ACYW-135 IM USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90734 90734 PR MCV4/MENACWY CONJ VACC GRPS ACYW-135 IM USE 193.00 $173.70 $77.20 $154.40 $108.08 $135.10 $123.52 $154.40 $150.54 $86.85 $79.13 $81.06 $77.20 $144.75 $125.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90736 90736 PR ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE 346.00 $311.40 $138.40 $276.80 $193.76 $242.20 $221.44 $276.80 $269.88 $155.70 $141.86 $145.32 $138.40 $259.50 $224.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90738 90738 PR JAPANESE ENCEPHALITIS VACCINE INACTIVATED IM 468.00 $421.20 $187.20 $374.40 $262.08 $327.60 $299.52 $374.40 $365.04 $210.60 $191.88 $196.56 $187.20 $351.00 $304.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90744 90744 PR HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM 49.00 $44.10 $19.60 $39.20 $27.44 $34.30 $31.36 $39.20 $38.22 $22.05 $20.09 $20.58 $19.60 $36.75 $31.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90744 90744 PR HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90746 90746 PR HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE 133.00 $119.70 $53.20 $106.40 $74.48 $93.10 $85.12 $106.40 $103.74 $59.85 $54.53 $55.86 $53.20 $99.75 $86.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90750 90750 PR HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX 234.00 $210.60 $93.60 $187.20 $131.04 $163.80 $149.76 $187.20 $182.52 $105.30 $95.94 $98.28 $93.60 $175.50 $152.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90785 90785 PR PSYCHOTHERAPY COMPLEX INTERACTIVE 27.00 $24.30 $10.80 $21.60 $15.12 $18.90 $17.28 $21.60 $21.06 $12.15 $11.07 $11.34 $10.80 $20.25 $17.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90791 90791 PR PSYCHIATRIC DIAGNOSTIC EVALUATION 342.00 $307.80 $136.80 $273.60 $191.52 $239.40 $218.88 $273.60 $266.76 $153.90 $140.22 $143.64 $136.80 $256.50 $222.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90792 90792 PR PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES 533.00 $479.70 $213.20 $426.40 $298.48 $373.10 $341.12 $426.40 $415.74 $239.85 $218.53 $223.86 $213.20 $399.75 $346.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90832 90832 PR PSYCHOTHERAPY W/PATIENT 30 MINUTES 142.00 $127.80 $56.80 $113.60 $79.52 $99.40 $90.88 $113.60 $110.76 $63.90 $58.22 $59.64 $56.80 $106.50 $92.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90833 90833 PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 30 MIN 116.00 $104.40 $46.40 $92.80 $64.96 $81.20 $74.24 $92.80 $90.48 $52.20 $47.56 $48.72 $46.40 $87.00 $75.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90834 90834 PR PSYCHOTHERAPY W/PATIENT 45 MINUTES 183.00 $164.70 $73.20 $146.40 $102.48 $128.10 $117.12 $146.40 $142.74 $82.35 $75.03 $76.86 $73.20 $137.25 $118.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90836 90836 PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 45 MIN 188.00 $169.20 $75.20 $150.40 $105.28 $131.60 $120.32 $150.40 $146.64 $84.60 $77.08 $78.96 $75.20 $141.00 $122.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90837 90837 PR PSYCHOTHERAPY W/PATIENT 60 MINUTES 191.00 $171.90 $76.40 $152.80 $106.96 $133.70 $122.24 $152.80 $148.98 $85.95 $78.31 $80.22 $76.40 $143.25 $124.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90838 90838 PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 60 MIN 252.00 $226.80 $100.80 $201.60 $141.12 $176.40 $161.28 $201.60 $196.56 $113.40 $103.32 $105.84 $100.80 $189.00 $163.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90839 90839 PR PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES 281.00 $252.90 $112.40 $224.80 $157.36 $196.70 $179.84 $224.80 $219.18 $126.45 $115.21 $118.02 $112.40 $210.75 $182.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90840 90840 PR PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES 160.00 $144.00 $64.00 $128.00 $89.60 $112.00 $102.40 $128.00 $124.80 $72.00 $65.60 $67.20 $64.00 $120.00 $104.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90846 90846 PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS 179.00 $161.10 $71.60 $143.20 $100.24 $125.30 $114.56 $143.20 $139.62 $80.55 $73.39 $75.18 $71.60 $134.25 $116.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90847 90847 PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS 226.00 $203.40 $90.40 $180.80 $126.56 $158.20 $144.64 $180.80 $176.28 $101.70 $92.66 $94.92 $90.40 $169.50 $146.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90849 90849 PR MULTIPLE FAMILY GROUP PSYCHOTHERAPY 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 90853 90853 PR GROUP PSYCHOTHERAPY 72.00 $64.80 $28.80 $57.60 $40.32 $50.40 $46.08 $57.60 $56.16 $32.40 $29.52 $30.24 $28.80 $54.00 $46.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 91010 91010 PR ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT 212.00 $190.80 $84.80 $169.60 $118.72 $148.40 $135.68 $169.60 $165.36 $95.40 $86.92 $89.04 $84.80 $159.00 $137.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 91035 91035 PR GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD "1,206.00" " $1,085.40 " $482.40 $964.80 $675.36 $844.20 $771.84 $964.80 $940.68 $542.70 $494.46 $506.52 $482.40 $904.50 $783.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 91110 91110 PR GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R 345.00 $310.50 $138.00 $276.00 $193.20 $241.50 $220.80 $276.00 $269.10 $155.25 $141.45 $144.90 $138.00 $258.75 $224.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 91300 91300 (IA) PR SARSCOV2 VACC DIL RECON 30 MCG/0.3 ML (PFIZER) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 91301 91301 (IA) PR SARSCOV2 VACC 100 MCG/0.5 ML (MODERNA) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 91303 91303 (IA) PR SARSCOV2 VACC AD26 VP/0.5ML (JANSSEN) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 91305 91305 (IA) PR SARSCOV2 VACC TRIS-SUCROSE 30 MCG/0.3 ML (PFIZER) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 91306 91306 (IA) PR SARSCOV2 VACC 50 MCG/0.25 ML (MODERNA) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 91307 91307 (IA) PR SARSCOV2 VACC TRIS-SUCROSE 10 MCG/0.2 ML (PFIZER) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 91311 91311 (IA) PR SARSCOV2 VACC 25 MCG/0.25 ML (MODERNA) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 91312 91312 (IA) PR SARSCOV2 VACC BIVALENT 30 MCG/0.3 ML (PFIZER) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 91313 91313 (IA) PR SARSCOV2 VACC BIVALENT 50 MCG/0.5 ML (MODERNA) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 91314 91314 (IA) PR SARSCOV2 VACC BIVALENT 25 MCG/0.25 ML (MODERNA) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 91315 91315 (IA) PR SARSCOV2 VACC BIVALENT 10 MCG/0.2 ML (PFIZER) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 91316 91316 (IA) PR SARSCOV2 VACC BIVALENT 10 MCG/0.2 ML (MODERNA) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 91317 91317 (IA) PR SARSCOV2 VACC BIVALENT 3 MCG/0.2 ML (PFIZER) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 91321 91321 PR SARSCOV2 VACCINE 25 MCG/0.25 ML FOR IM USE (MODERNA) 178.00 $160.20 $71.20 $142.40 $99.68 $124.60 $113.92 $142.40 $138.84 $80.10 $72.98 $74.76 $71.20 $133.50 $115.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 91322 91322 PR SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE (MODERNA) 185.00 $166.50 $74.00 $148.00 $103.60 $129.50 $118.40 $148.00 $144.30 $83.25 $75.85 $77.70 $74.00 $138.75 $120.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 91322 91322 PR SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE (MODERNA) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92002 92002 PR OPHTH MEDICAL XM&EVAL INTERMEDIATE NEW PT 158.00 $142.20 $63.20 $126.40 $88.48 $110.60 $101.12 $126.40 $123.24 $71.10 $64.78 $66.36 $63.20 $118.50 $102.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92004 92004 PR OPHTH MEDICAL XM&EVAL COMPRE NEW PT 1/> VST 93.00 $83.70 $37.20 $74.40 $52.08 $65.10 $59.52 $74.40 $72.54 $41.85 $38.13 $39.06 $37.20 $69.75 $60.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92012 92012 PR OPHTH MEDICAL XM&EVAL INTERMEDIATE ESTAB PT 56.00 $50.40 $22.40 $44.80 $31.36 $39.20 $35.84 $44.80 $43.68 $25.20 $22.96 $23.52 $22.40 $42.00 $36.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92014 92014 PR OPHTH MEDICAL XM&EVAL COMPRHNSV ESTAB PT 1/> 93.00 $83.70 $37.20 $74.40 $52.08 $65.10 $59.52 $74.40 $72.54 $41.85 $38.13 $39.06 $37.20 $69.75 $60.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92015 92015 PR DETERMINATION REFRACTIVE STATE 26.00 $23.40 $10.40 $20.80 $14.56 $18.20 $16.64 $20.80 $20.28 $11.70 $10.66 $10.92 $10.40 $19.50 $16.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92020 92020 PR GONIOSCOPY SEPARATE PROCEDURE 59.00 $53.10 $23.60 $47.20 $33.04 $41.30 $37.76 $47.20 $46.02 $26.55 $24.19 $24.78 $23.60 $44.25 $38.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92071 92071 PR FIT CONTACT LENS TX OCULAR SURFACE DISEASE 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92072 92072 PR FITTING CONTACT LENS FOR MNGT OF KERATOCONUS 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92081 92081 PR VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM 92.00 $82.80 $36.80 $73.60 $51.52 $64.40 $58.88 $73.60 $71.76 $41.40 $37.72 $38.64 $36.80 $69.00 $59.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92082 92082 PR VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM 142.00 $127.80 $56.80 $113.60 $79.52 $99.40 $90.88 $113.60 $110.76 $63.90 $58.22 $59.64 $56.80 $106.50 $92.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92083 92083 PR VISUAL FIELD XM UNI/BI W/INTERP EXTENDED EXAM 186.00 $167.40 $74.40 $148.80 $104.16 $130.20 $119.04 $148.80 $145.08 $83.70 $76.26 $78.12 $74.40 $139.50 $120.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92133 92133 PR COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92134 92134 PR COMPUTERIZED OPHTHALMIC IMAGING RETINA 96.00 $86.40 $38.40 $76.80 $53.76 $67.20 $61.44 $76.80 $74.88 $43.20 $39.36 $40.32 $38.40 $72.00 $62.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92250 92250 PR FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92285 92285 PR XTRNL OCULAR PHOTOG W/I&R DOCMT MEDICAL PROGRE 32.00 $28.80 $12.80 $25.60 $17.92 $22.40 $20.48 $25.60 $24.96 $14.40 $13.12 $13.44 $12.80 $24.00 $20.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92310 92310 PR RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK 46.00 $41.40 $18.40 $36.80 $25.76 $32.20 $29.44 $36.80 $35.88 $20.70 $18.86 $19.32 $18.40 $34.50 $29.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92310.10 92310 PR EVAL RENEW TXDIFFERENT MATERIAL 46.00 $41.40 $18.40 $36.80 $25.76 $32.20 $29.44 $36.80 $35.88 $20.70 $18.86 $19.32 $18.40 $34.50 $29.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92310.11 92310 PR EVAL OF SOFT DISPOSABLE AND DAILY 36.00 $32.40 $14.40 $28.80 $20.16 $25.20 $23.04 $28.80 $28.08 $16.20 $14.76 $15.12 $14.40 $27.00 $23.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92310.12 92310 (IA) PR CONTACT LENS FITTING BILAT 36.00 $32.40 $14.40 $28.80 $20.16 $25.20 $23.04 $28.80 $28.08 $16.20 $14.76 $15.12 $14.40 $27.00 $23.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92310.2 92310 PR EVAL COMPLEX CHANGE IN PARAMETERS 46.00 $41.40 $18.40 $36.80 $25.76 $32.20 $29.44 $36.80 $35.88 $20.70 $18.86 $19.32 $18.40 $34.50 $29.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92310.3 92310 PR EVAL OF SOFT TORIC 46.00 $41.40 $18.40 $36.80 $25.76 $32.20 $29.44 $36.80 $35.88 $20.70 $18.86 $19.32 $18.40 $34.50 $29.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92310.6 92310 PR EVAL OF BIFOCAL SOFTRGP DISPOSAL AFFILIATE ONLY 46.00 $41.40 $18.40 $36.80 $25.76 $32.20 $29.44 $36.80 $35.88 $20.70 $18.86 $19.32 $18.40 $34.50 $29.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92310.8 92310 PR EVAL OF RGP 46.00 $41.40 $18.40 $36.80 $25.76 $32.20 $29.44 $36.80 $35.88 $20.70 $18.86 $19.32 $18.40 $34.50 $29.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92504 92504 PR BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE 107.00 $96.30 $42.80 $85.60 $59.92 $74.90 $68.48 $85.60 $83.46 $48.15 $43.87 $44.94 $42.80 $80.25 $69.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92551 92551 PR SCREENING TEST PURE TONE AIR ONLY 46.00 $41.40 $18.40 $36.80 $25.76 $32.20 $29.44 $36.80 $35.88 $20.70 $18.86 $19.32 $18.40 $34.50 $29.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92567 92567 PR TYMPANOMETRY 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92950 92950 PR CARDIOPULMONARY RESUSCITATION "1,266.00" " $1,139.40 " $506.40 " $1,012.80 " $708.96 $886.20 $810.24 " $1,012.80 " $987.48 $569.70 $519.06 $531.72 $506.40 $949.50 $822.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 92960 92960 PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL "1,303.00" " $1,172.70 " $521.20 " $1,042.40 " $729.68 $912.10 $833.92 " $1,042.40 " " $1,016.34 " $586.35 $534.23 $547.26 $521.20 $977.25 $846.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 93000 93000 PR ECG ROUTINE ECG W/LEAST 12 LDS W/I&R 224.00 $201.60 $89.60 $179.20 $125.44 $156.80 $143.36 $179.20 $174.72 $100.80 $91.84 $94.08 $89.60 $168.00 $145.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 93005 93005 PR ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R 147.00 $132.30 $58.80 $117.60 $82.32 $102.90 $94.08 $117.60 $114.66 $66.15 $60.27 $61.74 $58.80 $110.25 $95.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 93016 93016 PR CV STRS TST XERS&/OR RX CONT ECG W/O I&R 157.00 $141.30 $62.80 $125.60 $87.92 $109.90 $100.48 $125.60 $122.46 $70.65 $64.37 $65.94 $62.80 $117.75 $102.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 93018 93018 PR CV STRS TST XERS&/OR RX CONT ECG I&R ONLY 258.00 $232.20 $103.20 $206.40 $144.48 $180.60 $165.12 $206.40 $201.24 $116.10 $105.78 $108.36 $103.20 $193.50 $167.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 93040 93040 PR RHYTHM ECG 1-3 LEADS W/INTERPRETATION & REPORT 71.00 $63.90 $28.40 $56.80 $39.76 $49.70 $45.44 $56.80 $55.38 $31.95 $29.11 $29.82 $28.40 $53.25 $46.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 93279 93279 PR PRGRMG DEV EVAL 1 LEAD PM/LDLS PM 1 CAR CHMBR IP 324.00 $291.60 $129.60 $259.20 $181.44 $226.80 $207.36 $259.20 $252.72 $145.80 $132.84 $136.08 $129.60 $243.00 $210.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 93280 93280 PR PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER 300.00 $270.00 $120.00 $240.00 $168.00 $210.00 $192.00 $240.00 $234.00 $135.00 $123.00 $126.00 $120.00 $225.00 $195.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 93281 93281 PR PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER 213.00 $191.70 $85.20 $170.40 $119.28 $149.10 $136.32 $170.40 $166.14 $95.85 $87.33 $89.46 $85.20 $159.75 $138.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 93282 93282 PR PRGRMNG DEV EVAL IMPLANTABLE IN PERSN 1 LD DFB 306.00 $275.40 $122.40 $244.80 $171.36 $214.20 $195.84 $244.80 $238.68 $137.70 $125.46 $128.52 $122.40 $229.50 $198.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 93283 93283 PR PRGRMG EVAL IMPLANTABLE IN PRSN DUAL LEAD DFB 248.00 $223.20 $99.20 $198.40 $138.88 $173.60 $158.72 $198.40 $193.44 $111.60 $101.68 $104.16 $99.20 $186.00 $161.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 93284 93284 PR PRGRMG EVAL IMPLANTABLE IN PERSON MULTI LEAD DFB 280.00 $252.00 $112.00 $224.00 $156.80 $196.00 $179.20 $224.00 $218.40 $126.00 $114.80 $117.60 $112.00 $210.00 $182.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 93285 93285 PR PRGRMG DEV EVAL SCRMS PHYS/QHP IN PERSON 130.00 $117.00 $52.00 $104.00 $72.80 $91.00 $83.20 $104.00 $101.40 $58.50 $53.30 $54.60 $52.00 $97.50 $84.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 93286 93286 PR PERI-PX DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON 78.00 $70.20 $31.20 $62.40 $43.68 $54.60 $49.92 $62.40 $60.84 $35.10 $31.98 $32.76 $31.20 $58.50 $50.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 93287 93287 PR PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB 176.00 $158.40 $70.40 $140.80 $98.56 $123.20 $112.64 $140.80 $137.28 $79.20 $72.16 $73.92 $70.40 $132.00 $114.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 93288 93288 PR INTERROG DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON 229.00 $206.10 $91.60 $183.20 $128.24 $160.30 $146.56 $183.20 $178.62 $103.05 $93.89 $96.18 $91.60 $171.75 $148.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 93289 93289 PR INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB 184.00 $165.60 $73.60 $147.20 $103.04 $128.80 $117.76 $147.20 $143.52 $82.80 $75.44 $77.28 $73.60 $138.00 $119.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 93290 93290 PR INTERROG DEV EVAL ICPMS PHYS/QHP IN PERSON 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 93291 93291 PR INTERROG DEV EVAL SCRMS PHYS/QHP IN PERSON 116.00 $104.40 $46.40 $92.80 $64.96 $81.20 $74.24 $92.80 $90.48 $52.20 $47.56 $48.72 $46.40 $87.00 $75.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 93293 93293 PR TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL 146.00 $131.40 $58.40 $116.80 $81.76 $102.20 $93.44 $116.80 $113.88 $65.70 $59.86 $61.32 $58.40 $109.50 $94.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 93294 93294 PR REM INTERROG PM/LDLS PM <90 D PHYS/QHP 205.00 $184.50 $82.00 $164.00 $114.80 $143.50 $131.20 $164.00 $159.90 $92.25 $84.05 $86.10 $82.00 $153.75 $133.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 93295 93295 PR INTERROGATION EVAL REMOTE HR REVIEW 110.00 $99.00 $44.00 $88.00 $61.60 $77.00 $70.40 $88.00 $85.80 $49.50 $45.10 $46.20 $44.00 $82.50 $71.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 94010 94010 PR SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ 214.00 $192.60 $85.60 $171.20 $119.84 $149.80 $136.96 $171.20 $166.92 $96.30 $87.74 $89.88 $85.60 $160.50 $139.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 94060 94060 PR BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN 375.00 $337.50 $150.00 $300.00 $210.00 $262.50 $240.00 $300.00 $292.50 $168.75 $153.75 $157.50 $150.00 $281.25 $243.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 94200 94200 PR MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ 44.00 $39.60 $17.60 $35.20 $24.64 $30.80 $28.16 $35.20 $34.32 $19.80 $18.04 $18.48 $17.60 $33.00 $28.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 94375 94375 PR RESPIRATORY FLOW VOLUME LOOP 127.00 $114.30 $50.80 $101.60 $71.12 $88.90 $81.28 $101.60 $99.06 $57.15 $52.07 $53.34 $50.80 $95.25 $82.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 94640 94640 PR PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT 113.00 $101.70 $45.20 $90.40 $63.28 $79.10 $72.32 $90.40 $88.14 $50.85 $46.33 $47.46 $45.20 $84.75 $73.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 95004 95004 PR PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 95018 95018 PR ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/I&R 68.00 $61.20 $27.20 $54.40 $38.08 $47.60 $43.52 $54.40 $53.04 $30.60 $27.88 $28.56 $27.20 $51.00 $44.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 95024 95024 PR INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS 22.00 $19.80 $8.80 $17.60 $12.32 $15.40 $14.08 $17.60 $17.16 $9.90 $9.02 $9.24 $8.80 $16.50 $14.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 95044 95044 PR PATCH/APPLICATION TEST SPECIFY NUMBER TESTS 36.00 $32.40 $14.40 $28.80 $20.16 $25.20 $23.04 $28.80 $28.08 $16.20 $14.76 $15.12 $14.40 $27.00 $23.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 95076 95076 PR INGESTION CHALLENGE TEST INITIAL 120 MINUTES 328.00 $295.20 $131.20 $262.40 $183.68 $229.60 $209.92 $262.40 $255.84 $147.60 $134.48 $137.76 $131.20 $246.00 $213.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 95115 95115 PR PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX 37.00 $33.30 $14.80 $29.60 $20.72 $25.90 $23.68 $29.60 $28.86 $16.65 $15.17 $15.54 $14.80 $27.75 $24.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 95117 95117 PR PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS 56.00 $50.40 $22.40 $44.80 $31.36 $39.20 $35.84 $44.80 $43.68 $25.20 $22.96 $23.52 $22.40 $42.00 $36.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 95165 95165 PR PREPJ& ALLERGEN IMMUNOTHERAPY 1/MLT ANTIGEN 40.00 $36.00 $16.00 $32.00 $22.40 $28.00 $25.60 $32.00 $31.20 $18.00 $16.40 $16.80 $16.00 $30.00 $26.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 95249 95249 PR CONT GLUC MONITORING PATIENT PROVIDED EQUIPTMENT 202.00 $181.80 $80.80 $161.60 $113.12 $141.40 $129.28 $161.60 $157.56 $90.90 $82.82 $84.84 $80.80 $151.50 $131.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 95250 95250 PR CONT GLUC MNTR PHYSICIAN/QHP PROVIDED EQUIPTMENT 446.00 $401.40 $178.40 $356.80 $249.76 $312.20 $285.44 $356.80 $347.88 $200.70 $182.86 $187.32 $178.40 $334.50 $289.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 95251 95251 PR CONTINUOUS GLUCOSE MONITORING ANALYSIS I&R 204.00 $183.60 $81.60 $163.20 $114.24 $142.80 $130.56 $163.20 $159.12 $91.80 $83.64 $85.68 $81.60 $153.00 $132.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 95806 95806 PR SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT 297.00 $267.30 $118.80 $237.60 $166.32 $207.90 $190.08 $237.60 $231.66 $133.65 $121.77 $124.74 $118.80 $222.75 $193.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 95886 95886 PR NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE 453.00 $407.70 $181.20 $362.40 $253.68 $317.10 $289.92 $362.40 $353.34 $203.85 $185.73 $190.26 $181.20 $339.75 $294.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 95907 95907 PR NERVE CONDUCTION STUDIES 1-2 STUDIES 253.00 $227.70 $101.20 $202.40 $141.68 $177.10 $161.92 $202.40 $197.34 $113.85 $103.73 $106.26 $101.20 $189.75 $164.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 95913 95913 PR NERVE CONDUCTION STUDIES 13/> STUDIES "1,383.00" " $1,244.70 " $553.20 " $1,106.40 " $774.48 $968.10 $885.12 " $1,106.40 " " $1,078.74 " $622.35 $567.03 $580.86 $553.20 " $1,037.25 " $898.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 96105 96105 PR ASSESSMENT APHASIA W/INTERP & REPORT PER HOUR 200.00 $180.00 $80.00 $160.00 $112.00 $140.00 $128.00 $160.00 $156.00 $90.00 $82.00 $84.00 $80.00 $150.00 $130.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 96116 96116 PR NEUROBEHAVIORAL STATUS XM PHYS/QHP 1ST HOUR 254.00 $228.60 $101.60 $203.20 $142.24 $177.80 $162.56 $203.20 $198.12 $114.30 $104.14 $106.68 $101.60 $190.50 $165.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 96127 96127 PR BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 96130 96130 PR PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR 468.00 $421.20 $187.20 $374.40 $262.08 $327.60 $299.52 $374.40 $365.04 $210.60 $191.88 $196.56 $187.20 $351.00 $304.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 96131 96131 PR PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR 365.00 $328.50 $146.00 $292.00 $204.40 $255.50 $233.60 $292.00 $284.70 $164.25 $149.65 $153.30 $146.00 $273.75 $237.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 96132 96132 PR NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR 519.00 $467.10 $207.60 $415.20 $290.64 $363.30 $332.16 $415.20 $404.82 $233.55 $212.79 $217.98 $207.60 $389.25 $337.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 96133 96133 PR NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR 406.00 $365.40 $162.40 $324.80 $227.36 $284.20 $259.84 $324.80 $316.68 $182.70 $166.46 $170.52 $162.40 $304.50 $263.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 96136 96136 PR PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN 207.00 $186.30 $82.80 $165.60 $115.92 $144.90 $132.48 $165.60 $161.46 $93.15 $84.87 $86.94 $82.80 $155.25 $134.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 96137 96137 PR PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN 193.00 $173.70 $77.20 $154.40 $108.08 $135.10 $123.52 $154.40 $150.54 $86.85 $79.13 $81.06 $77.20 $144.75 $125.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 96156 96156 PR HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT 217.00 $195.30 $86.80 $173.60 $121.52 $151.90 $138.88 $173.60 $169.26 $97.65 $88.97 $91.14 $86.80 $162.75 $141.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 96158 96158 PR HEALTH BEHAVIOR IVNTJ INDIV F2F 1ST 30 MIN 122.00 $109.80 $48.80 $97.60 $68.32 $85.40 $78.08 $97.60 $95.16 $54.90 $50.02 $51.24 $48.80 $91.50 $79.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 96159 96159 PR HEALTH BEHAVIOR IVNTJ INDIV F2F EA ADDL 15 MIN 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 96372 96372 PR THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM 68.00 $61.20 $27.20 $54.40 $38.08 $47.60 $43.52 $54.40 $53.04 $30.60 $27.88 $28.56 $27.20 $51.00 $44.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 97140.2 97140 PR CHIRO MANUAL THERAPY EA 15 MIN 74.00 $66.60 $29.60 $59.20 $41.44 $51.80 $47.36 $59.20 $57.72 $33.30 $30.34 $31.08 $29.60 $55.50 $48.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 97597 97597 PR DEBRIDEMENT OPEN WOUND 20 SQ CM/< 153.00 $137.70 $61.20 $122.40 $85.68 $107.10 $97.92 $122.40 $119.34 $68.85 $62.73 $64.26 $61.20 $114.75 $99.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 97598 97598 PR DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM 151.00 $135.90 $60.40 $120.80 $84.56 $105.70 $96.64 $120.80 $117.78 $67.95 $61.91 $63.42 $60.40 $113.25 $98.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 97602 97602 PR RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS 116.00 $104.40 $46.40 $92.80 $64.96 $81.20 $74.24 $92.80 $90.48 $52.20 $47.56 $48.72 $46.40 $87.00 $75.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 97605 97605 PR NEGATIVE PRESSURE WOUND THERAPY DME 50 SQ CM 149.00 $134.10 $59.60 $119.20 $83.44 $104.30 $95.36 $119.20 $116.22 $67.05 $61.09 $62.58 $59.60 $111.75 $96.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 97607 97607 PR NEG PRESSURE WOUND THERAPY NON DME 30 MIN 313.00 $281.70 $125.20 $250.40 $175.28 $219.10 $200.32 $250.40 $244.14 $140.85 $128.33 $131.46 $125.20 $234.75 $203.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99242 99242 PR OFFICE/OP CONSLTJ NEW/EST PT SF MDM 20 MINUTES 318.00 $286.20 $127.20 $254.40 $178.08 $222.60 $203.52 $254.40 $248.04 $143.10 $130.38 $133.56 $127.20 $238.50 $206.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99243 99243 PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES 361.00 $324.90 $144.40 $288.80 $202.16 $252.70 $231.04 $288.80 $281.58 $162.45 $148.01 $151.62 $144.40 $270.75 $234.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99244 99244 PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES 509.00 $458.10 $203.60 $407.20 $285.04 $356.30 $325.76 $407.20 $397.02 $229.05 $208.69 $213.78 $203.60 $381.75 $330.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99245 99245 PR OFFICE/OP CONSLTJ NEW/EST PT HIGH MDM 55 MINUTES 594.00 $534.60 $237.60 $475.20 $332.64 $415.80 $380.16 $475.20 $463.32 $267.30 $243.54 $249.48 $237.60 $445.50 $386.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99253 99253 PR IP/OBS CONSLTJ NEW/EST PT LOW MDM 45 MINUTES 415.00 $373.50 $166.00 $332.00 $232.40 $290.50 $265.60 $332.00 $323.70 $186.75 $170.15 $174.30 $166.00 $311.25 $269.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99282 99282 PR EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM 218.00 $196.20 $87.20 $174.40 $122.08 $152.60 $139.52 $174.40 $170.04 $98.10 $89.38 $91.56 $87.20 $163.50 $141.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99283 99283 PR EMERGENCY DEPARTMENT VISIT LOW MDM 335.00 $301.50 $134.00 $268.00 $187.60 $234.50 $214.40 $268.00 $261.30 $150.75 $137.35 $140.70 $134.00 $251.25 $217.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99284 99284 PR EMERGENCY DEPARTMENT VISIT MODERATE MDM 614.00 $552.60 $245.60 $491.20 $343.84 $429.80 $392.96 $491.20 $478.92 $276.30 $251.74 $257.88 $245.60 $460.50 $399.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99285 99285 PR EMERGENCY DEPARTMENT VISIT HIGH MDM 908.00 $817.20 $363.20 $726.40 $508.48 $635.60 $581.12 $726.40 $708.24 $408.60 $372.28 $381.36 $363.20 $681.00 $590.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99291 99291 PR CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN "1,107.00" $996.30 $442.80 $885.60 $619.92 $774.90 $708.48 $885.60 $863.46 $498.15 $453.87 $464.94 $442.80 $830.25 $719.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99292 99292 PR CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN 599.00 $539.10 $239.60 $479.20 $335.44 $419.30 $383.36 $479.20 $467.22 $269.55 $245.59 $251.58 $239.60 $449.25 $389.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99304 99304 PR INITIAL NURSING FACILITY CARE SF/LOW MDM 25 MIN 247.00 $222.30 $98.80 $197.60 $138.32 $172.90 $158.08 $197.60 $192.66 $111.15 $101.27 $103.74 $98.80 $185.25 $160.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99305 99305 PR INITIAL NURSING FACILITY CARE MOD MDM 35 MINUTES 317.00 $285.30 $126.80 $253.60 $177.52 $221.90 $202.88 $253.60 $247.26 $142.65 $129.97 $133.14 $126.80 $237.75 $206.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99306 99306 PR INITIAL NURSING FACILITY CARE HI MDM 45 MINUTES 557.00 $501.30 $222.80 $445.60 $311.92 $389.90 $356.48 $445.60 $434.46 $250.65 $228.37 $233.94 $222.80 $417.75 $362.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99307 99307 PR SBSQ NURSING FACILITY CARE SF MDM 10 MINUTES 123.00 $110.70 $49.20 $98.40 $68.88 $86.10 $78.72 $98.40 $95.94 $55.35 $50.43 $51.66 $49.20 $92.25 $79.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99308 99308 PR SBSQ NURSING FACILITY CARE LOW MDM 15 MINUTES 197.00 $177.30 $78.80 $157.60 $110.32 $137.90 $126.08 $157.60 $153.66 $88.65 $80.77 $82.74 $78.80 $147.75 $128.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99309 99309 PR SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES 259.00 $233.10 $103.60 $207.20 $145.04 $181.30 $165.76 $207.20 $202.02 $116.55 $106.19 $108.78 $103.60 $194.25 $168.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99310 99310 PR SBSQ NURSING FACILITY CARE HIGH MDM 45 MINUTES 460.00 $414.00 $184.00 $368.00 $257.60 $322.00 $294.40 $368.00 $358.80 $207.00 $188.60 $193.20 $184.00 $345.00 $299.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99315 99315 PR NURSING FACILITY DSCHRG MGMT 30 MIN/< TOT TIME 207.00 $186.30 $82.80 $165.60 $115.92 $144.90 $132.48 $165.60 $161.46 $93.15 $84.87 $86.94 $82.80 $155.25 $134.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99316 99316 PR NURSING FACILITY DSCHRG MGMT 30 MIN+ TOT TIME 297.00 $267.30 $118.80 $237.60 $166.32 $207.90 $190.08 $237.60 $231.66 $133.65 $121.77 $124.74 $118.80 $222.75 $193.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99341 99341 PR HOME/RES VISIT NEW PATIENT SF MDM 15 MINUTES 115.00 $103.50 $46.00 $92.00 $64.40 $80.50 $73.60 $92.00 $89.70 $51.75 $47.15 $48.30 $46.00 $86.25 $74.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99342 99342 PR HOME/RES VISIT NEW PATIENT LOW MDM 30 MINUTES 293.00 $263.70 $117.20 $234.40 $164.08 $205.10 $187.52 $234.40 $228.54 $131.85 $120.13 $123.06 $117.20 $219.75 $190.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99344 99344 PR HOME/RES VISIT NEW PATIENT MOD MDM 60 MINUTES 432.00 $388.80 $172.80 $345.60 $241.92 $302.40 $276.48 $345.60 $336.96 $194.40 $177.12 $181.44 $172.80 $324.00 $280.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99345 99345 PR HOME/RES VISIT NEW PATIENT HIGH MDM 75 MINUTES 509.00 $458.10 $203.60 $407.20 $285.04 $356.30 $325.76 $407.20 $397.02 $229.05 $208.69 $213.78 $203.60 $381.75 $330.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99347 99347 PR HOME/RES VISIT EST PATIENT SF MDM 20 MINUTES 102.00 $91.80 $40.80 $81.60 $57.12 $71.40 $65.28 $81.60 $79.56 $45.90 $41.82 $42.84 $40.80 $76.50 $66.30
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99348 99348 PR HOME/RES VISIT EST PATIENT LOW MDM 30 MINUTES 304.00 $273.60 $121.60 $243.20 $170.24 $212.80 $194.56 $243.20 $237.12 $136.80 $124.64 $127.68 $121.60 $228.00 $197.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99349 99349 PR HOME/RES VISIT EST PATIENT MOD MDM 40 MINUTES 441.00 $396.90 $176.40 $352.80 $246.96 $308.70 $282.24 $352.80 $343.98 $198.45 $180.81 $185.22 $176.40 $330.75 $286.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99350 99350 PR HOME/RES VISIT EST PATIENT HIGH MDM 60 MINUTES 440.00 $396.00 $176.00 $352.00 $246.40 $308.00 $281.60 $352.00 $343.20 $198.00 $180.40 $184.80 $176.00 $330.00 $286.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99358 99358 PR PROLNG E/M SVC BEFORE&/AFTER DIR PT CARE 1ST HR 412.00 $370.80 $164.80 $329.60 $230.72 $288.40 $263.68 $329.60 $321.36 $185.40 $168.92 $173.04 $164.80 $309.00 $267.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99359 99359 PR PROLNG E/M BEFORE&/AFTER DIR CARE EA 30 MINUTES 209.00 $188.10 $83.60 $167.20 $117.04 $146.30 $133.76 $167.20 $163.02 $94.05 $85.69 $87.78 $83.60 $156.75 $135.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99374 99374 PR SUPVJ PT HOME HEALTH AGENCY MO 15-29 MINUTES 217.00 $195.30 $86.80 $173.60 $121.52 $151.90 $138.88 $173.60 $169.26 $97.65 $88.97 $91.14 $86.80 $162.75 $141.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99381 99381 PR INITIAL PREVENTIVE MEDICINE NEW PATIENT <1YEAR 260.00 $234.00 $104.00 $208.00 $145.60 $182.00 $166.40 $208.00 $202.80 $117.00 $106.60 $109.20 $104.00 $195.00 $169.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99382 99382 PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS 278.00 $250.20 $111.20 $222.40 $155.68 $194.60 $177.92 $222.40 $216.84 $125.10 $113.98 $116.76 $111.20 $208.50 $180.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99383 99383 PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS 333.00 $299.70 $133.20 $266.40 $186.48 $233.10 $213.12 $266.40 $259.74 $149.85 $136.53 $139.86 $133.20 $249.75 $216.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99384 99384 PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR 358.00 $322.20 $143.20 $286.40 $200.48 $250.60 $229.12 $286.40 $279.24 $161.10 $146.78 $150.36 $143.20 $268.50 $232.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99385 99385 PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS 359.00 $323.10 $143.60 $287.20 $201.04 $251.30 $229.76 $287.20 $280.02 $161.55 $147.19 $150.78 $143.60 $269.25 $233.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99386 99386 PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS 424.00 $381.60 $169.60 $339.20 $237.44 $296.80 $271.36 $339.20 $330.72 $190.80 $173.84 $178.08 $169.60 $318.00 $275.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99387 99387 PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&> 461.00 $414.90 $184.40 $368.80 $258.16 $322.70 $295.04 $368.80 $359.58 $207.45 $189.01 $193.62 $184.40 $345.75 $299.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99391 99391 PR PERIODIC PREVENTIVE MED ESTABLISHED PATIENT <1Y 253.00 $227.70 $101.20 $202.40 $141.68 $177.10 $161.92 $202.40 $197.34 $113.85 $103.73 $106.26 $101.20 $189.75 $164.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99392 99392 PR PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS 267.00 $240.30 $106.80 $213.60 $149.52 $186.90 $170.88 $213.60 $208.26 $120.15 $109.47 $112.14 $106.80 $200.25 $173.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99393 99393 PR PERIODIC PREVENTIVE MED EST PATIENT 5-11YRS 267.00 $240.30 $106.80 $213.60 $149.52 $186.90 $170.88 $213.60 $208.26 $120.15 $109.47 $112.14 $106.80 $200.25 $173.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99394 99394 PR PERIODIC PREVENTIVE MED EST PATIENT 12-17YRS 295.00 $265.50 $118.00 $236.00 $165.20 $206.50 $188.80 $236.00 $230.10 $132.75 $120.95 $123.90 $118.00 $221.25 $191.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99395 99395 PR PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS 318.00 $286.20 $127.20 $254.40 $178.08 $222.60 $203.52 $254.40 $248.04 $143.10 $130.38 $133.56 $127.20 $238.50 $206.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99396 99396 PR PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS 331.00 $297.90 $132.40 $264.80 $185.36 $231.70 $211.84 $264.80 $258.18 $148.95 $135.71 $139.02 $132.40 $248.25 $215.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99397 99397 PR PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER 380.00 $342.00 $152.00 $304.00 $212.80 $266.00 $243.20 $304.00 $296.40 $171.00 $155.80 $159.60 $152.00 $285.00 $247.00
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99402 99402 PR PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 30 MIN 188.00 $169.20 $75.20 $150.40 $105.28 $131.60 $120.32 $150.40 $146.64 $84.60 $77.08 $78.96 $75.20 $141.00 $122.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99403 99403 PR PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 45 MIN 254.00 $228.60 $101.60 $203.20 $142.24 $177.80 $162.56 $203.20 $198.12 $114.30 $104.14 $106.68 $101.60 $190.50 $165.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99404 99404 PR PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 60 MIN 106.00 $95.40 $42.40 $84.80 $59.36 $74.20 $67.84 $84.80 $82.68 $47.70 $43.46 $44.52 $42.40 $79.50 $68.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99406 99406 PR TOBACCO USE CESSATION INTERMEDIATE >3-10 MINUTES 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99407 99407 PR TOBACCO USE CESSATION INTENSIVE >10 MINUTES 70.00 $63.00 $28.00 $56.00 $39.20 $49.00 $44.80 $56.00 $54.60 $31.50 $28.70 $29.40 $28.00 $52.50 $45.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99408 99408 PR ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN 76.00 $68.40 $30.40 $60.80 $42.56 $53.20 $48.64 $60.80 $59.28 $34.20 $31.16 $31.92 $30.40 $57.00 $49.40
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99409 99409 PR ALCOHOL/SUBSTANCE SCREEN & INTERVENTION >30 MIN 213.00 $191.70 $85.20 $170.40 $119.28 $149.10 $136.32 $170.40 $166.14 $95.85 $87.33 $89.46 $85.20 $159.75 $138.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99417 99417 PR PROLONGED OUTPATIENT E/M SERVICE EACH 15 MINUTES 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99441 99441 PR PHYS/QHP TELEPHONE EVALUATION 5-10 MIN 47.00 $42.30 $18.80 $37.60 $26.32 $32.90 $30.08 $37.60 $36.66 $21.15 $19.27 $19.74 $18.80 $35.25 $30.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99442 99442 PR PHYS/QHP TELEPHONE EVALUATION 11-20 MIN 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99443 99443 PR PHYS/QHP TELEPHONE EVALUATION 21-30 MIN 147.00 $132.30 $58.80 $117.60 $82.32 $102.90 $94.08 $117.60 $114.66 $66.15 $60.27 $61.74 $58.80 $110.25 $95.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99460 99460 PR 1ST HOSP/BIRTHING CENTER CARE PER DAY NML NB 329.00 $296.10 $131.60 $263.20 $184.24 $230.30 $210.56 $263.20 $256.62 $148.05 $134.89 $138.18 $131.60 $246.75 $213.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99462 99462 PR SUBQ HOSPITAL CARE PER DAY E/M NORMAL NEWBORN 138.00 $124.20 $55.20 $110.40 $77.28 $96.60 $88.32 $110.40 $107.64 $62.10 $56.58 $57.96 $55.20 $103.50 $89.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99463 99463 PR 1ST HOSP/BIRTHING CENTER NB ADMIT & DSCHG SM DAT 313.00 $281.70 $125.20 $250.40 $175.28 $219.10 $200.32 $250.40 $244.14 $140.85 $128.33 $131.46 $125.20 $234.75 $203.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99464 99464 PR ATTN AT DELIVERY 1ST STABILIZATION OF NEWBORN 314.00 $282.60 $125.60 $251.20 $175.84 $219.80 $200.96 $251.20 $244.92 $141.30 $128.74 $131.88 $125.60 $235.50 $204.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99465 99465 PR DELIVERY/BIRTHING ROOM RESUSCITATION 686.00 $617.40 $274.40 $548.80 $384.16 $480.20 $439.04 $548.80 $535.08 $308.70 $281.26 $288.12 $274.40 $514.50 $445.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99468 99468 PR 1ST INPATIENT CRITICAL CARE PR DAY AGE 28 DAYS/< "3,907.00" " $3,516.30 " " $1,562.80 " " $3,125.60 " " $2,187.92 " " $2,734.90 " " $2,500.48 " " $3,125.60 " " $3,047.46 " " $1,758.15 " " $1,601.87 " " $1,640.94 " " $1,562.80 " " $2,930.25 " " $2,539.55 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99477 99477 PR INITIAL HOSP NEONATE 28 D/< NOT CRITICALLY ILL "1,706.00" " $1,535.40 " $682.40 " $1,364.80 " $955.36 " $1,194.20 " " $1,091.84 " " $1,364.80 " " $1,330.68 " $767.70 $699.46 $716.52 $682.40 " $1,279.50 " " $1,108.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 99490 99490 PR CHRON CARE MANAGEMENT SRVC 20 MIN PER MONTH 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 EM021 EM021 PR TRCK NO CHARGE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 EM030 EM030 PR TRCK BLOOD PRESSURECHK NC 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 EM212 EM212 PR INR HOME CARE PATIENT 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 EM214 EM214 PR INR HOME MONITORING PATIENT 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 G0008 G0008 PR ADMIN INFLUENZA VIRUS VAC 32.00 $28.80 $12.80 $25.60 $17.92 $22.40 $20.48 $25.60 $24.96 $14.40 $13.12 $13.44 $12.80 $24.00 $20.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 G0009 G0009 PR ADMIN PNEUMOCOCCAL VACCINE 32.00 $28.80 $12.80 $25.60 $17.92 $22.40 $20.48 $25.60 $24.96 $14.40 $13.12 $13.44 $12.80 $24.00 $20.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 G0071 G0071 PR COMM SVCS BY RHC/FQHC 5 MIN 133.00 $119.70 $53.20 $106.40 $74.48 $93.10 $85.12 $106.40 $103.74 $59.85 $54.53 $55.86 $53.20 $99.75 $86.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 G0101 G0101 PR CA SCREEN;PELVIC/BREAST EXAM 132.00 $118.80 $52.80 $105.60 $73.92 $92.40 $84.48 $105.60 $102.96 $59.40 $54.12 $55.44 $52.80 $99.00 $85.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 G0102 G0102 PR PROSTATE CA SCREENING; DRE 70.00 $63.00 $28.00 $56.00 $39.20 $49.00 $44.80 $56.00 $54.60 $31.50 $28.70 $29.40 $28.00 $52.50 $45.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 G0104 G0104 PR CA SCREEN;FLEXI SIGMOIDSCOPE 487.00 $438.30 $194.80 $389.60 $272.72 $340.90 $311.68 $389.60 $379.86 $219.15 $199.67 $204.54 $194.80 $365.25 $316.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 G0105 G0105 PR COLORECTAL SCRN; HI RISK IND "1,485.00" " $1,336.50 " $594.00 " $1,188.00 " $831.60 " $1,039.50 " $950.40 " $1,188.00 " " $1,158.30 " $668.25 $608.85 $623.70 $594.00 " $1,113.75 " $965.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 G0108 G0108 PR DIAB MANAGE TRN PER INDIV 388.00 $349.20 $155.20 $310.40 $217.28 $271.60 $248.32 $310.40 $302.64 $174.60 $159.08 $162.96 $155.20 $291.00 $252.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 G0109 G0109 PR DIAB MANAGE TRN IND/GROUP 205.00 $184.50 $82.00 $164.00 $114.80 $143.50 $131.20 $164.00 $159.90 $92.25 $84.05 $86.10 $82.00 $153.75 $133.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 G0121 G0121 PR COLON CA SCRN NOT HI RSK IND "1,485.00" " $1,336.50 " $594.00 " $1,188.00 " $831.60 " $1,039.50 " $950.40 " $1,188.00 " " $1,158.30 " $668.25 $608.85 $623.70 $594.00 " $1,113.75 " $965.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 G0127 G0127 PR TRIM NAIL(S) 79.00 $71.10 $31.60 $63.20 $44.24 $55.30 $50.56 $63.20 $61.62 $35.55 $32.39 $33.18 $31.60 $59.25 $51.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 G0180 G0180 PR MD CERTIFICATION HHA PATIENT 250.00 $225.00 $100.00 $200.00 $140.00 $175.00 $160.00 $200.00 $195.00 $112.50 $102.50 $105.00 $100.00 $187.50 $162.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 G0248 G0248 PR DEMONSTRATE USE HOME INR MON 288.00 $259.20 $115.20 $230.40 $161.28 $201.60 $184.32 $230.40 $224.64 $129.60 $118.08 $120.96 $115.20 $216.00 $187.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 G0296 G0296 PR VISIT TO DETERM LDCT ELIG 91.00 $81.90 $36.40 $72.80 $50.96 $63.70 $58.24 $72.80 $70.98 $40.95 $37.31 $38.22 $36.40 $68.25 $59.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 G0372 G0372 PR MD SERVICE REQUIRED FOR PMD 28.00 $25.20 $11.20 $22.40 $15.68 $19.60 $17.92 $22.40 $21.84 $12.60 $11.48 $11.76 $11.20 $21.00 $18.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 G0396 G0396 PR ALCOHOL/SUBS INTERV 15-30MN 167.00 $150.30 $66.80 $133.60 $93.52 $116.90 $106.88 $133.60 $130.26 $75.15 $68.47 $70.14 $66.80 $125.25 $108.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 G0402 G0402 PR INITIAL PREVENTIVE EXAM 366.00 $329.40 $146.40 $292.80 $204.96 $256.20 $234.24 $292.80 $285.48 $164.70 $150.06 $153.72 $146.40 $274.50 $237.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 G0403 G0403 PR EKG FOR INITIAL PREVENT EXAM 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 G0404 G0404 PR EKG TRACING FOR INITIAL PREV 149.00 $134.10 $59.60 $119.20 $83.44 $104.30 $95.36 $119.20 $116.22 $67.05 $61.09 $62.58 $59.60 $111.75 $96.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 G0438 G0438 "PR PPPS, INITIAL VISIT" 366.00 $329.40 $146.40 $292.80 $204.96 $256.20 $234.24 $292.80 $285.48 $164.70 $150.06 $153.72 $146.40 $274.50 $237.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 G0439 G0439 "PR PPPS, SUBSEQ VISIT" 366.00 $329.40 $146.40 $292.80 $204.96 $256.20 $234.24 $292.80 $285.48 $164.70 $150.06 $153.72 $146.40 $274.50 $237.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 G0442 G0442 PR ANNUAL ALCOHOL SCREEN 15 MIN 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 G0443 G0443 PR BRIEF ALCOHOL MISUSE COUNSEL 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 G0444 G0444 PR DEPRESSION SCREEN ANNUAL 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 G2025 G2025 PR DIS SITE TELE SVCS RHC/FQHC 133.00 $119.70 $53.20 $106.40 $74.48 $93.10 $85.12 $106.40 $103.74 $59.85 $54.53 $55.86 $53.20 $99.75 $86.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 G2212 G2212 PR PROLONG OUTPT/OFFICE VIS 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J0171 J0171 PR INJECTION ADRENALIN EPINEPHRINE 0.1 MG 69.00 $62.10 $27.60 $55.20 $38.64 $48.30 $44.16 $55.20 $53.82 $31.05 $28.29 $28.98 $27.60 $51.75 $44.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J0561 J0561 PR INJECTION PENICILLIN G BENZATHINE 100000 UNITS 11.00 $9.90 $4.40 $8.80 $6.16 $7.70 $7.04 $8.80 $8.58 $4.95 $4.51 $4.62 $4.40 $8.25 $7.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J0585 J0585 PR INJECTION ONABOTULINUMTOXINA 1 UNIT 31.00 $27.90 $12.40 $24.80 $17.36 $21.70 $19.84 $24.80 $24.18 $13.95 $12.71 $13.02 $12.40 $23.25 $20.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J0696 J0696 PR INJECTION CEFTRIAXONE SODIUM PER 250 MG 25.00 $22.50 $10.00 $20.00 $14.00 $17.50 $16.00 $20.00 $19.50 $11.25 $10.25 $10.50 $10.00 $18.75 $16.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J0702 J0702 PR BETAMETHASONE ACET 3MG AND SOD PHOSP 3MG 13.00 $11.70 $5.20 $10.40 $7.28 $9.10 $8.32 $10.40 $10.14 $5.85 $5.33 $5.46 $5.20 $9.75 $8.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J1020 J1020 PR METHYLPREDNISOLONE 20 MG INJ 47.00 $42.30 $18.80 $37.60 $26.32 $32.90 $30.08 $37.60 $36.66 $21.15 $19.27 $19.74 $18.80 $35.25 $30.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J1030 J1030 PR METHYLPREDNISOLONE 40 MG INJ 54.00 $48.60 $21.60 $43.20 $30.24 $37.80 $34.56 $43.20 $42.12 $24.30 $22.14 $22.68 $21.60 $40.50 $35.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J1040 J1040 PR METHYLPREDNISOLONE 80 MG INJ 43.00 $38.70 $17.20 $34.40 $24.08 $30.10 $27.52 $34.40 $33.54 $19.35 $17.63 $18.06 $17.20 $32.25 $27.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J1050 J1050 PR INJECTION MEDROXYPROGESTERONE ACETATE 1 MG 4.00 $3.60 $1.60 $3.20 $2.24 $2.80 $2.56 $3.20 $3.12 $1.80 $1.64 $1.68 $1.60 $3.00 $2.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J1100 J1100 PR INJECTION DEXAMETHASONE SODIUM PHOSPHATE 1 MG 11.00 $9.90 $4.40 $8.80 $6.16 $7.70 $7.04 $8.80 $8.58 $4.95 $4.51 $4.62 $4.40 $8.25 $7.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J1170 J1170 PR INJECTION HYDROMORPHONE UP TO 4 MG 45.00 $40.50 $18.00 $36.00 $25.20 $31.50 $28.80 $36.00 $35.10 $20.25 $18.45 $18.90 $18.00 $33.75 $29.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J1200 J1200 PR INJECTION DIPHENHYDRAMINE HCL UP TO 50 MG 43.00 $38.70 $17.20 $34.40 $24.08 $30.10 $27.52 $34.40 $33.54 $19.35 $17.63 $18.06 $17.20 $32.25 $27.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J1380 J1380 PR ESTRADIOL VALERATE 10 MG INJ 75.00 $67.50 $30.00 $60.00 $42.00 $52.50 $48.00 $60.00 $58.50 $33.75 $30.75 $31.50 $30.00 $56.25 $48.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J1630 J1630 PR INJECTION HALOPERIDOL UP TO 5 MG 44.00 $39.60 $17.60 $35.20 $24.64 $30.80 $28.16 $35.20 $34.32 $19.80 $18.04 $18.48 $17.60 $33.00 $28.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J1726 J1726 "PR MAKENA, 10 MG" 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J1885 J1885 PR INJECTION KETOROLAC TROMETHAMINE PER 15 MG 12.00 $10.80 $4.80 $9.60 $6.72 $8.40 $7.68 $9.60 $9.36 $5.40 $4.92 $5.04 $4.80 $9.00 $7.80
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J1940 J1940 PR INJECTION FUROSEMIDE UP TO 20 MG 13.00 $11.70 $5.20 $10.40 $7.28 $9.10 $8.32 $10.40 $10.14 $5.85 $5.33 $5.46 $5.20 $9.75 $8.45
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J2060 J2060 PR INJECTION LORAZEPAM 2 MG 43.00 $38.70 $17.20 $34.40 $24.08 $30.10 $27.52 $34.40 $33.54 $19.35 $17.63 $18.06 $17.20 $32.25 $27.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J2175 J2175 PR MEPERIDINE HYDROCHL /100 MG 45.00 $40.50 $18.00 $36.00 $25.20 $31.50 $28.80 $36.00 $35.10 $20.25 $18.45 $18.90 $18.00 $33.75 $29.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J2270 J2270 PR INJECTION MORPHINE SULFATE UP TO 10 MG 44.00 $39.60 $17.60 $35.20 $24.64 $30.80 $28.16 $35.20 $34.32 $19.80 $18.04 $18.48 $17.60 $33.00 $28.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J2405 J2405 PR INJECTION ONDANSETRON HYDROCHLORIDE PER 1 MG 11.00 $9.90 $4.40 $8.80 $6.16 $7.70 $7.04 $8.80 $8.58 $4.95 $4.51 $4.62 $4.40 $8.25 $7.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J2550 J2550 PR INJECTION PROMETHAZINE HCL UP TO 50 MG 45.00 $40.50 $18.00 $36.00 $25.20 $31.50 $28.80 $36.00 $35.10 $20.25 $18.45 $18.90 $18.00 $33.75 $29.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J2790 J2790 PR RHO D IMMUNE GLOBULIN INJ 300 MICROGRAMS 1500 IU 170.00 $153.00 $68.00 $136.00 $95.20 $119.00 $108.80 $136.00 $132.60 $76.50 $69.70 $71.40 $68.00 $127.50 $110.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J2920 J2920 PR INJECTION METHYLPREDNISOLONE SODIUM SUCCINATE UP TO 40 MG 46.00 $41.40 $18.40 $36.80 $25.76 $32.20 $29.44 $36.80 $35.88 $20.70 $18.86 $19.32 $18.40 $34.50 $29.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J2930 J2930 PR INJECTION METHYLPREDNISOLONE SODIUM SUCCINATE UP TO 125 MG 48.00 $43.20 $19.20 $38.40 $26.88 $33.60 $30.72 $38.40 $37.44 $21.60 $19.68 $20.16 $19.20 $36.00 $31.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J3030 J3030 PR SUMATRIPTAN SUCCINATE / 6 MG 111.00 $99.90 $44.40 $88.80 $62.16 $77.70 $71.04 $88.80 $86.58 $49.95 $45.51 $46.62 $44.40 $83.25 $72.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J3260 J3260 PR INJECTION TOBRAMYCIN SULFATE UP TO 80 MG 74.00 $66.60 $29.60 $59.20 $41.44 $51.80 $47.36 $59.20 $57.72 $33.30 $30.34 $31.08 $29.60 $55.50 $48.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J3301 J3301 PR TRIAMCINOLONE ACET INJ NOS 10 MG 14.00 $12.60 $5.60 $11.20 $7.84 $9.80 $8.96 $11.20 $10.92 $6.30 $5.74 $5.88 $5.60 $10.50 $9.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J3360 J3360 PR INJECTION DIAZEPAM UP TO 5 MG 55.00 $49.50 $22.00 $44.00 $30.80 $38.50 $35.20 $44.00 $42.90 $24.75 $22.55 $23.10 $22.00 $41.25 $35.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J3410 J3410 PR INJECTION HYDROXYZINE HCL UP TO 25 MG 25.00 $22.50 $10.00 $20.00 $14.00 $17.50 $16.00 $20.00 $19.50 $11.25 $10.25 $10.50 $10.00 $18.75 $16.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J3420 J3420 PR INJECTION VITAMIN B-12 CYANOCOBALAMIN UP TO 1000 MCG 44.00 $39.60 $17.60 $35.20 $24.64 $30.80 $28.16 $35.20 $34.32 $19.80 $18.04 $18.48 $17.60 $33.00 $28.60
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J7296 J7296 PR KYLEENA IUD KIT W LEVONORGESTREL 19.5 MG "2,228.00" " $2,005.20 " $891.20 " $1,782.40 " " $1,247.68 " " $1,559.60 " " $1,425.92 " " $1,782.40 " " $1,737.84 " " $1,002.60 " $913.48 $935.76 $891.20 " $1,671.00 " " $1,448.20 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J7297 J7297 PR LILETTA IUD KIT W LEVONORGESTREL 52 MG "1,816.00" " $1,634.40 " $726.40 " $1,452.80 " " $1,016.96 " " $1,271.20 " " $1,162.24 " " $1,452.80 " " $1,416.48 " $817.20 $744.56 $762.72 $726.40 " $1,362.00 " " $1,180.40 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J7298 J7298 PR MIRENA IUD KIT W LEVONORGESTREL 52 MG "2,264.00" " $2,037.60 " $905.60 " $1,811.20 " " $1,267.84 " " $1,584.80 " " $1,448.96 " " $1,811.20 " " $1,765.92 " " $1,018.80 " $928.24 $950.88 $905.60 " $1,698.00 " " $1,471.60 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J7300 J7300 PR INTRAUTERINE COPPER CONTRACEPTIVE "2,066.00" " $1,859.40 " $826.40 " $1,652.80 " " $1,156.96 " " $1,446.20 " " $1,322.24 " " $1,652.80 " " $1,611.48 " $929.70 $847.06 $867.72 $826.40 " $1,549.50 " " $1,342.90 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J7301 J7301 PR SKYLA IUD KIT W LEVONORGESTREL 13.5 MG "1,820.00" " $1,638.00 " $728.00 " $1,456.00 " " $1,019.20 " " $1,274.00 " " $1,164.80 " " $1,456.00 " " $1,419.60 " $819.00 $746.20 $764.40 $728.00 " $1,365.00 " " $1,183.00 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J7307 J7307 PR ETONOGESTREL IMPLANT SYSTEM "2,155.00" " $1,939.50 " $862.00 " $1,724.00 " " $1,206.80 " " $1,508.50 " " $1,379.20 " " $1,724.00 " " $1,680.90 " $969.75 $883.55 $905.10 $862.00 " $1,616.25 " " $1,400.75 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J7318 J7318 "PR INJ, DUROLANE 1 MG" 49.00 $44.10 $19.60 $39.20 $27.44 $34.30 $31.36 $39.20 $38.22 $22.05 $20.09 $20.58 $19.60 $36.75 $31.85
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J7323 J7323 PR INJ EUFLEXXA PER DOSE "1,975.00" " $1,777.50 " $790.00 " $1,580.00 " " $1,106.00 " " $1,382.50 " " $1,264.00 " " $1,580.00 " " $1,540.50 " $888.75 $809.75 $829.50 $790.00 " $1,481.25 " " $1,283.75 "
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J7324 J7324 PR INJ ORTHOVISC PER DOSE 994.00 $894.60 $397.60 $795.20 $556.64 $695.80 $636.16 $795.20 $775.32 $447.30 $407.54 $417.48 $397.60 $745.50 $646.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J7325 J7325 "PR INJ SYNVISC OR SYNVISC-ONE, 1 MG" 65.00 $58.50 $26.00 $52.00 $36.40 $45.50 $41.60 $52.00 $50.70 $29.25 $26.65 $27.30 $26.00 $48.75 $42.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 J9260 J9260 PR METHOTREXATE SODIUM 50 MG 8.00 $7.20 $3.20 $6.40 $4.48 $5.60 $5.12 $6.40 $6.24 $3.60 $3.28 $3.36 $3.20 $6.00 $5.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 OB000 OB000 PR OB VISIT - NO CHARGE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 OB003 OB003 PR POST-PARTUM 6 WK VISIT -$0 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 OC1275 99213 PR OCH EST PT LEVEL III 108.00 $97.20 $43.20 $86.40 $60.48 $75.60 $69.12 $86.40 $84.24 $48.60 $44.28 $45.36 $43.20 $81.00 $70.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 OC1333 OC1333 PR OCH CUSTOM PRE EMP PHYSICAL ABILITY SCREEN 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 OC1340 OC1340 PB OCH NURSE ONLY VISIT 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 OC345 OC345 PR OCH VISION SCREENING 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 Q0091 Q0091 PR OBTAINING SCREEN PAP SMEAR 75.00 $67.50 $30.00 $60.00 $42.00 $52.50 $48.00 $60.00 $58.50 $33.75 $30.75 $31.50 $30.00 $56.25 $48.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 RS0006 RS0006 PR HEALTH COACH 6 VISIT INIT PK RETAIL WWH ONLY 155.00 $139.50 $62.00 $124.00 $86.80 $108.50 $99.20 $124.00 $120.90 $69.75 $63.55 $65.10 $62.00 $116.25 $100.75
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 RS0007 RS0007 PR HEALTH COACH 3 VISIT INIT PK RETAIL WWH ONLY 103.00 $92.70 $41.20 $82.40 $57.68 $72.10 $65.92 $82.40 $80.34 $46.35 $42.23 $43.26 $41.20 $77.25 $66.95
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 RS0008 RS0008 PR HEALTH COACH 3 VISIT CONT PK RETAIL WWH ONLY 77.00 $69.30 $30.80 $61.60 $43.12 $53.90 $49.28 $61.60 $60.06 $34.65 $31.57 $32.34 $30.80 $57.75 $50.05
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 RS0009 RS0009 PR HEALTH COACH SCHOLARSHIP RATE RETAIL WWH ONLY 41.00 $36.90 $16.40 $32.80 $22.96 $28.70 $26.24 $32.80 $31.98 $18.45 $16.81 $17.22 $16.40 $30.75 $26.65
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 RS0010 RS0010 PR HEALTH COACH GLOBAL PK NO CHARGE RETAIL WWH ONLY 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 RS0011 RS0011 PR HEALTH COACH INIT CONSULT NO CHARGE RETAIL WWH ONLY 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 RS0014 RS0014 PR OCT SCREENING RETAIL WWH ONLY 30.00 $27.00 $12.00 $24.00 $16.80 $21.00 $19.20 $24.00 $23.40 $13.50 $12.30 $12.60 $12.00 $22.50 $19.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 RS0027 RS0027 PR SPORTS PHYSICAL RETAIL AFFILIATE ONLY 67.00 $60.30 $26.80 $53.60 $37.52 $46.90 $42.88 $53.60 $52.26 $30.15 $27.47 $28.14 $26.80 $50.25 $43.55
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 RS0028 RS0028 PR DOT PHYSICAL RETAIL AFFILIATE ONLY 108.00 $97.20 $43.20 $86.40 $60.48 $75.60 $69.12 $86.40 $84.24 $48.60 $44.28 $45.36 $43.20 $81.00 $70.20
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 RS0029 RS0029 PR COURTESY BH VISIT DUE TO TRAGEDY RETAIL 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 RS0030 RS0030 PR COURT RELATED SERVICES FOR BH RETAIL 10.00 $9.00 $4.00 $8.00 $5.60 $7.00 $6.40 $8.00 $7.80 $4.50 $4.10 $4.20 $4.00 $7.50 $6.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 RS0031 RS0031 PR SPORT EXAM COMMUNITY BASED RETAIL 26.00 $23.40 $10.40 $20.80 $14.56 $18.20 $16.64 $20.80 $20.28 $11.70 $10.66 $10.92 $10.40 $19.50 $16.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 S2900 S2900 PR ROBOTIC SURGICAL SYSTEM 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS510361 L4350 PR ANKLE CONTROL ORTHOSIS PREFAB OTS PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS510584 L0140 PR COLLAR CERV UNIV PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS510587 L0172 PR CERVICAL COLLAR SEMI RIGID FOAM 2 PC PREFAB OTS PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS510625 L3670 PR SO ACRO CLAV CAN WEB PREFAB OTS PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS513728 L3807 PR WHFO WO JOINTS PREFAB CUSTOM FIT PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS515667 L1906 PR AFO MULTILIG ANKLE SUPPORT PREFAB OTS PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS515767 L4386 PR NONPNEUMATIC WALKING BOOT PREFAB CUSTOM FIT PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS516135 A4570 PR SPLINT PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS516202 L0625 PR LO FLEXIBLE L1 <= L5 PREFAB OTS PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS516213 A4565 PR SLING PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS516328 A4467 PR BELT RIB PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS516340 L3908 PR WHO COCKUP NONMOLDED PREFAB OTS PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS516343 L3260 PR POST OP SURGICAL BOOT PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS516468 L0120 PR CERVICAL COLLAR FLEXIBLE NONADJ FOAM PREFAB OTS PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS516469 L1830 PR KO IMMOB CANVAS LONG PREFAB OTS PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS516470 L1830 PR KO IMMOB CANVAS LONG PREFAB OTS PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS516554 L3485 PR PAD HEEL RMVBL PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS516616 L3480 PR HEEL CUP PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS516806 L4396 PR STATIC OR DYNAMIC AFO PREFAB CUSTOM FIT PR30 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS516861 L0625 PR LO FLEXIBLE L1 <= L5 PREFAB OTS PR30 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS517242 E0114 PR CRUTCHES ALUMINUM PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS517245 L3170 PR FOOT PLASTIC HEEL STABILIZER PREFAB OTS EA 6.00 $5.40 $2.40 $4.80 $3.36 $4.20 $3.84 $4.80 $4.68 $2.70 $2.46 $2.52 $2.40 $4.50 $3.90
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS517447 L0220 PR RIB BELT PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS518809 L1930 PR SPLINT NIGHT PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS518816 L3332 PR HEEL PAD PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS518818 L4386 PR NONPNEUMATIC WALKING BOOT PREFAB CUSTOM FIT PR30 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS518823 L1902 PR AFO ANKLE GAUNTLET PREFAB OTS PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS518978 L3908 PR WHO COCKUP NONMOLDED PREFAB OTS PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS519472 L0174 PR CERVICAL COLLAR SEMI RIGID 2 PC THORACIC EXT PREFAB OTS PR50 131.00 $117.90 $52.40 $104.80 $73.36 $91.70 $83.84 $104.80 $102.18 $58.95 $53.71 $55.02 $52.40 $98.25 $85.15
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS519967 L2999 PR LE ORTHOSIS PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS520079 L4360 PR PNEUMATIC WALKING BOOT PREFAB CUSTOM FIT PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS520100 L1832 PR KO RIGID SUPPORT ADJ JOINT POSTL PREFAB CUSTOM FIT PR30 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS520194 L4350 PR ANKLE CONTROL ORTHOSIS PREFAB OTS PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS520733 L2999 PR LE ORTHOSIS PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS520752 L4387 PR WALKING BOOT NONPNEUMATIC WWO JOINTS PREFAB OTS PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS520753 L4387 PR WALKING BOOT NONPNEUMATIC WWO JOINTS PREFAB OTS PR40 110.00 $99.00 $44.00 $88.00 $61.60 $77.00 $70.40 $88.00 $85.80 $49.50 $45.10 $46.20 $44.00 $82.50 $71.50
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS520754 L4387 PR WALKING BOOT NONPNEUMATIC WWO JOINTS PREFAB OTS PR30 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS521290 SS521290 PR MASK PR1 REHC ONLY 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS522235 L3702 PR ELBOW ORTHOSIS WO JOINTS CUSTOM FAB PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS522249 L1832 PR KO RIGID SUPPORT ADJ JOINT POSTL PREFAB CUSTOM FIT PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS522265 L3650 PR SO FIG 8 ABD RESTRAINT PREFAB OTS PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS522312 L3170 PR FOOT PLASTIC HEEL STABILIZER PREFAB OTS EA PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS522340 L3908 PR WHO COCKUP NONMOLDED PREFAB OTS PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS522432 L3807 PR WHFO WO JOINTS PREFAB CUSTOM FIT PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS522433 L3923 PR HFO WO JOINTS PREFAB CUSTOM FIT PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS522435 A6448 PR LT COMPRES BAND <3IN PER YD PR1 AFFILIATE ONLY 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS522436 A6449 PR LT COMPRES BAND >=3IN <5IN PER YD PR1 AFFILIATE ONLY 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS522437 A6450 PR LT COMPRES BAND >=5IN PER YD PR1 AFFILIATE ONLY 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS522438 A6451 PR MOD COMPRES BAND W>=3IN<5IN PER YD PR1 AFFILIATE ONLY 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS522439 A4352 PR CATH COUDE TIP URINARY PR1 AFFILIATE ONLY 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS522440 A4314 PR CATH W DRAINAGE 2-WAY LATEX PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS522441 A4358 PR URINARY DRAINAGE BAG LEG OR ABDOMEN PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS522442 E0191 PR HEEL OR ELBOW PROTECTOR EA PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS522443 A4570 PR SPLINT PR30 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS522444 A4620 PR VARIABLE CONCENTRATION MASK PR1 AFFILIATE ONLY 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS522445 A4500 PR BELOW KNEE SURGICAL STOCKING EA PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS522446 A4510 PR FULL LENGTH SURG STOCKING EA PR1 AFFILIATE ONLY 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS522447 A4510 PR FULL LENGTH SURG STOCKING EA PR5 AFFILIATE ONLY 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS522448 A4467 PR GARMENT BELT SLEEVE OTHER ELASTIC COVERING PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH PB CLINIC MAIN FEE SCHEDULE - 4210 SS522465 L3702 PR SPLINT TENNIS ELBOW PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH PB CLINIC MEDICARE ZERO FEE - 4211 0011A 0011A (IA) PR IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE (MODERNA) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 0013A 0013A (IA) PR IMM ADMN SARSCOV2 100 MCG/0.5 ML 3RD DOSE (MODERNA) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 0051A 0051A (IA) PR IMM ADMN SARSCOV2 30MCG/0.3ML TRIS-SUCROSE 1ST (PFIZER) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 0052A 0052A (IA) PR IMM ADMN SARSCOV2 30MCG/0.3ML TRIS-SUCROSE 2ND (PFIZER) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 0054A 0054A (IA) PR IMM ADMN SARSCOV2 30MCG/0.3ML TRIS-SUCROSE BST (PFIZER) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 0064A 0064A (IA) PR IMM ADMN SARSCOV2 50 MCG/0.25 ML BOOSTER DOSE (MODERNA) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 0071A 0071A (IA) PR IMM ADMN SARSCOV2 10MCG/0.2ML TRIS-SUCROSE 1ST (PFIZER) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 0072A 0072A (IA) PR IMM ADMN SARSCOV2 10MCG/0.2ML TRIS-SUCROSE 2ND (PFIZER) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 0074A 0074A (IA) PR IMM ADMN SARSCOV2 10MCG/0.2ML TRIS-SUCROSE BST (PFIZER) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 0124A 0124A (IA) PR IMM ADMN SARSCOV2 30MCG/0.3 ML BIVALENT BST (PFIZER) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 0134A 0134A (IA) PR IMM ADMN SARSCOV2 50MCG/0.5 ML BIVALENT BST (MODERNA) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 0141A 0141A (IA) PR IMM ADMN SARSCOV2 BIVALENT 25 MCG/0.25 ML 1ST (MODERNA) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 0144A 0144A (IA) PR IMM ADMN SARSCOV2 25MCG/0.25 ML BIVALENT BST (MODERNA) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 0154A 0154A (IA) PR IMM ADMN SARSCOV2 10MCG/0.2 ML BIVALENT BST (PFIZER) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 0164A 0164A (IA) PR IMM ADMN SARSCOV2 10MCG/0.2 ML BIVALENT ADDL (MODERNA) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 0173A 0173A (IA) PR IMM ADMN SARSCOV2 3 MCG/0.2 ML BIVALENT 3RD (PFIZER) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 90480 90480 PR IMM ADMN SARSCOV2 VACCINE SINGLE DOSE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 90653 90653 PR IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 90657 90657 PR IIV3 VACCINE SPLIT VIRUS 0.25 ML DOSAGE IM USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 90658 90658 PR IIV3 VACCINE SPLIT VIRUS 0.5 ML DOSAGE IM USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 90660 90660 PR LAIV3 VACCINE LIVE FOR INTRANASAL USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 90662 90662 PR IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 90670 90670 PR PCV13 VACCINE FOR INTRAMUSCULAR USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 90672 90672 PR LAIV4 VACCINE FOR INTRANASAL USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 90673 90673 PR RIV3 VACCINE PRESERVATIVE FREE FOR IM USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 90677 90677 PR PCV20 VACCINE FOR INTRAMUSCULAR USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 90682 90682 PR RIV4 VACC RECOMBINANT DNA PRSRV ANTIBIO FREE IM 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 90685 90685 PR IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 90686 90686 PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 90687 90687 PR IIV4 VACC SPLIT VIRUS 0.25 ML DOS FOR IM USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 90688 90688 PR IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 90732 90732 PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 91305 91305 (IA) PR SARSCOV2 VACC TRIS-SUCROSE 30 MCG/0.3 ML (PFIZER) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 91306 91306 (IA) PR SARSCOV2 VACC 50 MCG/0.25 ML (MODERNA) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 91314 91314 (IA) PR SARSCOV2 VACC BIVALENT 25 MCG/0.25 ML (MODERNA) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 91316 91316 (IA) PR SARSCOV2 VACC BIVALENT 10 MCG/0.2 ML (MODERNA) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 91317 91317 (IA) PR SARSCOV2 VACC BIVALENT 3 MCG/0.2 ML (PFIZER) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 91321 91321 PR SARSCOV2 VACCINE 25 MCG/0.25 ML FOR IM USE (MODERNA) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 91322 91322 PR SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE (MODERNA) 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 G0008 G0008 PR ADMIN INFLUENZA VIRUS VAC 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 G0009 G0009 PR ADMIN PNEUMOCOCCAL VACCINE 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 Q2038 Q2038 "PR FLUZONE VACC, 3 YRS & >, IM" 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH PB CLINIC MEDICARE ZERO FEE - 4211 Q2039 Q2039 "PR INFLUENZA VIRUS VACCINE, NOS" 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH SUPPLIES FEE SCHEDULE - 4207 510051 510051 HCHG KIT BASIC BPSY W/O NDL 4380 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 510361 L4350 HCHG ANKLE CONTROL ORTHOSIS PREFAB OTS PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 510517 510517 HCHG CATH SUCT PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 510625 L3670 HCHG SO ACRO CLAV CAN WEB PREFAB OTS PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 510983 510983 HCHG KIT PNEUMOTHORAX 489.00 $440.10 $195.60 $391.20 $273.84 $342.30 $312.96 $391.20 $381.42 $220.05 $200.49 $205.38 $195.60 $366.75 $317.85
WWH SUPPLIES FEE SCHEDULE - 4207 511581 C1757 HCHG CATH THROMBECTOMY PR30 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH SUPPLIES FEE SCHEDULE - 4207 511684 511684 HCHG KIT CO2 DETECTOR PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 511689 511689 HCHG NDL PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 511911 511911 HCHG DRSG PROFORE 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 512039 512039 HCHG SLEEVE KNEE PR 10 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH SUPPLIES FEE SCHEDULE - 4207 512463 512463 HCHG O2 SHORT TERM < 4 HRS 139.00 $125.10 $55.60 $111.20 $77.84 $97.30 $88.96 $111.20 $108.42 $62.55 $56.99 $58.38 $55.60 $104.25 $90.35
WWH SUPPLIES FEE SCHEDULE - 4207 512558 512558 HCHG ORTHOTIC INSOLE 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 513008 513008 HCHG SPLINT NIGHT 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 513079 513079 HCHG TUBE MIC KEY G-J 231.00 $207.90 $92.40 $184.80 $129.36 $161.70 $147.84 $184.80 $180.18 $103.95 $94.71 $97.02 $92.40 $173.25 $150.15
WWH SUPPLIES FEE SCHEDULE - 4207 513292 513292 HCHG CATH DIAGNOSTIC PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 513303 513303 HCHG CNNLA PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 513313 C1769 HCHG GUIDEWIRE PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 513314 C1769 HCHG GUIDEWIRE PR110 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH SUPPLIES FEE SCHEDULE - 4207 513334 513334 HCHG KIT PUMP BREAST PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 513335 513335 HCHG KIT PUMP BREAST PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 513357 513357 HCHG SPLINT PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 513359 513359 HCHG SPLINT PR50 131.00 $117.90 $52.40 $104.80 $73.36 $91.70 $83.84 $104.80 $102.18 $58.95 $53.71 $55.02 $52.40 $98.25 $85.15
WWH SUPPLIES FEE SCHEDULE - 4207 513535 C1725 HCHG CATH BALLOON PR230 571.00 $513.90 $228.40 $456.80 $319.76 $399.70 $365.44 $456.80 $445.38 $256.95 $234.11 $239.82 $228.40 $428.25 $371.15
WWH SUPPLIES FEE SCHEDULE - 4207 513680 513680 HCHG WIRE PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 513693 513693 HCHG CATH DIAG PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 513698 513698 HCHG CONTAINER EMPTY EVAC PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 513711 513711 HCHG NDL BPSY PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 513712 513712 HCHG NDL BPSY PR30 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH SUPPLIES FEE SCHEDULE - 4207 513713 513713 HCHG NDL PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 513714 513714 HCHG NDL PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 513728 L3807 HCHG WHFO WO JOINTS PREFAB CUSTOM FIT PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 513729 513729 HCHG SUT PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 513732 513732 HCHG TUBE FEEDING PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 513831 513831 HCHG BLANKET BAIR HUGGER PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 513832 513832 HCHG BLANKET BAIR HUGGER PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 513893 513893 HCHG INTRDCR SHEATH PR50 131.00 $117.90 $52.40 $104.80 $73.36 $91.70 $83.84 $104.80 $102.18 $58.95 $53.71 $55.02 $52.40 $98.25 $85.15
WWH SUPPLIES FEE SCHEDULE - 4207 513896 513896 HCHG ADPTR PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 513897 513897 HCHG ADPTR PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 513901 513901 HCHG BAG DRAIN PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 513955 513955 HCHG CATH DIAGNOSTIC PR70 182.00 $163.80 $72.80 $145.60 $101.92 $127.40 $116.48 $145.60 $141.96 $81.90 $74.62 $76.44 $72.80 $136.50 $118.30
WWH SUPPLIES FEE SCHEDULE - 4207 513966 513966 HCHG CNNCTR PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 514005 514005 HCHG DRAIN PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 514009 514009 HCHG DRSG PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 514010 514010 HCHG DRSG PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 514011 514011 HCHG DRSG PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 514012 514012 HCHG DRSG PR60 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH SUPPLIES FEE SCHEDULE - 4207 514015 514015 HCHG ELECTRODE PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 514036 514036 HCHG FILTER PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 514120 514120 HCHG KIT DRAIN PR70 182.00 $163.80 $72.80 $145.60 $101.92 $127.40 $116.48 $145.60 $141.96 $81.90 $74.62 $76.44 $72.80 $136.50 $118.30
WWH SUPPLIES FEE SCHEDULE - 4207 514125 514125 HCHG KIT ENEMA BARIUM 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH SUPPLIES FEE SCHEDULE - 4207 514128 514128 HCHG KIT EXT PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 514203 514203 HCHG KIT TUBING PR40 110.00 $99.00 $44.00 $88.00 $61.60 $77.00 $70.40 $88.00 $85.80 $49.50 $45.10 $46.20 $44.00 $82.50 $71.50
WWH SUPPLIES FEE SCHEDULE - 4207 514239 A4648 HCHG TISSUE MARKER IMPLANTABLE PR70 182.00 $163.80 $72.80 $145.60 $101.92 $127.40 $116.48 $145.60 $141.96 $81.90 $74.62 $76.44 $72.80 $136.50 $118.30
WWH SUPPLIES FEE SCHEDULE - 4207 514244 514244 HCHG MASK PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 514246 514246 HCHG MASK PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 514249 514249 HCHG MATERNITY SI LOC PR30 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH SUPPLIES FEE SCHEDULE - 4207 514257 514257 HCHG NDL PR100 252.00 $226.80 $100.80 $201.60 $141.12 $176.40 $161.28 $201.60 $196.56 $113.40 $103.32 $105.84 $100.80 $189.00 $163.80
WWH SUPPLIES FEE SCHEDULE - 4207 514261 514261 HCHG NDL PR40 110.00 $99.00 $44.00 $88.00 $61.60 $77.00 $70.40 $88.00 $85.80 $49.50 $45.10 $46.20 $44.00 $82.50 $71.50
WWH SUPPLIES FEE SCHEDULE - 4207 514342 514342 HCHG SPNG PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 514348 514348 HCHG STAPLER SKIN PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 514483 514483 HCHG BLADE PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 514491 C1729 HCHG CATH DRAIN PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 514504 514504 HCHG NDL BPSY PR40 110.00 $99.00 $44.00 $88.00 $61.60 $77.00 $70.40 $88.00 $85.80 $49.50 $45.10 $46.20 $44.00 $82.50 $71.50
WWH SUPPLIES FEE SCHEDULE - 4207 514523 514523 HCHG ELECTRODE PR397 "1,028.00" $925.20 $411.20 $822.40 $575.68 $719.60 $657.92 $822.40 $801.84 $462.60 $421.48 $431.76 $411.20 $771.00 $668.20
WWH SUPPLIES FEE SCHEDULE - 4207 514532 514532 HCHG KIT IV START PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 514736 Q9966 HCHG OMNIPAQUE 240 50ML 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 514769 514769 HCHG AEROCHAMBER 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 514800 514800 HCHG NDL SET INTRAOSSECUS 327.00 $294.30 $130.80 $261.60 $183.12 $228.90 $209.28 $261.60 $255.06 $147.15 $134.07 $137.34 $130.80 $245.25 $212.55
WWH SUPPLIES FEE SCHEDULE - 4207 514824 514824 HCHG KIT PR40 110.00 $99.00 $44.00 $88.00 $61.60 $77.00 $70.40 $88.00 $85.80 $49.50 $45.10 $46.20 $44.00 $82.50 $71.50
WWH SUPPLIES FEE SCHEDULE - 4207 514834 514834 HCHG SOL IRR PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 514880 Q4101 HCHG APLIGRAF PER SQ CM 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH SUPPLIES FEE SCHEDULE - 4207 515111 515111 HCHG BRUSH CYTOLOGY ENDO 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 515127 515127 HCHG BRACE ANKLE PR70 182.00 $163.80 $72.80 $145.60 $101.92 $127.40 $116.48 $145.60 $141.96 $81.90 $74.62 $76.44 $72.80 $136.50 $118.30
WWH SUPPLIES FEE SCHEDULE - 4207 515151 515151 HCHG CAUTERY PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 515152 515152 HCHG CNNLA PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 515155 515155 HCHG NDL PR110 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH SUPPLIES FEE SCHEDULE - 4207 515160 515160 HCHG SUT PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 515191 C1751 HCHG CATH INFUSION PR176 435.00 $391.50 $174.00 $348.00 $243.60 $304.50 $278.40 $348.00 $339.30 $195.75 $178.35 $182.70 $174.00 $326.25 $282.75
WWH SUPPLIES FEE SCHEDULE - 4207 515330 515330 HCHG TUBING PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 515361 515361 HCHG SENSOR PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 515383 515383 HCHG TUBE PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 515445 515445 HCHG DRSG PR30 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH SUPPLIES FEE SCHEDULE - 4207 515518 C1726 HCHG CATH BLLN DILATION PR50 131.00 $117.90 $52.40 $104.80 $73.36 $91.70 $83.84 $104.80 $102.18 $58.95 $53.71 $55.02 $52.40 $98.25 $85.15
WWH SUPPLIES FEE SCHEDULE - 4207 515537 515537 HCHG SYR PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 515540 515540 HCHG TUBE TRACH PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 515555 C1751 HCHG CATH INFUSION PR110 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH SUPPLIES FEE SCHEDULE - 4207 515583 515583 HCHG STATLOCK PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 515586 515586 HCHG TUBING PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 515587 515587 HCHG TUBING PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 515598 515598 HCHG PAD PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 515619 515619 HCHG POUCH OSTOMY PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 515626 515626 HCHG NDL PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 515649 515649 HCHG INSTRUMENT DISP PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 515650 515650 HCHG INSTRUMENT DISP PR30 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH SUPPLIES FEE SCHEDULE - 4207 515651 515651 HCHG INSTRUMENT DISP PR40 110.00 $99.00 $44.00 $88.00 $61.60 $77.00 $70.40 $88.00 $85.80 $49.50 $45.10 $46.20 $44.00 $82.50 $71.50
WWH SUPPLIES FEE SCHEDULE - 4207 515662 515662 HCHG SENSOR PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 515708 C1769 HCHG GUIDEWIRE PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 515714 515714 HCHG PACKING NASAL PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 515716 515716 HCHG PACKING NASAL PR30 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH SUPPLIES FEE SCHEDULE - 4207 515749 515749 HCHG DRSG PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 515764 515764 HCHG INSTRUMENT DISP PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 515767 L4386 HCHG WALKING BOOT NON PNEUMATIC PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 515786 C1758 HCHG CATH URETERAL PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 515790 515790 HCHG TUBING PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 515793 L3908 HCHG WHO COCKUP NONMOLDED PREFAB OTS PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 515811 515811 HCHG CIRCUIT BREATHING PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 515813 515813 HCHG AIRWAY PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 515820 515820 HCHG NITROUS OXIDE PER 15 MIN 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH SUPPLIES FEE SCHEDULE - 4207 515847 515847 HCHG CIRCUIT PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 515866 515866 HCHG TUBE ET PR50 131.00 $117.90 $52.40 $104.80 $73.36 $91.70 $83.84 $104.80 $102.18 $58.95 $53.71 $55.02 $52.40 $98.25 $85.15
WWH SUPPLIES FEE SCHEDULE - 4207 515874 515874 HCHG NEB PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 515906 515906 HCHG DEVICE CATH PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 515991 515991 HCHG DRSG PR40 110.00 $99.00 $44.00 $88.00 $61.60 $77.00 $70.40 $88.00 $85.80 $49.50 $45.10 $46.20 $44.00 $82.50 $71.50
WWH SUPPLIES FEE SCHEDULE - 4207 516006 Q9967 HCHG ISOVUE 300 100ML 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 516023 C1729 HCHG CATH DRAIN PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 516081 516081 HCHG DILATOR PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 516097 516097 HCHG ADPTR PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 516105 516105 HCHG FILTER PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 516128 516128 HCHG CNNLA PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 516135 516135 HCHG SPLINT PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 516139 C1892 HCHG INTRDCR GUIDING PEEL AWAY PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 516154 516154 HCHG STATLOCK PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 516189 516189 HCHG LUMBAR ROLL PR5 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 516190 516190 HCHG BLADE PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 516202 A4467 HCHG BINDER ABD PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 516213 516213 HCHG SLING PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 516221 516221 HCHG MANIFOLD PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 516227 516227 HCHG STAPLER SKIN PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 516246 516246 HCHG SHIELD EYE PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 516261 516261 HCHG DRSG PR50 131.00 $117.90 $52.40 $104.80 $73.36 $91.70 $83.84 $104.80 $102.18 $58.95 $53.71 $55.02 $52.40 $98.25 $85.15
WWH SUPPLIES FEE SCHEDULE - 4207 516269 516269 HCHG CANISTER VAC PR30 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH SUPPLIES FEE SCHEDULE - 4207 516280 516280 HCHG INSTRUMENT DISP PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 516302 C1758 HCHG CATH URETERAL PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 516309 516309 HCHG INSTRUMENT DISP PR70 182.00 $163.80 $72.80 $145.60 $101.92 $127.40 $116.48 $145.60 $141.96 $81.90 $74.62 $76.44 $72.80 $136.50 $118.30
WWH SUPPLIES FEE SCHEDULE - 4207 516316 L1830 HCHG KO IMMOB CANVAS LONG PREFAB OTS PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 516317 L1830 HCHG KO IMMOB CANVAS LONG PREFAB OTS PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 516332 L3808 HCHG WRIST HAND FINGER ORTHOSIS RIGID WO JOINTS PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 516340 L3908 HCHG WHO COCKUP NONMOLDED PREFAB OTS PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 516343 L3260 HCHG POST OP SURGICAL BOOT PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 516345 516345 HCHG STOCKING PR30 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH SUPPLIES FEE SCHEDULE - 4207 516346 516346 HCHG STOCKING PR40 110.00 $99.00 $44.00 $88.00 $61.60 $77.00 $70.40 $88.00 $85.80 $49.50 $45.10 $46.20 $44.00 $82.50 $71.50
WWH SUPPLIES FEE SCHEDULE - 4207 516369 516369 HCHG BAG DRAIN PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 516376 516376 HCHG CIRCUIT BREATHING PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 516444 516444 HCHG KIT MONITORING PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 516445 516445 HCHG KIT NEB PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 516456 516456 HCHG TUBE GASTRIC PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 516462 516462 HCHG TUBE TRACH PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 516468 L0120 HCHG CERVICAL COLLAR FLEXIBLE NONADJ FOAM PREFAB OTS PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 516476 L3650 HCHG SO FIG 8 ABD RESTRAINT PREFAB OTS PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 516486 516486 HCHG SHIELD BREAST PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 516487 516487 HCHG PAD PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 516493 516493 HCHG TUBE FEEDING PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 516496 516496 (IA) HCHG BARRIER SKIN PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 516506 L0625 HCHG LO FLEXIBLE L1 <= L5 PREFAB OTS PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 516541 516541 HCHG AIRWAY PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 516554 516554 HCHG PAD PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 516558 516558 HCHG SUPPORT LUMBAR PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 516559 516559 HCHG AIRWAY PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 516567 516567 HCHG TUBE ET PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 516581 516581 HCHG SUCTION PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 516597 516597 HCHG BAG DRAIN PR30 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH SUPPLIES FEE SCHEDULE - 4207 516616 L3480 HCHG HEEL CUP PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 516630 516630 HCHG CIRCUIT PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 516751 C1769 HCHG GLIDEWIRE PR50 131.00 $117.90 $52.40 $104.80 $73.36 $91.70 $83.84 $104.80 $102.18 $58.95 $53.71 $55.02 $52.40 $98.25 $85.15
WWH SUPPLIES FEE SCHEDULE - 4207 516806 L4396 HCHG STATIC OR DYNAMIC AFO PREFAB CUSTOM FIT PR30 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH SUPPLIES FEE SCHEDULE - 4207 516843 516843 HCHG SUPPORT KNEE PR30 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH SUPPLIES FEE SCHEDULE - 4207 516861 516861 HCHG BRACE PR30 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH SUPPLIES FEE SCHEDULE - 4207 516892 516892 HCHG KIT PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 516917 516917 HCHG TOURNIQUET CUFF STERILE PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 516974 L0140 HCHG COLLAR CERV RIGID PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 516999 516999 HCHG CUFF PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 517002 517002 HCHG DRAIN PR30 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH SUPPLIES FEE SCHEDULE - 4207 517031 517031 HCHG SKIN TISSUE ADHESIVE PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 517112 517112 HCHG TUBE FEEDING PR90 231.00 $207.90 $92.40 $184.80 $129.36 $161.70 $147.84 $184.80 $180.18 $103.95 $94.71 $97.02 $92.40 $173.25 $150.15
WWH SUPPLIES FEE SCHEDULE - 4207 517113 L4386 HCHG NONPNEUMATIC WALKING BOOT PREFAB CUSTOM FIT PR30 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH SUPPLIES FEE SCHEDULE - 4207 517120 517120 HCHG PAD PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 517143 517143 HCHG AIRWAY PR50 131.00 $117.90 $52.40 $104.80 $73.36 $91.70 $83.84 $104.80 $102.18 $58.95 $53.71 $55.02 $52.40 $98.25 $85.15
WWH SUPPLIES FEE SCHEDULE - 4207 517162 C1893 HCHG INTRDCR GUIDING NON PEEL AWAY PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 517194 517194 HCHG BRACE SHOULDER PREFAB PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 517198 517198 HCHG SUPPORT KNEE PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 517241 517241 HCHG MASK PR40 110.00 $99.00 $44.00 $88.00 $61.60 $77.00 $70.40 $88.00 $85.80 $49.50 $45.10 $46.20 $44.00 $82.50 $71.50
WWH SUPPLIES FEE SCHEDULE - 4207 517248 517248 HCHG HEELBOOT ORTHOTIC PR50 131.00 $117.90 $52.40 $104.80 $73.36 $91.70 $83.84 $104.80 $102.18 $58.95 $53.71 $55.02 $52.40 $98.25 $85.15
WWH SUPPLIES FEE SCHEDULE - 4207 518754 518754 HCHG KIT PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 518756 518756 HCHG KIT PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 518786 518786 HCHG KIT PR482 "1,208.00" " $1,087.20 " $483.20 $966.40 $676.48 $845.60 $773.12 $966.40 $942.24 $543.60 $495.28 $507.36 $483.20 $906.00 $785.20
WWH SUPPLIES FEE SCHEDULE - 4207 518802 L4386 HCHG NONPNEUMATIC WALKING BOOT PREFAB CUSTOM FIT PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 518809 L1930 HCHG AFO PLASTIC PREFAB PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 518950 518950 HCHG SPLINT NASAL PR40 110.00 $99.00 $44.00 $88.00 $61.60 $77.00 $70.40 $88.00 $85.80 $49.50 $45.10 $46.20 $44.00 $82.50 $71.50
WWH SUPPLIES FEE SCHEDULE - 4207 518978 L3908 HCHG WHO COCKUP NONMOLDED PREFAB OTS PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 519028 519028 HCHG OXYGEN PER DAY 486.00 $437.40 $194.40 $388.80 $272.16 $340.20 $311.04 $388.80 $379.08 $218.70 $199.26 $204.12 $194.40 $364.50 $315.90
WWH SUPPLIES FEE SCHEDULE - 4207 519210 519210 HCHG TUBE HOLDER PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 519214 519214 HCHG IRR GUN AND VALVE PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 519236 A9585 HCHG GADAVIST 10ML 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 519369 A9585 HCHG GADAVIST 7.5ML 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 519441 519441 HCHG DRAIN PR40 110.00 $99.00 $44.00 $88.00 $61.60 $77.00 $70.40 $88.00 $85.80 $49.50 $45.10 $46.20 $44.00 $82.50 $71.50
WWH SUPPLIES FEE SCHEDULE - 4207 519487 519487 HCHG STOCKING PR80 203.00 $182.70 $81.20 $162.40 $113.68 $142.10 $129.92 $162.40 $158.34 $91.35 $83.23 $85.26 $81.20 $152.25 $131.95
WWH SUPPLIES FEE SCHEDULE - 4207 519488 519488 HCHG STOCKING PR50 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH SUPPLIES FEE SCHEDULE - 4207 519552 519552 HCHG STYLET PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 519561 519561 HCHG TRAY PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 519583 519583 HCHG TUBE PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 519596 519596 HCHG KIT PR80 203.00 $182.70 $81.20 $162.40 $113.68 $142.10 $129.92 $162.40 $158.34 $91.35 $83.23 $85.26 $81.20 $152.25 $131.95
WWH SUPPLIES FEE SCHEDULE - 4207 519610 519610 HCHG SENSOR PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 519623 519623 HCHG TEMP PROBE PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 519684 519684 HCHG STOCKING PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 519756 519756 HCHG FEEDING DEVICE PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 519771 519771 HCHG CATH PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 519775 519775 HCHG HOOK PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 519788 519788 HCHG HEMOSTATIC AGENT PR60 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH SUPPLIES FEE SCHEDULE - 4207 519801 519801 HCHG CIRCUIT BREATHING PR50 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH SUPPLIES FEE SCHEDULE - 4207 519824 519824 HCHG COMPRESSION GARMENT PR40 110.00 $99.00 $44.00 $88.00 $61.60 $77.00 $70.40 $88.00 $85.80 $49.50 $45.10 $46.20 $44.00 $82.50 $71.50
WWH SUPPLIES FEE SCHEDULE - 4207 519825 519825 HCHG TUBE HOLDER PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 519830 519830 HCHG COMPRESSION GARMENT PR50 131.00 $117.90 $52.40 $104.80 $73.36 $91.70 $83.84 $104.80 $102.18 $58.95 $53.71 $55.02 $52.40 $98.25 $85.15
WWH SUPPLIES FEE SCHEDULE - 4207 519849 519849 HCHG COMPRESSION GARMENT PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 519870 L2999 HCHG LE ORTHOSIS PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 519946 519946 HCHG KIT PR90 231.00 $207.90 $92.40 $184.80 $129.36 $161.70 $147.84 $184.80 $180.18 $103.95 $94.71 $97.02 $92.40 $173.25 $150.15
WWH SUPPLIES FEE SCHEDULE - 4207 520010 520010 HCHG TRAY PR30 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH SUPPLIES FEE SCHEDULE - 4207 520011 520011 HCHG TRAY PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 520034 520034 HCHG COMPRESSION GARMENT PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 520036 520036 HCHG DRAIN PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 520046 L2999 HCHG LE ORTHOSIS PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 520063 520063 HCHG TUBE FEEDING PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 520100 L1832 HCHG KO RIGID SUPPORT ADJ JOINT POSTL PREFAB CUSTOM FIT PR30 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH SUPPLIES FEE SCHEDULE - 4207 520195 L3332 HCHG SHOE LIFTS TAPERED =< HALF INCH PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 520726 Q4145 HCHG EPIFIX INJ 1 MG AFFILIATE ONLY 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH SUPPLIES FEE SCHEDULE - 4207 520733 L2999 HCHG LE ORTHOSIS PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 520769 L1902 HCHG BRACE AFO ANKLE PREFAB PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 521007 L3999 HCHG UE ORTHOSIS PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 521106 521106 HCHG TRAY PR50 131.00 $117.90 $52.40 $104.80 $73.36 $91.70 $83.84 $104.80 $102.18 $58.95 $53.71 $55.02 $52.40 $98.25 $85.15
WWH SUPPLIES FEE SCHEDULE - 4207 521219 521219 HCHG TUBE JEJUNAL PR210 529.00 $476.10 $211.60 $423.20 $296.24 $370.30 $338.56 $423.20 $412.62 $238.05 $216.89 $222.18 $211.60 $396.75 $343.85
WWH SUPPLIES FEE SCHEDULE - 4207 521220 C1769 HCHG WIRE GUIDE PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 521235 C1758 HCHG CATH URETERAL PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 521321 521321 HCHG BARRIER POUCH OSTOMY PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 521369 521369 HCHG BRACE PR30 AFFILIATE ONLY 84.00 $75.60 $33.60 $67.20 $47.04 $58.80 $53.76 $67.20 $65.52 $37.80 $34.44 $35.28 $33.60 $63.00 $54.60
WWH SUPPLIES FEE SCHEDULE - 4207 521373 521373 HCHG BRACE WRIST PR20 AFFILIATE ONLY 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 521477 L2999 HCHG STRAP KNEE PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 521516 521516 HCHG BAG DRAIN PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 521521 521521 HCHG BAG DRAIN PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 521532 521532 HCHG BELT PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 521546 521546 HCHG BLLN CATH PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 521570 521570 HCHG BOOT PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 521572 521572 HCHG BOOT PR80 203.00 $182.70 $81.20 $162.40 $113.68 $142.10 $129.92 $162.40 $158.34 $91.35 $83.23 $85.26 $81.20 $152.25 $131.95
WWH SUPPLIES FEE SCHEDULE - 4207 521620 521620 HCHG CATH DRN PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 521621 521621 HCHG CATH DRN PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 521624 521624 HCHG CATH DRN PR30 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH SUPPLIES FEE SCHEDULE - 4207 521672 L0174 HCHG CERVICAL COLLAR SEMI RIGID 2 PC THOR EXT PREFAB OTS PR50 131.00 $117.90 $52.40 $104.80 $73.36 $91.70 $83.84 $104.80 $102.18 $58.95 $53.71 $55.02 $52.40 $98.25 $85.15
WWH SUPPLIES FEE SCHEDULE - 4207 521794 521794 HCHG KIT IRRIGATION PR30 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH SUPPLIES FEE SCHEDULE - 4207 521808 521808 HCHG KIT PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 521866 521866 HCHG MARKER PR90 231.00 $207.90 $92.40 $184.80 $129.36 $161.70 $147.84 $184.80 $180.18 $103.95 $94.71 $97.02 $92.40 $173.25 $150.15
WWH SUPPLIES FEE SCHEDULE - 4207 521916 L4387 HCHG NON PNEUM WALKING BOOT PREFAB OTS PR40 110.00 $99.00 $44.00 $88.00 $61.60 $77.00 $70.40 $88.00 $85.80 $49.50 $45.10 $46.20 $44.00 $82.50 $71.50
WWH SUPPLIES FEE SCHEDULE - 4207 521931 521931 HCHG PACKING NASAL PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 521942 521942 HCHG PEAK FLOW METER PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 521976 521976 HCHG PROTTR PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 521981 521981 HCHG RESUS PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 521982 521982 HCHG RESUS PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 521997 521997 HCHG SHIELD BREAST PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 521999 521999 HCHG SHOE WEDGE PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 522009 522009 HCHG SLEEVE COMPRESSION CALF PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 522013 L3670 HCHG SO ACRO CLAV CAN WEB PREFAB OTS PR50 131.00 $117.90 $52.40 $104.80 $73.36 $91.70 $83.84 $104.80 $102.18 $58.95 $53.71 $55.02 $52.40 $98.25 $85.15
WWH SUPPLIES FEE SCHEDULE - 4207 522017 522017 HCHG SPIROMETER PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 522038 522038 HCHG STOCKING PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 522039 522039 HCHG STOCKING PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 522040 522040 HCHG STOPCOCK PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 522044 522044 HCHG SUCTION PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 522096 522096 HCHG VALVE PR90 231.00 $207.90 $92.40 $184.80 $129.36 $161.70 $147.84 $184.80 $180.18 $103.95 $94.71 $97.02 $92.40 $173.25 $150.15
WWH SUPPLIES FEE SCHEDULE - 4207 522097 522097 HCHG VEST WRAP PR70 182.00 $163.80 $72.80 $145.60 $101.92 $127.40 $116.48 $145.60 $141.96 $81.90 $74.62 $76.44 $72.80 $136.50 $118.30
WWH SUPPLIES FEE SCHEDULE - 4207 522207 522207 HCHG TRAY PR40 110.00 $99.00 $44.00 $88.00 $61.60 $77.00 $70.40 $88.00 $85.80 $49.50 $45.10 $46.20 $44.00 $82.50 $71.50
WWH SUPPLIES FEE SCHEDULE - 4207 522217 E0190 HCHG ABD PILLOW PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 522219 522219 HCHG AIRWAY PR176 435.00 $391.50 $174.00 $348.00 $243.60 $304.50 $278.40 $348.00 $339.30 $195.75 $178.35 $182.70 $174.00 $326.25 $282.75
WWH SUPPLIES FEE SCHEDULE - 4207 522223 522223 HCHG BANDAGE PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 522224 522224 HCHG BANDAGE PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 522225 522225 HCHG BANDAGE PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 522227 522227 HCHG BOOT UNNA PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 522228 L0172 HCHG CERVICAL COLLAR SEMI RIGID FOAM 2 PC PREFAB OTS PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 522230 522230 HCHG CLEANSER WOUND PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 522231 522231 HCHG CORD CLAMP PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 522232 522232 HCHG DRAIN PR150 381.00 $342.90 $152.40 $304.80 $213.36 $266.70 $243.84 $304.80 $297.18 $171.45 $156.21 $160.02 $152.40 $285.75 $247.65
WWH SUPPLIES FEE SCHEDULE - 4207 522233 A4467 HCHG ELASTIC GARMENT COVERING PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 522234 A4467 HCHG ELASTIC GARMENT COVERING PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 522235 L3702 HCHG ELBOW ORTHOSIS WO JOINTS CUSTOM FAB PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 522236 522236 HCHG FEEDING DEVICE PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 522237 522237 HCHG FINGER GUARD PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 522239 522239 HCHG FLUID WARMING PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 522240 A6212 HCHG FOAM DRSG <= 16 SQ IN W BORDER PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 522241 A6210 HCHG FOAM DRSG > 16 <= 48 SQ IN WO BORDER EA PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 522242 A6211 HCHG FOAM DRSG > 48 SQ IN WO BORDER EA PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 522243 A6215 HCHG FOAM DRSG WOUND FILLER STERILE PER GRAM PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 522244 522244 HCHG FOOT CAST PR100 252.00 $226.80 $100.80 $201.60 $141.12 $176.40 $161.28 $201.60 $196.56 $113.40 $103.32 $105.84 $100.80 $189.00 $163.80
WWH SUPPLIES FEE SCHEDULE - 4207 522245 L3170 HCHG FOOT HEEL STABILIZER PREFAB OTS EA PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 522247 522247 HCHG HEALING SHOE PR100 252.00 $226.80 $100.80 $201.60 $141.12 $176.40 $161.28 $201.60 $196.56 $113.40 $103.32 $105.84 $100.80 $189.00 $163.80
WWH SUPPLIES FEE SCHEDULE - 4207 522248 522248 HCHG INTRAUTERINE SYSTEM PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 522249 L1832 HCHG KO RIGID SUPPORT ADJ JOINT POSTL PREFAB CUSTOM FIT PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 522251 522251 HCHG MUCUS DEVICE PR70 182.00 $163.80 $72.80 $145.60 $101.92 $127.40 $116.48 $145.60 $141.96 $81.90 $74.62 $76.44 $72.80 $136.50 $118.30
WWH SUPPLIES FEE SCHEDULE - 4207 522252 L4386 HCHG NONPNEUMATIC WALKING BOOT PREFAB CUSTOM FIT PR80 203.00 $182.70 $81.20 $162.40 $113.68 $142.10 $129.92 $162.40 $158.34 $91.35 $83.23 $85.26 $81.20 $152.25 $131.95
WWH SUPPLIES FEE SCHEDULE - 4207 522256 522256 HCHG RESPRITORY TRAINER PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 522257 522257 HCHG ROSIDAL PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 522258 522258 HCHG ROSIDAL PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 522261 522261 HCHG SHEATH INTRDCR PR10 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 522262 522262 HCHG SLEEVE COMPRESSION PR30 85.00 $76.50 $34.00 $68.00 $47.60 $59.50 $54.40 $68.00 $66.30 $38.25 $34.85 $35.70 $34.00 $63.75 $55.25
WWH SUPPLIES FEE SCHEDULE - 4207 522264 A4565 HCHG SLING PR1 AFFILIATE ONLY 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 522265 L3650 HCHG SO FIG 8 ABD RESTRAINT PREFAB OTS PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 522267 522267 HCHG SPLINT NASAL PR50 131.00 $117.90 $52.40 $104.80 $73.36 $91.70 $83.84 $104.80 $102.18 $58.95 $53.71 $55.02 $52.40 $98.25 $85.15
WWH SUPPLIES FEE SCHEDULE - 4207 522268 522268 HCHG SPNG PR50 131.00 $117.90 $52.40 $104.80 $73.36 $91.70 $83.84 $104.80 $102.18 $58.95 $53.71 $55.02 $52.40 $98.25 $85.15
WWH SUPPLIES FEE SCHEDULE - 4207 522269 522269 HCHG SUPPORTER ATHLETIC PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 522271 522271 HCHG SURGICEL PR50 131.00 $117.90 $52.40 $104.80 $73.36 $91.70 $83.84 $104.80 $102.18 $58.95 $53.71 $55.02 $52.40 $98.25 $85.15
WWH SUPPLIES FEE SCHEDULE - 4207 522272 522272 HCHG TRAP MUCUS PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 522273 522273 HCHG TUBE EAR PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 522275 522275 HCHG VEST WRAP PR60 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH SUPPLIES FEE SCHEDULE - 4207 522277 522277 HCHG WOUND CLOSURE PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 522279 522279 HCHG WRAP SHOULDER PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 522327 522327 HCHG KIT IRRIGATION PR20 58.00 $52.20 $23.20 $46.40 $32.48 $40.60 $37.12 $46.40 $45.24 $26.10 $23.78 $24.36 $23.20 $43.50 $37.70
WWH SUPPLIES FEE SCHEDULE - 4207 522328 522328 HCHG KIT IRRIGATION PR5 19.00 $17.10 $7.60 $15.20 $10.64 $13.30 $12.16 $15.20 $14.82 $8.55 $7.79 $7.98 $7.60 $14.25 $12.35
WWH SUPPLIES FEE SCHEDULE - 4207 522433 L3923 HCHG HFO WO JOINTS PREFAB CUSTOM FIT PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 522434 L3649 HCHG ORTHOPEDIC SHOE MODIFICATION NOS PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 522763 522763 HCHG OB NITROUS OXIDE PER 15 MIN 64.00 $57.60 $25.60 $51.20 $35.84 $44.80 $40.96 $51.20 $49.92 $28.80 $26.24 $26.88 $25.60 $48.00 $41.60
WWH SUPPLIES FEE SCHEDULE - 4207 522780 522780 HCHG CANISTER VAC PR60 152.00 $136.80 $60.80 $121.60 $85.12 $106.40 $97.28 $121.60 $118.56 $68.40 $62.32 $63.84 $60.80 $114.00 $98.80
WWH SUPPLIES FEE SCHEDULE - 4207 522784 Q4133 HCHG GRAFIX PRIME PER SQ CM PR110 AFF ONLY 271.00 $243.90 $108.40 $216.80 $151.76 $189.70 $173.44 $216.80 $211.38 $121.95 $111.11 $113.82 $108.40 $203.25 $176.15
WWH SUPPLIES FEE SCHEDULE - 4207 522906 L3260 HCHG SHOE POST OP AFFILIATE ONLY 34.00 $30.60 $13.60 $27.20 $19.04 $23.80 $21.76 $27.20 $26.52 $15.30 $13.94 $14.28 $13.60 $25.50 $22.10
WWH SUPPLIES FEE SCHEDULE - 4207 523103 Q4196 HCHG PURAPLY ANTIMICROBIAL PER SQ CM AFF ONLY 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH SUPPLIES FEE SCHEDULE - 4207 523127 523127 HCHG NON STERILE SUPPLY PR250 649.00 $584.10 $259.60 $519.20 $363.44 $454.30 $415.36 $519.20 $506.22 $292.05 $266.09 $272.58 $259.60 $486.75 $421.85
WWH SUPPLIES FEE SCHEDULE - 4207 523287 523287 HCHG DRAIN PR160 412.00 $370.80 $164.80 $329.60 $230.72 $288.40 $263.68 $329.60 $321.36 $185.40 $168.92 $173.04 $164.80 $309.00 $267.80
WWH SUPPLIES FEE SCHEDULE - 4207 523307 523307 HCHG GLV REHAB PR1 5.00 $4.50 $2.00 $4.00 $2.80 $3.50 $3.20 $4.00 $3.90 $2.25 $2.05 $2.10 $2.00 $3.75 $3.25
WWH SUPPLIES FEE SCHEDULE - 4207 523420 Q4186 HCHG EPIFIX PER SQ CM AFFILIATE ONLY 0.00 $- $- $- $- $- $- $- $- $- $- $- $- $- $-
WWH SUPPLIES FEE SCHEDULE - 4207 523575 523575 HCHG PNEUMOPERICARDIAL DRAINAGE SET PR150 AFFILIATE ONLY 380.00 $342.00 $152.00 $304.00 $212.80 $266.00 $243.20 $304.00 $296.40 $171.00 $155.80 $159.60 $152.00 $285.00 $247.00
WWH SUPPLIES FEE SCHEDULE - 4207 523615 523615 HCHG NDL MAGNUM BPSY PR40 AFFILIATE ONLY 110.00 $99.00 $44.00 $88.00 $61.60 $77.00 $70.40 $88.00 $85.80 $49.50 $45.10 $46.20 $44.00 $82.50 $71.50
WWH SUPPLIES FEE SCHEDULE - 4207 523744 523744 HCHG RETRIEVER PR90 231.00 $207.90 $92.40 $184.80 $129.36 $161.70 $147.84 $184.80 $180.18 $103.95 $94.71 $97.02 $92.40 $173.25 $150.15