Imaging prices at Ascension St. Vincent's St. Johns County

St. Johns, FL · every code in this section with a posted price and a Medicare benchmark.

270 codes. Prices are the hospital's own posted facility charges.

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ProcedureCash priceGross charge× Medicare
Acute gi blood loss imaging (78278) $1,550.95 $4,191.75 3.7×
Angio extremity unilateral (75710) $1,729.01 $4,673 0.5×
Angio pulmonary unilateral (75741) $907.06 $2,451.50 0.3×
Angiogram extremity bilateral (75716) $1,990.79 $5,380.50 0.6×
Angiogram pelvic (75736)
unusually low: confirm this is the full procedure
$1,832.61 $4,953 0.3×
Angiography internal mammary rs&i (75756) $1,745.20 $4,716.75 0.5×
Angiography pulmonary bilateral slctv rs&i (75743) $2,192.25 $5,925 0.7×
Angiography visceral slctv/supraslctv rs&i (75726)
likely a partial charge, not the full procedure
$1,320.35 $3,568.50 0.2×
Angrph pulmonary nonslctv cath/ven njx rs&i (75746) $2,211.12 $5,976 0.7×
Ankle 2 views (73600) $215.44 $582.25 2.4×
Barium enema (74270) $538.17 $1,454.50 2.9×
Bilat selctv renal venogram (75833) $4,043.45 $10,928.25 1.2×
Bone age studies (77072) $185.65 $501.75 1.7×
Bone imaging limited area (78300) $1,436.06 $3,881.25 3.4×
Bone survey complete (77075) $620.54 $1,677.12 5.7×
Bowel imaging (78290) $1,550.95 $4,191.75 3.7×
Brain image w/flow 4 + views (78606) $1,550.95 $4,191.75 2.7×
Cardiac MRI w/wo contrast & further seq (75561) $761.46 $2,058 2.1×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $216.82 $586 1.2×
Clavicle complete (73000) $202.12 $546.25 2.2×
Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) $624.28 $1,687.25 3.4×
Contrast exam abdominl aorta (75625) $1,281.31 $3,463 0.4×
Contrast exam thoracic aorta (75605)
unusually low: confirm this is the full procedure
$1,767.68 $4,777.50 0.3×
CT - st neck w&wo contr (70492) $693.10 $1,873.25 3.8×
CT abdomen and pelvis without and with contrast (74178) $738.98 $1,997.25 2.0×
CT abdomen and pelvis without contrast (74176) $647.32 $1,749.50 2.6×
CT abdomen w wo contrast (74170) $693.10 $1,873.25 3.8×
CT abdomen w/contrast (74160) $647.32 $1,749.50 3.5×
CT abdomen w/o contrast (74150) $601.44 $1,625.50 5.5×
CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) $647.32 $1,749.50 1.8×
CT angio abdom w/o & w/dye (74175) $647.32 $1,749.50 3.5×
CT angio abdominal arteries (75635) $647.32 $1,749.50 3.5×
CT angio hrt w/3d image (75574) $647.32 $1,749.50 1.8×
CT angiograph pelv w/o&w/dye (72191) $647.32 $1,749.50 3.5×
CT cervical spine w/contrast (72126) $693.10 $1,873.25 1.9×
CT cervical spine w/o contrast (72125) $647.32 $1,749.50 5.9×
CT chest w/contrast (71260) $693.10 $1,873.25 3.8×
CT extremity upper w & w/o contrast (73202) $693.10 $1,873.25 3.8×
CT head/brain with contrast (70460) $722.43 $1,952.50 3.9×
CT head/brain without and with contrast (70470) $768.31 $2,076.50 4.2×
CT heart contrast eval cardiac structure&morph (75572) $647.32 $1,749.50 1.8×
CT heart w/o contrast quant eval coronary calcium (75571) $38.85 $105 0.4×
CT lower ext w/wo contrast (73702) $647.32 $1,749.50 3.5×
CT lower extremity w contrast (73701) $601.44 $1,625.50 3.3×
CT lower extremity w/o contrast unilateral (73700) $555.56 $1,501.50 5.1×
CT lumbar spine w/contrast (72132) $647.32 $1,749.50 1.8×
CT lumbar spine w/o contrast (72131) $601.44 $1,625.50 5.5×
CT lumbar spine w/o then w/ con (72133) $693.10 $1,873.25 3.8×
CT maxillofacial area w/o contrast (70486) $601.44 $1,625.50 5.5×
CT maxillofacial w/contrast (70487) $647.32 $1,749.50 3.5×
CT maxillofacial w/o then w/ con (70488) $693.10 $1,873.25 3.8×
CT orbit sella ear w/o con (70480) $578.40 $1,563.25 5.3×
CT orbit/ear/fossa w/o then w/ con (70482) $670.16 $1,811.25 3.7×
CT pelvis w & w/o contrast (72194) $716.04 $1,935.25 3.9×
CT pelvis w/o contrast (72192) $624.28 $1,687.25 5.7×
CT soft tissue neck w/contrast (70491) $647.32 $1,749.50 3.5×
CT soft tissue neck w/o contrast (70490) $601.44 $1,625.50 5.5×
CT spine cervical w/wo contrast (72127) $785.70 $2,123.50 4.3×
CT thoracic spine w/contrast (72129) $624.28 $1,687.25 3.4×
CT thoracic spine w/o contrast (72128) $578.40 $1,563.25 5.3×
CT thoracic spine w/o then w/ con (72130) $670.16 $1,811.25 3.7×
CT thorax lung cancer scr c- (71271) $647.32 $1,749.50 5.9×
CT thorax w/o contrast (71250) $647.32 $1,749.50 5.9×
CT thorax w/o then w/ contrast (71270) $738.98 $1,997.25 4.0×
CT upper extremity w/dye (73201) $647.32 $1,749.50 1.8×
CT upper extremity w/o contrast rt (73200) $601.44 $1,625.50 5.5×
CTA chest w/wo contrast (71275) $647.32 $1,749.50 3.5×
CTA head w contrast (70496) $647.32 $1,749.50 3.5×
CTA lower extremity w/wo contrast unilateral (73706) $647.32 $1,749.50 3.5×
Cta Neck (70498) $647.32 $1,749.50 3.5×
CTA upper extremity w/wo contrast unilateral (73206) $647.32 $1,749.50 3.5×
Diskography lumbar (72295) $2,805.80 $7,583.25 1.4×
Esophogram (74220) $419.77 $1,134.50 2.3×
Fetal biophysical profile non-stress testing (76818) $564.72 $1,526.25 5.2×
Fluoroscopy up to 1 hour physician/qhp time (76000) $248.27 $671 1.0×
Gastric emptying study (78264) $1,550.95 $4,191.75 3.7×
Gated heart planar single (78472) $1,550.95 $4,191.75 3.7×
Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Other… (75889) $4,359.25 $11,781.75 1.3×
Hepatobil syst image w/drug (78227) $1,550.95 $4,191.75 2.7×
Hepatobiliary system imaging (78226) $1,550.95 $4,191.75 3.7×
Humerus min 2 views (73060) $177.23 $479 2.0×
Hysterosalpingography (74740) $665.50 $1,798.62 2.7×
Ivp (74400) $743.33 $2,009 4.1×
Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) $1,550.95 $4,191.75 2.7×
Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) $1,550.95 $4,191.75 2.7×
Liver & spleen; static only (78215) $1,550.95 $4,191.75 3.7×
Lung perfusion differential (78597) $1,550.95 $4,191.75 3.7×
Lung ventilat&perfus imaging (78582) $1,550.95 $4,191.75 2.7×
Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) $794.58 $2,147.50 2.2×
Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) $794.58 $2,147.50 2.2×
Mr safety determination physician/other qhp (76016) $156.42 $422.75 1.7×
Mr safety implt electronics prepj supvj phys/qhp (76018) $135.88 $367.25 1.4×
MRA head w & w/o contrast (70546) $775.10 $2,094.88 2.1×
MRA head w/contrast (70545) $606.15 $1,638.25 1.7×
MRA head w/o contrast (70544) $697.08 $1,884 2.8×
MRA neck w/contrast (70548) $590.15 $1,595 1.6×
MRA neck w/o contrast (70547) $677.61 $1,831.38 2.7×
MRA neck w/wo contrast (70549) $755.59 $2,042.12 2.1×
MRI abdomen w/contrast (74182) $843.05 $2,278.50 2.3×
MRI abdomen w/o & w/contrast material (74183) $755.59 $2,042.12 2.1×
MRI abdomen w/o contrast (74181) $677.61 $1,831.38 2.7×
MRI any jnt lwr ext with con lt (73722) $755.59 $2,042.12 0.9×
MRI breast without contrast bilateral (77047) $687.32 $1,857.62 2.8×
MRI cardiac w/o contrast (75557) $388.59 $1,050.25 1.6×
MRI cervical spine w/o contrast (72141) $677.61 $1,831.38 2.7×
MRI cervical spine with contrast (72142) $697.08 $1,884 1.9×
MRI chest w & w/o contrast (71552) $794.58 $2,147.50 2.2×
MRI chest w/o contrast (71550) $716.60 $1,936.75 2.9×
MRI joint upper ext w/contrast (73222) $755.59 $2,042.12 0.9×
MRI joint upr extr w/o&w/dye (73223) $794.58 $2,147.50 2.2×
MRI joint upr extrem w/o dye (73221) $989.66 $2,674.75 4.0×
Mri Lower Extremity W/O Dye (73718) $716.60 $1,936.75 2.9×
MRI lumbar spine with contrast (72149) $755.59 $2,042.12 2.1×
MRI lumbar w/wo contrast (72158) $794.58 $2,147.50 2.2×
MRI lwr ext w/o jnts with con rt (73719) $802.90 $2,170 2.2×
MRI orbit/face/neck w/contrast (70542) $797.17 $2,154.50 2.2×
MRI orbit/face/neck w/o & w/contrast (70543) $716.60 $1,936.75 2.0×
MRI orbit/face/neck w/o contrast (70540) $638.58 $1,725.88 2.6×
MRI pelvis w/ contrast (72196) $874.31 $2,363 2.4×
MRI pelvis w/o contrast (72195) $638.58 $1,725.88 2.6×
MRI pelvis w/wo contrast (72197) $716.60 $1,936.75 2.0×
MRI spine cervical wo/w contrast (72156) $736.07 $1,989.38 2.0×
MRI spine thoracic w/contrast (72147) $716.60 $1,936.75 2.0×
MRI thoracic spine w wo contrast (72157) $755.59 $2,042.12 2.1×
MRI thoracic spine w/o contrast (72146) $677.61 $1,831.38 2.7×
MRI tmj (70336) $716.60 $1,936.75 2.9×
MRI upper extremity oth than jt w/o contr matrl (73218) $677.61 $1,831.38 2.7×
Mri Upper Extremity W/Dye (73219) $1,101.40 $2,976.75 3.0×
MRI upr ext w/o jnts w/o-w/con rt (73220) $755.59 $2,042.12 2.1×
Myocardial spect single study at rest or stress (78451) $1,493.51 $4,036.50 1.1×
N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) $1,210.55 $3,271.76 1.3×
Nm bone 3 phase (78315) $1,550.95 $4,191.75 3.7×
Nm bone imaging whole body (78306) $1,665.83 $4,502.25 4.0×
Nm bone marrow scan limited (78102) $1,550.95 $4,191.75 3.7×
Nm heart perfusion spect stress rest (78452) $1,608.39 $4,347 1.2×
Nm lymph system (78195) $1,550.95 $4,191.75 2.7×
Nuclear medicine study of heart pumping function by labeling red blood cells with measurement of internal blood volume… (78494) $1,550.95 $4,191.75 3.7×
Ob us < 14 wks single fetus (76801) $497.14 $1,343.62 4.6×
Parathyroid imaging (78070) $1,550.95 $4,191.75 3.7×
Parathyroid planar imaging w/wo subtraction (78071) $1,723.28 $4,657.50 4.1×
Peritoneal-venous shunt patency test (78291) $752.49 $2,033.75 1.8×
Peritoneogram rs&i (74190) $466.11 $1,259.75 0.8×
Pulmonary perfusion imaging particulate (78580) $1,550.95 $4,191.75 3.7×
Radex abscess/fistula/sinus tract rs&i (76080) $507.55 $1,371.75 0.9×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $130.98 $354 1.4×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $186.57 $504.25 1.7×
Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) $337.26 $911.50 3.1×
Radex hip unilateral with pelvis 1 view (73501) $179.40 $484.88 2.0×
Radex hip unilateral with pelvis 2-3 views (73502) $197.30 $533.25 2.2×
Radex hip unilateral with pelvis minimum 4 views (73503) $191.48 $517.50 1.8×
Radex hips bilateral with pelvis 2 views (73521) $228.84 $618.50 2.1×
Radex hips bilateral with pelvis minimum 5 views (73523) $250.68 $677.50 2.3×
Radex spine cervical 2 or 3 views (72040) $264.14 $713.88 2.9×
Radex spine cervical 4 or 5 views (72050) $396.36 $1,071.25 3.6×
Radex spine cervical 6 or more views (72052) $430.82 $1,164.38 3.9×
Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) $178.06 $481.25 2.0×
Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) $192.82 $521.12 1.8×
Radiologic exam upr gi trc single contrast study (74240) $581.27 $1,571 3.2×
Radiologic Examination Femur 1 View - Xr Femur 1 Vw Right (73551) $114.89 $310.50 1.3×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $256.32 $692.75 2.8×
Radiologic examination, spine; thoracic, minimum of 4 views Other Diagnostic Radiology FS (72074) $148.83 $402.25 1.4×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $1,493.51 $4,036.50 3.6×
Rp loclzj tum plnr whole body 2+ days imaging (78804) $1,608.39 $4,347 2.8×
Rp loclzj tum plnr whole body single day imaging (78802) $1,608.39 $4,347 2.8×
Rp loclzj tum spect 1 area single day imaging (78803) $1,493.51 $4,036.50 2.6×
Rp loclzj tum spect CT 2area/sep acquisj img (78832) $3,064.53 $8,282.50 2.1×
Rp therapy intra-arterial particulate admn (79445) $403.39 $1,090.25 1.7×
Screening digital breast tomosynthesis; bilateral (77063) $76.04 $205.50 3.3×
Shuntogram indwelling nonvascular shunt rs&i (75809) $199.25 $538.50 1.8×
Small bowel series (74250) $480.17 $1,297.75 2.6×
Tbs technical calculation only (77091) $145.23 $392.50 1.6×
Thyroid met imaging body (78018) $1,665.83 $4,502.25 2.9×
Thyroid uptake w/blood flow sngle/mult quan meas (78014) $1,550.95 $4,191.75 3.7×
Trabecular bone score (TBS), structural condition of the bone microarchitecture; technical preparation and transmission… (77090) $145.23 $392.50 1.6×
Ultrasound breast limited (76642) $350.95 $948.50 3.9×
Ultrasound, abdomen limited (76705) $802.72 $2,169.50 7.4×
Urethrocystography retrograde rs&i (74450) $370 $1,000 1.5×
Urethrocystography voiding (74455) $432.81 $1,169.75 1.7×
Urography antegrade (74425) $588.49 $1,590.50 1.6×
Urography retrograde w/wo kub (74420) $555.83 $1,502.25 1.5×
Us abdominal aorta real time screen study aaa (76706) $219.69 $593.75 2.0×
Us breast uni real time with image complete (76641) $377.40 $1,020 3.5×
Us chest (76604) $444.56 $1,201.50 4.1×
Us compl joint r-t w/image documentation (76881) $635.52 $1,717.62 5.8×
Us kidney transplanted (76776) $471.10 $1,273.25 4.3×
Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) $627.20 $1,695.12 5.7×
Us ob limited 1 or more fetuses (76815) $312.56 $844.75 2.9×
Us obstetric transvaginal (76817) $503.48 $1,360.75 4.6×
Us pelvic limited or f/u non-ob (76857) $393.86 $1,064.50 3.6×
Us pelvis complete (76856) $699.21 $1,889.75 6.4×
Us retroperitoneal complete (76770) $518.23 $1,400.62 4.7×
Us retroperitoneal limited (76775) $407.51 $1,101.38 3.7×
Us scrotum (76870) $579.88 $1,567.25 5.3×
Us soft tissue head/neck (76536) $601.34 $1,625.25 5.5×
Us transrectal (76872) $750.36 $2,028 6.9×
Us transrectal prostate volume (76873) $1,963.78 $5,307.50 18.0×
Vein X-ray liver w/hemodynam (75885) $2,370.04 $6,405.50 0.7×
Venogram extremity bilateral (75822) $590.24 $1,595.25 0.4×
Venogram ivc w serialography (75825) $1,115.09 $3,013.75 0.3×
Venogram svc w serialography (75827) $1,312.11 $3,546.25 0.8×
Venography ext unilateral (75820) $581.83 $1,572.50 0.4×
Venography renal unilateral selective rs&i (75831) $4,043.45 $10,928.25 1.2×
Venography venous sinus/jugular cath rs&i (75860) $2,854.36 $7,714.50 0.9×
Venous sampling by catheter (75893) $4,416.78 $11,937.25 0.8×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $259.14 $700.38 2.9×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $232.68 $628.88 2.6×
X-ray aorta leg arteries (75630) $1,235.43 $3,339 0.4×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $948.87 $2,564.50 5.2×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $163.68 $442.38 1.8×
X-ray exam hips bi 3-4 views (73522) $239.16 $646.38 2.2×
X-ray exam of finger(s) (73140) $176.16 $476.12 1.9×
X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) $219.28 $592.62 2.4×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $221.68 $599.12 2.4×
X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) $213.21 $576.25 2.0×
X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) $224.04 $605.50 2.5×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $203.78 $550.75 2.2×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $186.94 $505.25 2.1×
X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) $264.97 $716.12 2.9×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $310.20 $838.38 2.8×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $212.80 $575.12 2.3×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $294.52 $796 2.7×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $533.72 $1,442.50 4.9×
X-Ray Mastoids 3+ Vw - Xr Mastoids 3+ Views (70130) $195.46 $528.25 1.8×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $300.62 $812.50 3.3×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $446.46 $1,206.62 4.1×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $159.34 $430.62 1.5×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $186.80 $504.88 2.1×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $237.26 $641.25 2.6×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $237.08 $640.75 2.6×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $213.68 $577.50 2.0×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $276.30 $746.75 3.0×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $147.36 $398.25 1.6×
X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) $236.94 $640.38 2.6×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $247.76 $669.62 2.7×
Xr abdomen 1 view (74018) $183.38 $495.62 2.0×
Xr abdomen 2 views (74019) $196.29 $530.50 1.8×
Xr abdomen 3 views (74021) $209.19 $565.38 1.9×
Xr bone density appendicular (77081) $145.88 $394.25 1.6×
Xr bone density axial (77080) $281.71 $761.38 2.6×
Xr bone length study (77073) $218.86 $591.50 2.0×
Xr bone survey infant (77076) $610.87 $1,651 5.6×
Xr chest 1 view (71045) $147.36 $398.25 1.6×
Xr chest 2 views (71046) $159.66 $431.50 1.8×
Xr chest 3 views (71047) $176.16 $476.12 1.9×
Xr cystogram 3+ views (74430) $366.02 $989.25 1.0×
Xr eye foreign body (70030) $147.36 $398.25 1.6×
Xr facial bones 3 views (70150) $183.66 $496.38 1.7×
Xr lower extremity 2 views infant (73592) $123.86 $334.75 1.4×
Xr lumbar spine 4 views w/ flex ext (72120) $504.17 $1,362.62 4.6×
Xr mandible 4 views (70110) $232.27 $627.75 2.1×
Xr nasal bones (70160) $242.58 $655.62 2.7×
Xr pelvis 3 views (72190) $166.92 $451.12 1.5×
Xr spine 1 view (72020) $241.80 $653.50 2.7×
Xr sternum 2 views (71120) $233.19 $630.25 2.6×
Xr upper extremity 2 views infant (73092) $109.80 $296.75 1.0×
Xray elbow 2 views (73070) $146.52 $396 1.6×
Xray forearm 2 views (73090) $208.54 $563.62 2.3×
Xray knee 1 or 2 views rt (73560) $236.94 $640.38 2.6×
Xray neck soft tissue (70360) $179.32 $484.62 2.0×
Xray orbits complete min 4 views (70200) $162.57 $439.38 1.5×
Xray pelvis 1 or 2 views (72170) $169.32 $457.62 1.6×
Xray ribs bilateral 3 views (71110) $270.98 $732.38 2.5×
Xray ribs unilat w/ pa chest 3v rt (71101) $306.04 $827.12 2.8×
Xray scapula complete (73010) $249.42 $674.12 2.3×
Xray shoulder 1 view (73020) $110.08 $297.50 1.2×
Xray sinuses paranasal <3 views (70210) $190.22 $514.12 2.1×
Xray spine thoracic 2 views (72070) $140.10 $378.62 1.3×
Xray spine thoracic 3 views (72072) $161.50 $436.50 1.5×
Xray tibia-fibula 2 views bil (73590) $242.49 $655.38 2.7×
Xray tmj's bilateral open-clsc (70330) $167.01 $451.38 1.8×