| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,494.93 |
$5,412 |
1.7× |
| Abdomen 1 View (74018) |
$124.64 |
$442 |
1.3× |
| Abdomen 2 views (74019) |
$152 |
$539 |
1.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$771.37 |
$1,943 |
1.8× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
$838.07 |
$2,111 |
0.6× |
| Angio internal mammary (75756) |
$627.72 |
$2,975 |
0.2× |
| Angio pulmonary bilat (75743) |
$1,183.71 |
$5,610 |
0.4× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$899.28 |
$4,262 |
0.3× |
| Angiography extremity bilateral rs&i (75716) |
$1,775.14 |
$8,413 |
0.5× |
| Angiography extremity unilateral rs&i (75710) |
$1,713.11 |
$8,119 |
0.5× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,053.52 |
$4,993 |
0.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,038.75 |
$4,923 |
0.3× |
| Ankle 2 views (73600) |
$95.60 |
$339 |
1.0× |
Aortography thoracic serialography rs&i (75605)
likely a partial charge, not the full procedure |
$1,073.78 |
$5,089 |
0.2× |
| Aortography thoracic w/o serialography rs&i (75600) |
$1,331.83 |
$6,312 |
0.4× |
Artery X-Rays Abdomen (75726)
likely a partial charge, not the full procedure |
$1,631.45 |
$7,732 |
0.3× |
| Artery X-Rays Adrenal Gland (75731) |
$832.40 |
$3,945 |
0.2× |
Artery X-Rays Pelvis (75736)
likely a partial charge, not the full procedure |
$1,268.53 |
$6,012 |
0.2× |
Artery X-Rays Spine (75705)
likely a partial charge, not the full procedure |
$1,233.30 |
$5,845 |
0.2× |
| Arthrogram ankle (73615) |
$338.01 |
$1,101 |
0.9× |
| Arthrogram hip (73525) |
$380.68 |
$1,240 |
1.0× |
| Arthrogram Wrist (73115) |
$334.63 |
$1,090 |
0.9× |
| Basic radiation dosimetry calculation (77300) |
$259.54 |
$563 |
1.8× |
| Bone age studies (77072) |
$93.91 |
$333 |
0.8× |
| Bone Imaging 3 Phase (78315) |
$1,655.09 |
$4,169 |
3.9× |
| Bone Imaging Limited Area (78300) |
$720.95 |
$1,816 |
1.7× |
| Bone Imaging Multiple Areas (78305) |
$1,059.20 |
$2,668 |
2.5× |
| Bone Imaging Whole Body (78306) |
$1,439.12 |
$3,625 |
3.4× |
| Bone marrow imaging limited area (78102) |
$631.23 |
$1,590 |
1.5× |
| Bone marrow imaging; multiple areas (78103) |
$848.39 |
$2,137 |
2.0× |
| Bone marrow imaging; whole body (78104) |
$981.78 |
$2,473 |
2.3× |
| Bone survey infant (77076) |
$296.95 |
$1,053 |
2.7× |
| Brachytx isodose complex (77318) |
$979.62 |
$2,125 |
2.5× |
| Brachytx isodose intermed (77317) |
$724.69 |
$1,572 |
1.8× |
| Brachytx Isodose Plan Simple (77316) |
$469.76 |
$1,019 |
1.2× |
| Brain Flow Imaging Only (78610) |
$524.83 |
$1,322 |
0.9× |
| Brain Image W/Flow < 4 Views (78601) |
$485.13 |
$1,222 |
1.1× |
| Brain imaging < 4 static views (78600) |
$411.69 |
$1,037 |
1.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$918.66 |
$2,314 |
1.6× |
| Brain Imaging Minimum 4 Static Views (78605) |
$441.07 |
$1,111 |
0.8× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,707.55 |
$4,704 |
1.1× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$497.84 |
$1,254 |
1.2× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$498.24 |
$2,595 |
1.3× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$698.11 |
$3,636 |
0.8× |
| Cardiac Shunt Detection (78428) |
$463.30 |
$1,167 |
1.1× |
| Cat Scan Follow-Up Study (76380) |
$100.21 |
$586 |
1.1× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$599.47 |
$1,510 |
1.0× |
| Cerebrospinal Fluid Scan (78630) |
$658.62 |
$1,659 |
1.1× |
| Chest 1 view (71045) |
$65.28 |
$272 |
0.7× |
| Chest 2 views (71046) |
$78.72 |
$328 |
0.8× |
| Chest 3 views (71047) |
$87.84 |
$366 |
0.9× |
| Chest 4 or more views (71048) |
$106.32 |
$443 |
1.0× |
| Cholecystography Oral Contrast (74290) |
$207.83 |
$737 |
1.1× |
| Clavicle complete (73000) |
$90.24 |
$320 |
1.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$77.52 |
$467 |
0.7× |
| Continuing medical physics consltj pr wk (77336) |
$348.06 |
$755 |
2.4× |
| Contrast Exam Abdominl Aorta (75625) |
$1,038.75 |
$4,923 |
0.3× |
| Contrast X-Ray Bladder (74430) |
$287.08 |
$1,018 |
0.8× |
| Contrast X-Ray Of Elbow (73085) |
$338.01 |
$1,101 |
0.9× |
| Contrast X-Ray Of Knee Joint (73580) |
$338.01 |
$1,101 |
0.9× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$144.67 |
$513 |
0.8× |
| Corpora cavernosography (74445) |
$230.68 |
$818 |
2.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$630.80 |
$3,800 |
1.7× |
| CT abdomen and pelvis without contrast (74176) |
$420.48 |
$2,533 |
1.7× |
| CT abdomen w contrast (74160) |
$369.35 |
$2,225 |
2.0× |
| CT abdomen w wo contrast (74170) |
$443.22 |
$2,670 |
2.4× |
| CT abdomen w/o contrast (74150) |
$295.48 |
$1,780 |
2.6× |
| CT Angio Abdomen and Pelvis (74174) |
$662.34 |
$3,990 |
1.8× |
| CT Angio Chest (71275) |
$613.87 |
$3,698 |
3.3× |
| CT Angio Head (70496) |
$427.69 |
$2,561 |
2.3× |
| CT angio hrt w/3d image (75574) |
$429.04 |
$2,509 |
1.2× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$426.79 |
$2,571 |
2.3× |
| CT Angio Neck (70498) |
$390.78 |
$2,340 |
2.1× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$450.36 |
$2,713 |
2.4× |
| CT cervical spine w/ contrast (72126) |
$548.30 |
$3,303 |
1.5× |
| CT cervical spine w/o contrast (72125) |
$438.57 |
$2,642 |
3.9× |
| CT cervical spine w/wo cont (72127) |
$657.86 |
$3,963 |
3.5× |
| CT chest w contrast (71260) |
$487.04 |
$2,934 |
2.6× |
| CT chest w/wo contrast (71270) |
$584.49 |
$3,521 |
3.1× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) |
$277.53 |
$1,623 |
1.5× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$221.96 |
$1,298 |
2.0× |
| CT head/brain with contrast (70460) |
$339.51 |
$2,033 |
1.8× |
| CT head/brain without and with contrast (70470) |
$407.31 |
$2,439 |
2.2× |
| CT heart contrast eval cardiac structure&morph (75572) |
$390.39 |
$2,283 |
1.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$442.55 |
$2,588 |
4.8× |
| CT hrt w/3d image congen (75573) |
$408.52 |
$2,389 |
1.1× |
| CT iac w contrast (70481) |
$397.79 |
$2,382 |
2.1× |
| CT l-spine w&w/o contrast (72133) |
$645.74 |
$3,890 |
3.5× |
| CT lower ext w/o (73700) |
$270.91 |
$1,632 |
2.4× |
| CT lower extremity w/contrast material (73701) |
$338.64 |
$2,040 |
1.8× |
| CT lumbar spine w contrast (72132) |
$538.17 |
$3,242 |
1.4× |
| CT lumbar spine w/o contrast (72131) |
$430.44 |
$2,593 |
3.9× |
| CT maxillofacial w contrast (70487) |
$317.97 |
$1,904 |
1.7× |
| CT maxillofacial wo contrast (70486) |
$254.34 |
$1,523 |
2.3× |
| CT neck tissue combo (70492) |
$372.08 |
$2,228 |
2.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$477.29 |
$2,858 |
2.6× |
| CT orbits w/o contrast (70480) |
$318.14 |
$1,905 |
2.9× |
| CT pelvis w&w/o contrast (72194) |
$487.38 |
$2,936 |
2.6× |
| CT pelvis w/o contrast (72192) |
$324.86 |
$1,957 |
2.9× |
| CT scan of leg combo (73702) |
$406.37 |
$2,448 |
2.2× |
| CT scans face/jaw combo (70488) |
$381.60 |
$2,285 |
2.0× |
| CT soft tissue neck w contrast (70491) |
$310.12 |
$1,857 |
1.7× |
| CT soft tissue neck w/o contrast (70490) |
$248 |
$1,485 |
2.2× |
| CT thoracic spine w contrast (72129) |
$545.97 |
$3,289 |
2.9× |
| CT thoracic spine w/o contrast (72128) |
$436.75 |
$2,631 |
3.9× |
| CT thoracic spine w/wo cont (72130) |
$655.20 |
$3,947 |
3.5× |
| CT thorax w/o contrast (71250) |
$389.60 |
$2,347 |
3.5× |
| CT unlisted procedure (76497) |
$676.12 |
$4,073 |
7.3× |
| CT upper ext wo (73200) |
$285.85 |
$1,722 |
2.6× |
| CT upper extremity w/o & w/contrast material (73202) |
$428.78 |
$2,583 |
2.3× |
| CT upper extremity with contrast (73201) |
$357.40 |
$2,153 |
1.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$418.27 |
$2,446 |
2.2× |
| Cta Abdomen (74175) |
$465.46 |
$2,804 |
2.5× |
| CTA pelvis (72191) |
$511.78 |
$3,083 |
2.7× |
| Dilation ureters/urethra rs&i (74485) |
$722.48 |
$2,562 |
0.3× |
| Diskography lumbar (72295) |
$1,012.94 |
$3,592 |
0.5× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$210.45 |
$603 |
1.9× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$268.03 |
$768 |
2.4× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$139.25 |
$399 |
1.2× |
| Dxa Bone Density Axial (77080) |
$124.64 |
$442 |
1.1× |
| Dxa bone density study (77085) |
$100.67 |
$357 |
0.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$76.14 |
$270 |
0.8× |
| Echo exam of fetal heart (76825) |
$504.30 |
$1,445 |
0.9× |
| Echo exam uterus (76831) |
$240.11 |
$688 |
0.9× |
| Echo Guide For Artery Repair (76936) |
$218.47 |
$626 |
0.9× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$240.11 |
$688 |
0.9× |
| Echograp Trans R Pros Study (76873) |
$184.27 |
$528 |
1.7× |
| Esophageal Motility Study (78258) |
$591.93 |
$1,491 |
1.4× |
| Esophagram (74220) |
$150.59 |
$534 |
0.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$221.96 |
$636 |
2.0× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$158.02 |
$823 |
0.6× |
| Fluoroscopy up to 1 hr (76000) |
$194.02 |
$688 |
0.8× |
| Follow-Up Angiography (75898) |
$457.45 |
$2,168 |
0.1× |
| Foot 2 views (73620) |
$87.98 |
$312 |
0.9× |
| Forearm 2 views (73090) |
$91.65 |
$325 |
1.0× |
| Gastric emptying imaging study (78264) |
$741.60 |
$1,868 |
1.7× |
| Gastroesophageal Reflux Exam (78262) |
$772.17 |
$1,945 |
1.8× |
| Gated Heart Planar Single (78472) |
$1,042.52 |
$2,626 |
2.4× |
| Gated Heart, Multiple (78473) |
$1,312.48 |
$3,306 |
3.1× |
| Hand 2 views (73120) |
$91.93 |
$326 |
0.8× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$3,727.65 |
$8,086 |
5.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$2,074.04 |
$4,499 |
2.8× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$1,161.72 |
$2,520 |
1.6× |
| Heart first pass single,planar (78481) |
$570.49 |
$1,437 |
1.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$1,388.29 |
$4,923 |
0.4× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$1,400.98 |
$4,968 |
0.4× |
| Hepatobil Syst Image W/Drug (78227) |
$715.79 |
$1,803 |
1.2× |
| Hepatobiliary System Imaging (78226) |
$582.80 |
$1,468 |
1.4× |
| Ht Musc Image Planar Mult (78454) |
$1,703.53 |
$4,291 |
1.2× |
| Ht Muscle Image Spect Sing (78451) |
$1,413.72 |
$3,561 |
1.0× |
| Hyperthermia external generated superficial (77600) |
$509.87 |
$1,106 |
1.2× |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) |
$748.20 |
$1,623 |
1.3× |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators Non-Facility (77615) |
$1,167.25 |
$2,532 |
2.0× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) |
$927.99 |
$2,013 |
1.2× |
| Hysterosalpingogram (74740) |
$194.02 |
$688 |
0.8× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$196.14 |
$562 |
2.1× |
| Infant hip ultrasound, limited static exam (76886) |
$143.44 |
$411 |
1.5× |
| Infusion Ivp (74410) |
$659.60 |
$2,339 |
3.5× |
Interstitial radiation source applic complex (77778)
range across 2 matching MRF lines |
$1,675.58–$1,940.81 |
$4,210 |
varies |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,404.21 |
$3,046 |
1.9× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$991.15 |
$2,150 |
1.7× |
| Intracavitary radiation source applic simple (77761) |
$750.97 |
$1,629 |
1.3× |
| Joint Survey Single View (77077) |
$100.67 |
$357 |
0.9× |
| K Flow/Funct Image Multiple (78709) |
$1,080.63 |
$2,722 |
1.9× |
| K Flow/Funct Image W/Drug (78708) |
$692.76 |
$1,745 |
1.2× |
| K Flow/Funct Image W/O Drug (78707) |
$914.29 |
$2,303 |
1.6× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$525.23 |
$1,323 |
1.2× |
| Kidney Imaging Morphol (78700) |
$668.94 |
$1,685 |
1.6× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$1,073.88 |
$2,705 |
2.5× |
| Knee 3 Views (73562) |
$112.80 |
$400 |
1.2× |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) |
$705.47 |
$1,777 |
1.7× |
| Leveen/Shunt Patency Exam (78291) |
$490.30 |
$1,235 |
1.1× |
| Liver & Spleen Imaging Static Only (78215) |
$581.21 |
$1,464 |
1.4× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$511.34 |
$1,288 |
1.2× |
| Liver imaging static only (78201) |
$634.41 |
$1,598 |
1.1× |
| Liver imaging w/vascular flow (78202) |
$685.22 |
$1,726 |
1.2× |
| Lung Perf&Ventilat Diferentl (78598) |
$731.27 |
$1,842 |
1.3× |
| Lung perfusion differential (78597) |
$631.23 |
$1,590 |
1.5× |
| Lung Ventilat&Perfus Imaging (78582) |
$736.44 |
$1,855 |
1.3× |
| Lung Ventilation Imaging (78579) |
$489.10 |
$1,232 |
1.1× |
| Lymph System Imaging (78195) |
$855.14 |
$2,154 |
1.5× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
$849.95 |
$3,014 |
0.5× |
| Lymphangiography extremity only unilateral rs&i (75801) |
$665.52 |
$2,360 |
1.0× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$767.04 |
$2,720 |
0.2× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$529.31 |
$1,877 |
0.2× |
Magnetic Image Jaw Joint (70336)
range across 3 matching MRF lines |
$317.76–$476.74 |
$1,655–$2,483 |
varies |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) |
$676.54 |
$4,255 |
3.6× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) |
$541.24 |
$3,404 |
0.9× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) |
$811.85 |
$5,106 |
4.3× |
| Magnetic Resonance Elastography (76391) |
$213.12 |
$1,110 |
0.8× |
| Mammary ductogram or galactogram multiple (77054) |
$293 |
$1,039 |
1.2× |
| Mammary ductogram or galactogram single (77053) |
$225.32 |
$799 |
0.9× |
| Meckels Divert Exam (78290) |
$704.68 |
$1,775 |
1.7× |
| Mlc imrt design & construction per imrt plan (77338) |
$729.76 |
$1,583 |
1.8× |
| Mr safety determination physician/other qhp (76016) |
$38.07 |
$135 |
0.4× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$11.28 |
$40 |
0.4× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$58.37 |
$207 |
0.6× |
| Mr safety implt pos&/immoblj (76019) |
$81.78 |
$290 |
1.3× |
| Mr safety med physics xm customization plng&mntr (76017) |
$153.41 |
$544 |
0.6× |
| Mra Head W/O & W/Contrast Material (70546) |
$654.86 |
$3,258 |
1.8× |
| MRA head w/o contrast (70544) |
$436.57 |
$2,172 |
1.7× |
| MRA head with contrast (70545) |
$545.72 |
$2,715 |
1.5× |
| MRA neck w contrast (70548) |
$450.04 |
$2,239 |
1.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$540.09 |
$2,687 |
1.5× |
| MRA neck w/o contrast (70547) |
$359.99 |
$1,791 |
1.4× |
| MRI abdomen w contrast (74182) |
$506.50 |
$2,638 |
1.4× |
| MRI abdomen w/o contrast (74181) |
$405.12 |
$2,110 |
1.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$571.01 |
$2,974 |
0.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$685.25 |
$3,569 |
1.8× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$584.64 |
$3,045 |
0.7× |
| MRI bone marrow blood supply (77084) |
$349.06 |
$1,818 |
1.4× |
| MRI brain functional w/o physician admnistration (70554) |
$495.94 |
$2,583 |
1.9× |
| MRI brain functional w/physician admnistration (70555) |
$372.67 |
$1,941 |
1.5× |
| MRI Breast W/O Contrast Bilateral (77047) |
$559.87 |
$2,916 |
2.2× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$373.25 |
$1,944 |
1.5× |
| MRI cardiac w/o cont stress (75559) |
$465.41 |
$2,424 |
0.8× |
| MRI cardiac w/o contrast (75557) |
$332.16 |
$1,730 |
1.3× |
| MRI cervical spine w contrast (72142) |
$433.87 |
$3,013 |
1.2× |
| MRI cervical spine w/o cont (72141) |
$347.04 |
$2,410 |
1.4× |
| MRI chest w/o contrast (71550) |
$327.94 |
$1,708 |
1.3× |
| MRI chest with contrast (71551) |
$409.92 |
$2,135 |
0.5× |
| MRI chest wo w contrast (71552) |
$491.90 |
$2,562 |
1.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$500.93 |
$2,609 |
1.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$601.15 |
$3,131 |
1.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$400.70 |
$2,087 |
1.6× |
| MRI lumbar spine w contrast (72149) |
$435.17 |
$3,022 |
1.2× |
| Mri Neck Spine W/O & W/Dye (72156) |
$520.56 |
$3,615 |
1.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$323.41 |
$2,034 |
1.3× |
| MRI orbit face neck w contrast (70542) |
$404.34 |
$2,543 |
1.1× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$485.11 |
$3,051 |
1.3× |
| MRI pelvis w contrast (72196) |
$476.74 |
$2,483 |
1.3× |
| MRI pelvis w/o & w contrast (72197) |
$571.97 |
$2,979 |
1.5× |
| MRI pelvis w/o contrast (72195) |
$381.31 |
$1,986 |
1.5× |
| MRI spectroscopy (76390) |
$399.74 |
$2,082 |
4.3× |
| MRI thoracic spine w/o contrast (72146) |
$346.18 |
$2,404 |
1.4× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$397.06 |
$2,068 |
1.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$317.57 |
$1,654 |
1.2× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$476.35 |
$2,481 |
1.3× |
| MRI, abdomen, combo (74183) |
$607.68 |
$3,165 |
1.6× |
| MRI, dorsal spine combo (72157) |
$519.26 |
$3,606 |
1.4× |
| MRI, dorsal spine contrast (72147) |
$432.72 |
$3,005 |
1.2× |
| MRI, joint upper extrem (73221) |
$467.71 |
$2,436 |
1.8× |
| MRI, joint upper extrem combo (73223) |
$701.57 |
$3,654 |
1.9× |
| MRI, lumbar spine combo (72158) |
$522.14 |
$3,626 |
1.4× |
| Myelogram cervical (72240) |
$603.20 |
$2,139 |
0.7× |
| Myelogram Lumbar (72265) |
$603.20 |
$2,139 |
0.7× |
| Myelography thoracic (72255) |
$603.76 |
$2,141 |
0.7× |
| Myelograpy 2/more regions rs&i (72270) |
$762.25 |
$2,703 |
0.9× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$673.71 |
$1,697 |
1.6× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$1,446.56 |
$3,985 |
1.0× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,413.72 |
$3,561 |
1.0× |
| Myocardial Spect Multiple Studies (78452) |
$1,703.53 |
$4,291 |
1.2× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) |
$1,522.78 |
$4,195 |
1.0× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$1,063.59 |
$2,930 |
0.7× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) |
$1,339.83 |
$3,691 |
0.6× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) |
$1,446.19 |
$3,984 |
0.6× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) |
$1,318.78 |
$3,633 |
0.8× |
| N-invas est c ffr sw aly CTA (75580) |
$1,337.84 |
$4,566 |
1.5× |
| Neck soft tissue (70360) |
$87.14 |
$309 |
0.9× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$263.61 |
$664 |
0.6× |
| Nm csf leak detection (78650) |
$838.07 |
$2,111 |
0.6× |
| Nm myocard infarct spect (78469) |
$748.74 |
$1,886 |
1.3× |
| Nm whole blood volume (78122) |
$611.38 |
$1,540 |
1.1× |
| Nonvascular Shunt X-Ray (75809) |
$91.93 |
$326 |
0.8× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$3,264.80 |
$7,082 |
2.2× |
| Nuclear Rx Intra-Arterial (79445) |
$994.60 |
$2,499 |
4.0× |
| Nuclear Rx Oral Admin (79005) |
$714.01 |
$1,794 |
2.9× |
| Panoramic X-ray of jaws (70355) |
$82.34 |
$292 |
0.9× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$1,080.24 |
$2,721 |
1.9× |
| Parathyroid Planar Imaging (78070) |
$771.37 |
$1,943 |
1.8× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$880.94 |
$2,219 |
2.1× |
| Pelvis 1 or 2 views (72170) |
$100.39 |
$356 |
0.9× |
| Perineogram (74775) |
$333.32 |
$1,182 |
1.3× |
| Peritoneogram Rs&I (74190) |
$233.21 |
$827 |
0.4× |
| Pet Image Skull-Thigh (78812) |
$1,958.02 |
$5,394 |
1.3× |
| Pet Image W/Ct Lmtd (78814) |
$2,320.66 |
$6,393 |
1.5× |
| PET image w/CT, full body (78816) |
$2,655.34 |
$7,315 |
1.7× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$2,469.85 |
$6,804 |
1.6× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$1,555.45 |
$4,285 |
1.1× |
| PET whole body (78813) |
$2,264.39 |
$6,238 |
1.5× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$764.22 |
$1,925 |
0.6× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,388.29 |
$4,923 |
0.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$619.72 |
$1,561 |
1.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$202.76 |
$719 |
1.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$299.48 |
$1,062 |
0.5× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$105.19 |
$373 |
1.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$80.93 |
$287 |
0.9× |
| Radex elbow complete minimum 3 views (73080) |
$103.78 |
$368 |
1.1× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$98.98 |
$351 |
0.9× |
| Radex fingr minimum 2 views (73140) |
$73.32 |
$260 |
0.8× |
| Radex foot complete minimum 3 views (73630) |
$103.78 |
$368 |
1.1× |
| Radex Hand Minimum 3 Views (73130) |
$101.52 |
$360 |
1.1× |
| Radex lower extremity infant minimum 2 views (73592) |
$132.82 |
$471 |
1.4× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$235.75 |
$836 |
2.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$84.88 |
$301 |
0.9× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
$148.90 |
$528 |
1.6× |
| Radex Ribs Unilateral 2 Views (71100) |
$81.50 |
$289 |
0.9× |
| Radex shoulder complete minimum 2 views (73030) |
$109.42 |
$388 |
1.2× |
| Radex Sinuses Paransl < 3 Views (70210) |
$80.37 |
$285 |
0.9× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$557.23 |
$1,976 |
3.0× |
| Radex Spine 1 View Specify Level (72020) |
$68.53 |
$243 |
0.7× |
| Radex Sternum Minimum 2 Views (71120) |
$93.62 |
$332 |
1.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$110.83 |
$393 |
1.2× |
| Radex Toe Minimum 2 Views (73660) |
$70.78 |
$251 |
0.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$147.49 |
$523 |
1.3× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$99.83 |
$354 |
1.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$229.55 |
$814 |
2.1× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$8,007.57 |
$17,370 |
1.0× |
| Radiation treatment delivery level 1 (77402) |
$200.07 |
$434 |
1.8× |
| Radiation treatment delivery level 2 (77407) |
$254.47 |
$552 |
0.6× |
| Radiation treatment delivery level 3 (77412) |
$338.84 |
$735 |
0.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$109.70 |
$389 |
1.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$175.40 |
$622 |
1.6× |
| Radiologic exam colon double contrast study (74280) |
$294.41 |
$1,044 |
1.6× |
| Radiologic exam colon single contrast study (74270) |
$264.52 |
$938 |
1.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$161.02 |
$571 |
0.9× |
| Radiologic exam knee complete 4/more views (73564) |
$126.34 |
$448 |
1.1× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$124.36 |
$441 |
1.1× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$154.82 |
$549 |
0.8× |
| Radiologic exam swallow function contrast study (74230) |
$174.56 |
$619 |
0.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$173.43 |
$615 |
0.9× |
| Radiologic examination femur 1 view (73551) |
$68.24 |
$242 |
0.7× |
| Radiologic examination femur minimum 2 views (73552) |
$104.34 |
$370 |
1.1× |
| Radiologic examination knee 1/2 views (73560) |
$95.88 |
$340 |
1.0× |
| Radiologic Examination Osseous Survey Limited (77074) |
$116.47 |
$413 |
1.0× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$66.27 |
$235 |
0.7× |
| Radiologic examination tibia & fibula 2 views (73590) |
$89.11 |
$316 |
1.0× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$159.89 |
$567 |
0.3× |
| Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) |
$355.81 |
$894 |
1.4× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$956 |
$2,402 |
3.8× |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
$425.98 |
$1,073 |
1.0× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$462.90 |
$1,166 |
0.8× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$2,149.64 |
$4,663 |
5.2× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$1,431.40 |
$3,105 |
3.5× |
| Renal Cyst Study (74470) |
$395.36 |
$1,402 |
0.7× |
| Ribs bilateral 3 views (71110) |
$95.60 |
$339 |
0.9× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$432.73 |
$1,090 |
1.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,385.93 |
$3,491 |
2.4× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$651.48 |
$1,641 |
1.1× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$817.82 |
$2,060 |
1.4× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,497.09 |
$3,771 |
1.1× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,940.54 |
$4,888 |
1.3× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$1,012.75 |
$2,551 |
0.7× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$1,004.15 |
$2,523 |
4.0× |
| Rp Therapy Intravenous Administration (79101) |
$746.65 |
$1,876 |
3.0× |
| Salivary Gland Imaging Serial Images (78231) |
$406.13 |
$1,023 |
1.0× |
| Scapula (73010) |
$102.37 |
$363 |
0.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$28.60 |
$52 |
1.2× |
| Shoulder 1 view (73020) |
$78.68 |
$279 |
0.8× |
| Shoulder Arthrography (73040) |
$338.01 |
$1,101 |
0.9× |
| Sialogram (70390) |
$194.02 |
$688 |
0.8× |
| Skull less than 4 views (70250) |
$95.32 |
$338 |
0.9× |
| Special dosimetry (77331) |
$276.60 |
$600 |
1.9× |
| Special Physics Consult (77370) |
$542.60 |
$1,177 |
3.8× |
| Special teletherapy port plan (77321) |
$850.08 |
$1,844 |
2.1× |
| Special treatment procedure (77470) |
$1,551.27 |
$3,365 |
2.6× |
| Speech evaluation, complex (70371) |
$210.65 |
$747 |
0.8× |
| Spleen Imaging (78185) |
$404.54 |
$1,019 |
0.9× |
| Stereotactic Body Radiation Delivery (77373) |
$5,334.23 |
$11,571 |
2.8× |
| Sternoclavicular joints (71130) |
$119.29 |
$423 |
1.3× |
| Superior sagittal sinus venogram (75870) |
$1,388.29 |
$4,923 |
0.4× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$245.71 |
$533 |
2.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$554.12 |
$1,202 |
1.4× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$360.04 |
$781 |
0.9× |
| Testicular Imaging W/Flow (78761) |
$585.58 |
$1,475 |
1.4× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$955.65 |
$2,073 |
2.4× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$857.46 |
$1,860 |
2.1× |
| Ther rad simulaj-aided field setting simple (77280) |
$535.22 |
$1,161 |
3.7× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$378.44 |
$1,342 |
2.0× |
| Thoracic spine 2 views (72070) |
$91.93 |
$326 |
0.8× |
| Thoracic spine 3 views (72072) |
$106.03 |
$376 |
1.0× |
| Thoracolumbar 2 views (72080) |
$96.44 |
$342 |
1.0× |
| Thyroid Imaging With Vascular Flow (78013) |
$421.22 |
$1,061 |
1.0× |
| Thyroid Met Imaging Body (78018) |
$1,026.64 |
$2,586 |
1.8× |
| Thyroid Uptake Measurement (78012) |
$243.36 |
$613 |
0.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$658.23 |
$1,658 |
1.5× |
| Tx Devices Design & Construction Complex (77334) |
$583.17 |
$1,265 |
1.5× |
| Tx devices design & construction intermediate (77333) |
$476.67 |
$1,034 |
3.3× |
| Tx devices design & construction simple (77332) |
$261.85 |
$568 |
1.8× |
Ultrasound Breast Limited (76642)
range across 3 matching MRF lines |
$112.73–$169.26 |
$323–$485 |
varies |
| Ultrasound elastography first target lesion (76982) |
$114.12 |
$327 |
1.0× |
| Ultrasound Elastography Parenchyma (76981) |
$137.16 |
$393 |
1.2× |
| Ultrasound Exam Aaa Screen (76706) |
$138.90 |
$398 |
1.2× |
| Ultrasound, abdomen limited (76705) |
$214.99 |
$658 |
1.9× |
| Umbilical-artery Doppler (OB) (76820) |
$136.11 |
$390 |
1.2× |
| Unlisted magnetic resonance procedure (76498) |
$782.02 |
$4,073 |
8.4× |
| Upper gi w/o kub (74240) |
$170.89 |
$606 |
0.9× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$211.60 |
$533 |
19.1× |
| Urea breath test c-14 isotopic analysis (78268) |
$1,761.09 |
$4,436 |
18.7× |
| Ureteral Reflux Study (78740) |
$654.65 |
$1,649 |
1.5× |
| Urethrocystogram voiding (74455) |
$194.02 |
$688 |
0.8× |
| Urethrocystography retrograde (74450) |
$299.48 |
$1,062 |
1.2× |
Us breast unilateral complete (76641)
range across 3 matching MRF lines |
$146.58–$219.87 |
$420–$630 |
varies |
| Us chest (76604) |
$153.91 |
$441 |
1.4× |
| Us complete joint (76881) |
$163.33 |
$468 |
1.5× |
| Us exam, pelvic, limited (76857) |
$228.25 |
$654 |
2.0× |
| Us head (76506) |
$258.96 |
$742 |
2.3× |
| Us kidney transplant (76776) |
$194.74 |
$558 |
1.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$117.61 |
$337 |
1.1× |
| Us ob detailed single fetus (76811) |
$304.68 |
$873 |
1.2× |
| Us ob limited 1 or more fetuses (76815) |
$176.24 |
$505 |
1.6× |
| Us ob transvaginal (76817) |
$200.33 |
$574 |
1.8× |
| Us pelvic non ob complete (76856) |
$270.13 |
$774 |
2.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$186.71 |
$535 |
1.7× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$177.29 |
$508 |
1.6× |
| Us retroperitoneal complete (76770) |
$236.97 |
$679 |
2.1× |
| Us retroperitoneal limited (76775) |
$152.86 |
$438 |
1.4× |
| Us scrotum and contents (76870) |
$249.19 |
$714 |
2.2× |
| Us spinal canal and contents (76800) |
$273.62 |
$784 |
2.5× |
| Us thyroid (76536) |
$206.26 |
$591 |
1.8× |
| Us transrectal (76872) |
$189.16 |
$542 |
1.7× |
| Vascular Flow Imaging (78445) |
$359.29 |
$905 |
0.8× |
| Vasogram (74440) |
$197.96 |
$702 |
0.8× |
| Vein X-Ray Chest (75827) |
$361.52 |
$1,282 |
0.2× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$825.41 |
$2,927 |
0.2× |
| Vein X-Ray Skull Epidural (75872) |
$777.19 |
$2,756 |
1.2× |
| Vein X-Ray Spleen/Liver (75810) |
$760.84 |
$2,698 |
0.2× |
| Venogram Sinus/Jugular (75860) |
$1,155.92 |
$4,099 |
0.3× |
| Venography Adrenal Unilateral (75840) |
$1,003.92 |
$3,560 |
0.3× |
| Venography caval inferior serialography rs&i (75825) |
$1,388.29 |
$4,923 |
0.4× |
| Venography extremity bilateral rs&i (75822) |
$643.52 |
$2,282 |
0.4× |
| Venography extremity unilateral rs&i (75820) |
$549.90 |
$1,950 |
0.3× |
| Venography Orbital Rs&I (75880) |
$651.42 |
$2,310 |
1.0× |
| Venography Renal Bilateral (75833) |
$1,238.83 |
$4,393 |
0.4× |
| Venography Renal Unilateral (75831) |
$1,032.12 |
$3,660 |
0.3× |
Venous sampling by catheter (75893)
likely a partial charge, not the full procedure |
$1,313.56 |
$4,658 |
0.2× |
| Venous thrombosis imaging (78457) |
$683.24 |
$1,721 |
1.2× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$799.16 |
$2,013 |
1.9× |
| Vertebral fracture assessment via dxa (77086) |
$76.14 |
$270 |
0.8× |
| Wrist 2 views (73100) |
$83.75 |
$297 |
0.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$84.88 |
$301 |
0.9× |
| X-ray antegrade pyelogram tube (74425) |
$381.55 |
$1,353 |
1.0× |
| X-Ray Aorta Leg Arteries (75630) |
$1,222.11 |
$5,792 |
0.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$95.60 |
$339 |
1.0× |
| X-Ray Exam Breast Specimen (76098) |
$144.95 |
$514 |
0.2× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$101.52 |
$360 |
1.1× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$166.38 |
$590 |
1.5× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$192.89 |
$684 |
1.7× |
| X-Ray Exam Hip Uni 1 View (73501) |
$73.60 |
$261 |
0.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$89.39 |
$317 |
1.0× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$110.83 |
$393 |
1.0× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$91.93 |
$326 |
0.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$106.31 |
$377 |
1.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$125.21 |
$444 |
1.1× |
| X-Ray Exam L-S Spine Bending (72114) |
$168.07 |
$596 |
1.5× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$104.34 |
$370 |
1.1× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$151.15 |
$536 |
1.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$93.34 |
$331 |
0.8× |
| X-ray eye for foreign body (70030) |
$68.24 |
$242 |
0.7× |
| X-ray humerus (73060) |
$99.26 |
$352 |
1.1× |
| X-ray IV pyelogram (ivp) (74400) |
$427.23 |
$1,515 |
2.3× |
| X-ray IV pyelogram+tomography (74415) |
$769.86 |
$2,730 |
4.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$96.44 |
$342 |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$111.67 |
$396 |
1.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$124.36 |
$441 |
1.1× |
| X-ray nose-rectum child f.b. (76010) |
$95.32 |
$338 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$130.28 |
$462 |
1.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$102.08 |
$362 |
0.9× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$91.93 |
$326 |
0.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$102.37 |
$363 |
1.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$95.60 |
$339 |
1.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$121.26 |
$430 |
1.1× |
| X-Ray Stress View (77071) |
$88.83 |
$315 |
1.0× |
| X-ray thoracic spine 4 vw (72074) |
$113.65 |
$403 |
1.0× |
| X-Ray Tmj Unilat (70328) |
$90.24 |
$320 |
1.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$310.48 |
$1,101 |
0.8× |
| X-Rays Bone Length Studies (77073) |
$108.01 |
$383 |
1.0× |
| X-Rays Bone Survey Complete (77075) |
$154.82 |
$549 |
1.4× |
| Xr c-spine 4 or 5 views (72050) |
$113.36 |
$402 |
1.0× |
| Xr facial bones less than 3 views (70140) |
$89.68 |
$318 |
1.0× |
| XR Mastoids < 3 Views Bilateral (70120) |
$144.67 |
$513 |
1.3× |
| Xr orbits complete 4 views (70200) |
$122.11 |
$433 |
1.1× |
| Xr Tomogram Single Plane (76100) |
$226.45 |
$803 |
2.0× |