Imaging prices at Citizens Memorial Hospital

Bolivar, MO · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $47.20 $59 0.5×
Acute gastrointestinal blood loss imaging (78278) $664.80 $831 1.7×
Angiography extremity bilateral rs&i (75716) $4,061.30 $5,076.62 1.3×
Angiography extremity unilateral rs&i (75710) $3,842.80 $4,803.50 1.2×
Angiography pulmonary bilateral slctv rs&i (75743) $2,570.40 $3,213 0.8×
Angiography pulmonary unilateral slctv rs&i (75741) $1,586.20 $1,982.75 0.5×
Angiography visceral slctv/supraslctv rs&i (75726) $3,485.40 $4,356.75 0.6×
Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) $1,222.80 $1,528.50 0.4×
Ankle 2 views (73600) $103.20 $129 1.2×
Antegrade urography radiological supvj & interpj (74425) $520.40 $650.50 1.5×
Aortogram thoracic (75605) $3,626 $4,532.50 0.7×
Aortography abdl bi iliofem low extrem cath rs&i (75630) $3,119.80 $3,899.75 1.0×
Aortography abdominal serialography rs&i (75625) $3,266.10 $4,082.62 1.0×
Arthrogram shoulder (73040) $777 $971.25 2.2×
Arthrography knee lt (73580) $361.80 $452.25 1.0×
Bone &/Joint Imaging Limited Area (78300) $1,009.10 $1,261.38 2.5×
Bone &/Joint Imaging Multiple Areas (78305) $1,082.40 $1,353 2.7×
Bone &/joint imaging whole body (78306) $1,568.10 $1,960.12 3.9×
Bone age studies (77072) $293.40 $366.75 2.8×
Bone Imaging 3 Phase (78315) $1,775.60 $2,219.50 4.4×
Bone survey complete (77075) $579.50 $724.38 5.5×
Brain Imaging Minimum 4 Static Views (78605) $881.60 $1,102 1.6×
Brain Imaging Pet Metabolic Evaluation (78608) $5,859.80 $7,324.75 4.1×
Cervical spine 2 or 3 views (72040) $274.30 $342.88 3.1×
Chest 1 view (71045) $243.80 $304.75 2.8×
Chest 3 views (71047) $54.40 $68 0.6×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $387.10 $483.88 2.2×
Clavicle complete (73000) $108.80 $136 1.2×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $1,215.60 $1,519.50 11.6×
Corpora cavernosography (74445) $512.20 $640.25 4.9×
CT abdomen and pelvis without and with contrast (74178) $5,640 $7,050 16.1×
CT abdomen and pelvis without contrast (74176) $4,074.10 $5,092.62 17.0×
CT abdomen w contrast (74160) $2,730.60 $3,413.25 15.5×
CT abdomen w wo contrast (74170) $3,269 $4,086.25 18.6×
CT abdomen w/o contrast (74150) $2,172.20 $2,715.25 20.7×
CT angio hrt w/3d image (75574) $1,633.50 $2,041.88 4.7×
CT angiography upper extremity lt (73206) $2,819.20 $3,524 16.0×
CT c-spine w/o contrast (72125) $2,506.80 $3,133.50 23.9×
CT cervical spine w&w/o contrast (72127) $2,154.40 $2,693 12.3×
CT cervical spine with contrast (72126) $2,735.60 $3,419.50 7.8×
CT chest w/wo contrast (71270) $3,254 $4,067.50 18.5×
CT chest with contrast (71260) $2,582.80 $3,228.50 14.7×
CT head/brain with contrast (70460) $2,109.80 $2,637.25 12.0×
CT head/brain without and with contrast (70470) $2,839.80 $3,549.75 16.2×
CT heart no contrast quant eval coronry calcium (75571) $58.82 $73.53 0.7×
CT iac w contrast (70481) $2,157.40 $2,696.75 12.3×
CT limited/localized follow up study (76380) $770.60 $963.25 8.8×
CT lower ext w/o (73700) $2,007.40 $2,509.25 19.2×
CT lower extremity w wo contrast (73702) $1,879.80 $2,349.75 10.7×
CT lower extremity with contrast (73701) $2,265 $2,831.25 12.9×
CT lumbar spine w & w/o contrast (72133) $2,537.60 $3,172 14.4×
CT lumbar spine w/o contrast (72131) $2,368.20 $2,960.25 22.6×
CT lumbar spine with contrast (72132) $2,766 $3,457.50 7.9×
CT maxillofacial w contrast (70487) $2,365.90 $2,957.38 13.5×
CT maxillofacial w/o contrast (70486) $2,025.70 $2,532.12 19.3×
CT maxillofacial w/wo contrast (70488) $2,944.20 $3,680.25 16.8×
CT neck soft tissue w contrast (70491) $2,515.20 $3,144 14.3×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $3,020.30 $3,775.38 17.2×
CT orbits w/o contrast (70480) $2,019.20 $2,524 19.3×
CT pelvis w & w/o contrast (72194) $3,386.90 $4,233.62 19.3×
CT pelvis w/o contrast (72192) $2,178.40 $2,723 20.8×
CT soft tissue neck w/o & w/contrast material (70492) $3,155.60 $3,944.50 18.0×
CT soft tissue neck w/o contrast (70490) $2,115.60 $2,644.50 20.2×
CT thoracic spine w/contrast (72129) $2,711.60 $3,389.50 15.4×
CT thoracic spine w/o contrast (72128) $2,427.20 $3,034 23.2×
CT thoracic spine w/wo contrast (72130) $2,006.20 $2,507.75 11.4×
CT thorax w/o contrast (71250) $2,278.60 $2,848.25 21.8×
CT upper extremity w/o & w/contrast material (73202) $3,353.40 $4,191.75 19.1×
CT upper extremity w/o contrast rt (73200) $1,971.80 $2,464.75 18.8×
CT upper extremity with contrast (73201) $2,224.20 $2,780.25 6.4×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $3,952.80 $4,941 22.5×
Cta Abdomen (74175) $2,469.20 $3,086.50 14.1×
CTA abdomen pelvis (74174) $5,014.10 $6,267.62 14.3×
CTA chest (71275) $2,476 $3,095 14.1×
Cta Head (70496) $2,789.10 $3,486.38 15.9×
CTA lwr ext w&w/o contrast (73706) $2,508 $3,135 14.3×
Cta Neck (70498) $2,798.40 $3,498 15.9×
Cystography minimum 3 views rs&i (74430) $487 $608.75 1.4×
Dxa bone density study 1/> sites axial skel (77080) $495.50 $619.38 4.7×
Echo exam of fetal heart (76825) $1,053.60 $1,317 1.9×
Echoencephalography real time imaging (76506) $392.20 $490.25 3.7×
Esophagus (74220) $348.70 $435.88 2.0×
Fetal biophysical profile non-stress testing (76818) $313.10 $391.38 3.0×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $160 $200 1.5×
Fluoroscopy up to 1 hr (76000) $620.60 $775.75 2.6×
Foot 2 views (73620) $103.20 $129 1.2×
Forearm 2 views (73090) $340.20 $425.25 3.9×
Gastric mucosa imaging (78261) $971 $1,213.75 2.4×
Gated Heart Planar Single (78472) $1,608.60 $2,010.75 4.0×
Hand 2 views (73120) $103.20 $129 1.0×
Hand 3 views (73130) $109.60 $137 1.3×
Heart Infarct Image (78466) $777.60 $972 1.9×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $2,094.50 $2,618.12 3.9×
Hepatobiliary syst imaging including gallbladder (78226) $2,050.80 $2,563.50 5.1×
Humerus Min 2 Views Left (73060) $116.80 $146 1.3×
Hysterosalpingogram (74740) $711.80 $889.75 3.0×
Kidney funcj study non-img radioisotopic study (78725) $454.80 $568.50 1.1×
Kidney imaging morphology (78700) $866 $1,082.50 2.2×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $1,295.60 $1,619.50 2.4×
Kidney img morphology vascular flow 1 w/rx (78708) $1,745.60 $2,182 3.2×
Kidney Img Morphology Vascular Flow Multiple (78709) $2,620 $3,275 4.8×
Knee 3 views (73562) $120.80 $151 1.4×
Liver & spleen imaging static only (78215) $958.60 $1,198.25 2.4×
Liver & Spleen Imaging W/Vascular Flow (78216) $1,027.60 $1,284.50 2.6×
Liver imaging static only (78201) $646.80 $808.50 1.2×
Lung perfusion differential (78597) $1,878.60 $2,348.25 4.7×
Lung Ventilation Imaging (78579) $829.60 $1,037 2.1×
Lymphoscintigraphy (78195) $1,878.20 $2,347.75 3.5×
Meckels Diverticulum (78290) $933.40 $1,166.75 2.3×
MRA head w & w/o contrast (70546) $1,868.60 $2,335.75 5.3×
MRA head w/o contrast (70544) $2,613.40 $3,266.75 10.9×
MRA head with contrast (70545) $1,717 $2,146.25 4.9×
MRA neck w contrast (70548) $2,328.40 $2,910.50 6.7×
Mra Neck W/O &W/Contrast Material (70549) $2,486.20 $3,107.75 7.1×
MRA neck w/o contrast (70547) $2,538.40 $3,173 10.6×
MRI abdomen w contrast (74182) $3,039.80 $3,799.75 8.7×
MRI abdomen w/o & w/contrast material (74183) $4,048.20 $5,060.25 11.6×
MRI abdomen w/o contrast (74181) $2,726.80 $3,408.50 11.4×
MRI any jnt lwr ext with con lt (73722) $3,125.60 $3,907 4.0×
MRI any jt upper extremity w/contrast matrl (73222) $3,325.80 $4,157.25 4.2×
MRI bone marrow blood supply (77084) $2,269 $2,836.25 9.5×
MRI breast w/o contrast bilateral (77047) $2,394 $2,992.50 10.0×
MRI c-spine with contrast (72142) $3,332.20 $4,165.25 9.5×
MRI cardiac w/o contrast (75557) $1,856.20 $2,320.25 7.8×
MRI cervical spine w/o contrast (72141) $3,000.20 $3,750.25 12.6×
MRI chest w/o & w/contrast material (71552) $4,384.80 $5,481 12.5×
MRI chest w/o contrast (71550) $2,540.20 $3,175.25 10.6×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $2,614 $3,267.50 7.5×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $2,874.40 $3,593 8.2×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $4,202.70 $5,253.38 17.6×
MRI orbit face &/neck w/o contrast (70540) $2,304.20 $2,880.25 9.6×
MRI orbit/face/neck w&w/o cont (70543) $4,050.20 $5,062.75 11.6×
MRI orbit/face/neck w/contrast (70542) $2,614 $3,267.50 7.5×
MRI pelvis w contrast (72196) $2,614 $3,267.50 7.5×
MRI pelvis w/o & w/contrast material (72197) $3,889 $4,861.25 11.1×
MRI pelvis w/o contrast (72195) $3,015.10 $3,768.88 12.6×
MRI scan of arm joint before and after contrast (73223) $3,873.80 $4,842.25 11.1×
MRI scan of leg joint before and after contrast (73723) $6,225.20 $7,781.50 17.8×
MRI spinal canal cervical w/o & w/contr matrl (72156) $4,031.60 $5,039.50 11.5×
MRI spinal canal lumbar w/contrast material (72149) $3,482.40 $4,353 10.0×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $3,870 $4,837.50 11.1×
MRI spinal canal thoracic w/contrast matrl (72147) $3,520.40 $4,400.50 10.1×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $3,968.80 $4,961 11.4×
MRI thoracic spine w/o contrast (72146) $3,129.40 $3,911.75 13.1×
MRI tmj (70336) $3,081.80 $3,852.25 12.9×
MRI upper ext joint w/o contrast (73221) $2,945 $3,681.25 12.3×
MRI upper extrem other than jt w/o & w/contras (73220) $3,515 $4,393.75 10.1×
MRI upper extremity oth than jt w/o contr matrl (73218) $2,777.80 $3,472.25 11.6×
Myelogram Lumbar (72265) $1,444.40 $1,805.50 1.8×
Myocardial infarct spect (78469) $2,353.20 $2,941.50 4.3×
Myocardial Spect Multiple Studies (78452) $4,598.20 $5,747.75 3.5×
Neck soft tissue (70360) $64 $80 0.7×
Nm gastric emptying study (78264) $1,593.50 $1,991.88 4.0×
Nuclear Rx Oral Admin (79005) $1,115.70 $1,394.62 4.8×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $245.60 $307 2.3×
Osseous survey infant (77076) $424.60 $530.75 4.1×
Osseous survey limited (77074) $664.40 $830.50 6.3×
Parathyroid imaging (78070) $1,000 $1,250 2.5×
Pelvis 1 or 2 views (72170) $319.60 $399.50 3.1×
PET image w/CT, skull-thigh (78815) $6,958.20 $8,697.75 4.9×
PET imaging CT for attenuation limited area (78814) $1,520 $1,900 1.1×
PET imaging for CT attenuation whole body (78816) $6,985 $8,731.25 4.9×
Pr heart first pass single,planar (78481) $1,422.80 $1,778.50 2.6×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $7,369.40 $9,211.75 21.1×
Pulmonary Perfusion Imaging Particulate (78580) $881.60 $1,102 2.2×
Pulmonary Ventilation & Perfusion Imaging (78582) $1,578.30 $1,972.88 2.9×
Radex abscess/fistula/sinus tract rs&i (76080) $594.40 $743 1.1×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $234.20 $292.75 2.2×
Radex hips bilateral with pelvis 2 views (73521) $101.60 $127 1.0×
Radex mastoids compl minimum 3 views pr side (70130) $205.70 $257.12 2.0×
Radiolog exam mandible compl minimum 4 views (70110) $73.60 $92 0.7×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $203.30 $254.12 2.3×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $204.60 $255.75 2.3×
Radiologic exam colon single contrast study (74270) $933.60 $1,167 5.3×
Radiologic exam upr gi trc double contrast study (74246) $860.80 $1,076 4.9×
Radiologic exam upr gi trc single contrast study (74240) $792.80 $991 4.5×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $107.60 $134.50 1.2×
Radiological examination surgical specimen (76098) $231.10 $288.88 0.4×
Ribs bilateral 3 views (71110) $82.40 $103 0.8×
Sacroiliac Joints < 3 Views (72200) $87.20 $109 0.8×
Saline Infus Sonohysterography W/Color Doppler (76831) $108.80 $136 0.5×
Scanogram (77073) $249.30 $311.62 2.4×
Scapula complete (73010) $250.90 $313.62 2.4×
Screening digital breast tomosynthesis (77063) $114.20 $142.75 4.9×
Small bowel series (74250) $664.60 $830.75 3.8×
Spine thoracic 3 views (72072) $63.20 $79 0.6×
Thoracolumbar 2 views (72080) $345.80 $432.25 4.0×
Thyroid carcinoma metastases img whole body (78018) $1,745.60 $2,182 3.2×
Thyroid Imaging With Vascular Flow (78013) $585.40 $731.75 1.5×
Thyroid uptake measurement (78012) $538.20 $672.75 1.3×
Tomogram (76100) $1,067.40 $1,334.25 10.2×
Ultrasound scan to determine eye length and lens power (76519) $128.80 $161 1.2×
Ultrasound, abdomen limited (76705) $422.70 $528.38 4.0×
Unlisted Ultrasound Procedure (76999) $533.80 $667.25 6.1×
Upper Extremity Infant (73092) $204.20 $255.25 2.0×
Urethrocystography voiding (74455) $931.40 $1,164.25 3.9×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $1,174.20 $1,467.75 6.7×
Urograpy infusion drip &/bolus techq w/wo tomo (74415) $766.40 $958 4.4×
Us abdl aorta screen aaa (76706) $525.40 $656.75 5.0×
Us breast unilateral limited (76642) $812.60 $1,015.75 9.3×
Us chest (76604) $610.20 $762.75 5.8×
Us elastography parenchyma (76981) $385.20 $481.50 3.7×
Us infant hips dynamic (76885) $880.80 $1,101 10.1×
Us ob detailed single fetus (76811) $1,087.80 $1,359.75 4.6×
Us ob transvaginal (76817) $158.40 $198 1.5×
Us pelvic non ob complete (76856) $662 $827.50 6.3×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $106.40 $133 1.0×
Us pregnancy ltd (76815) $285.80 $357.25 2.7×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $314.40 $393 3.0×
Us retroperitoneal complete (76770) $537 $671.25 5.1×
Us retroperitoneal limited (76775) $366.90 $458.62 3.5×
Us scrotum and contents (76870) $892.80 $1,116 8.5×
Us soft tissue head/neck (76536) $807.60 $1,009.50 7.7×
Us spinal canal and contents (76800) $519.40 $649.25 5.0×
Us transrectal (76872) $507.90 $634.88 4.9×
Us xtr non-vasc lmtd (76882) $533.80 $667.25 5.1×
Us, eye b-scan (76512) $261.20 $326.50 2.5×
Vascular flow imaging (78445) $511 $638.75 1.3×
Venogram extremity bilateral (75822) $3,014.05 $3,767.56 1.9×
Venography extremity unilateral rs&i (75820) $1,007 $1,258.75 0.6×
Venography venous sinus/jugular cath rs&i (75860) $2,057.40 $2,571.75 0.7×
Wrist 2 views (73100) $304 $380 3.5×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $77.60 $97 0.7×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $62.40 $78 0.7×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $109.60 $137 1.3×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $1,214.40 $1,518 6.9×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $152 $190 1.7×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $122.40 $153 1.4×
X-ray exam hip uni 1 view (73501) $271 $338.75 3.1×
X-Ray Exam Hip Uni 2-3 Views (73502) $89.60 $112 1.0×
X-Ray Exam Hips Bi 3-4 Views (73522) $368.80 $461 3.5×
X-Ray Exam Hips Bi 5/> Views (73523) $96 $120 0.9×
X-ray eye for foreign body (70030) $229 $286.25 2.6×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $109.60 $137 1.0×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $213.30 $266.62 2.4×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $109.60 $137 1.3×
X-ray guide gu dilation - ir nephrostomy dilation (74485) $571.80 $714.75 0.3×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $108 $135 1.2×
X-ray IV pyelogram+drip infusn (74410) $720.60 $900.75 4.1×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $482.20 $602.75 4.6×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $73.60 $92 0.8×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $159 $198.75 1.8×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $101.60 $127 1.0×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $672.60 $840.75 6.4×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $54.40 $68 0.6×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $165.50 $206.88 1.9×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $84 $105 0.8×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $100.80 $126 1.0×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $207.20 $259 0.6×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $72.40 $90.50 0.8×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $386.80 $483.50 3.7×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $234.50 $293.12 2.2×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $64 $80 0.6×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $87.20 $109 1.0×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $251.80 $314.75 2.9×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $67.20 $84 0.8×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $204.60 $255.75 2.3×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $493 $616.25 4.7×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $352.80 $441 3.4×
X-Ray Spine One View - Xr Spine (72020) $148.50 $185.62 1.7×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $97.60 $122 1.1×
X-Ray Teeth Single - Xr Teeth 1 View (70300) $187.60 $234.50 2.2×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $237.60 $297 2.3×
X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) $452.80 $566 4.3×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $280.90 $351.12 3.2×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $222 $277.50 2.5×
Xr c-spine 6 or more views (72052) $384.60 $480.75 3.7×
Xr chest 4+ views (71048) $58.40 $73 0.6×
Xr Cholecystography Oral Contrast (74290) $269.20 $336.50 1.5×
Xr finger(s) 2+ views (73140) $90.40 $113 1.0×
XR Mastoids < 3 Views Bilateral (70120) $281.40 $351.75 2.7×
Xr shoulder 1 view (73020) $99.20 $124 1.1×
Xr spine cervical 4 or 5 views (72050) $309 $386.25 3.0×
Xr tibia/fibula 2 views (73590) $227.60 $284.50 2.6×
Xr tmj bilateral (70330) $268.40 $335.50 3.1×
Xray knee 1 or 2 views rt (73560) $324 $405 3.7×