Imaging prices at Evanston Regional Hospital

Evanston, WY · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Acute gi blood loss imaging (78278) $986.49 $1,644.15 2.4×
Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) $3,252.52 $5,420.87 1.0×
Ankle 2 views (73600) $387.58 $645.96 4.4×
Clavicle complete (73000) $156.73 $261.22 1.8×
Complex dynamic pharyngeal and speech evaluation by cine or video recording Age Under 21 (70371) $390.69 $651.15 1.6×
Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) including… (74262) $0.69 $1.15 0.0×
Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material Age Under… (74261) $319.81 $533.01 3.0×
Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) $3,223.94 $5,373.23 9.0×
Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) $2,095.59 $3,492.65 11.7×
Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) $2,095.59 $3,492.65 11.7×
Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) $2,481.05 $4,135.09 13.8×
Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) $1,287.30 $2,145.50 7.2×
Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) $2,095.59 $3,492.65 11.7×
Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) $2,095.59 $3,492.65 11.7×
Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) $1,227.66 $2,046.09 6.9×
Computed tomography, lower extremity; without contrast material Age Under 21 (73700) $1,066.46 $1,777.44 10.0×
Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) $2,801.74 $4,669.57 15.6×
Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) $1,443.04 $2,405.06 8.1×
Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) $1,349.77 $2,249.62 12.6×
Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) $1,443.04 $2,405.06 8.1×
Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) $1,349.77 $2,249.62 12.6×
Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) $1,536.26 $2,560.43 8.6×
Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) $1,536.26 $2,560.43 8.6×
Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) $2,801.74 $4,669.57 15.6×
Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) $2,645.92 $4,409.86 14.8×
CT abdomen and pelvis without and with contrast (74178) $3,163.04 $5,271.74 8.9×
CT abdomen and pelvis without contrast (74176) $3,223.94 $5,373.23 13.2×
CT abdomen w & w/o contrast (74170) $1,530.79 $2,551.31 8.5×
CT abdomen w/contrast (74160) $1,640.17 $2,733.62 9.2×
CT abdomen w/o contrast (74150) $1,550.56 $2,584.27 14.5×
CT cervical spine w/contrast (72126) $2,693.13 $4,488.55 7.6×
CT cervical spine w/o contrast (72125) $2,779.04 $4,631.73 26.0×
CT chest w/contrast (71260) $2,885.80 $4,809.66 16.1×
CT extremity upper w/o contrast (73200) $950.60 $1,584.34 8.9×
CT head/brain with contrast (70460) $1,443.04 $2,405.06 8.1×
CT head/brain without and with contrast (70470) $1,536.26 $2,560.43 8.6×
CT l-spine w/contrast (72132) $2,651.05 $4,418.41 7.4×
CT limited/localized follow up study (76380) $1,766.72 $2,944.54 19.9×
CT lower extremity w/dye (73701) $1,098.10 $1,830.17 6.1×
CT lumbar spine w/o contrast (72131) $3,420.96 $5,701.60 32.0×
CT maxillofacial w/wo contrast (70488) $1,917.89 $3,196.48 10.7×
CT neck w/contrast (70491) $1,443.04 $2,405.06 8.1×
CT neck w/o contrast (70490) $2,082.67 $3,471.12 19.5×
CT pelvis w & w/o contrast (72194) $1,632.76 $2,721.26 9.1×
CT pelvis w/o contrast (72192) $1,673.54 $2,789.24 15.7×
CT thoracic spine w/contrast (72129) $2,104.01 $3,506.68 11.7×
CT thoracic spine w/o contrast (72128) $3,463.23 $5,772.05 32.4×
CT thorax lung cancer scr c- (71271) $1,246.78 $2,077.97 11.7×
CT thorax w/o contrast (71250) $1,277.35 $2,128.92 12.0×
CT upper extremity w/dye (73201) $1,082.44 $1,804.07 3.0×
CTA head w contrast (70496) $2,095.59 $3,492.65 11.7×
Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) $332.78 $554.63 0.9×
Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) $465.81 $776.35 4.4×
Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76825) $633.73 $1,056.21 1.1×
Fetal biophysical profile non-stress testing (76818) $649.02 $1,081.70 6.1×
Fluoroscopy up to 1 hour physician/qhp time (76000) $564.08 $940.14 2.3×
Hepatobil syst imag inc gb w/pharma intervenj (78227) $1,510.04 $2,516.74 2.7×
Hepatobiliary syst imaging including gallbladder (78226) $958.39 $1,597.32 2.3×
Ht muscle image spect sing (78451) $1,305.92 $2,176.54 1.0×
Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) $986.49 $1,644.15 2.4×
Kidney imaging morphol - nm kidney cortex (78700) $504.96 $841.60 1.2×
Kidney imaging morphology; with vascular flow Age Under 21 (78701) $504.96 $841.60 1.2×
Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) $504.96 $841.60 0.9×
Liver and spleen imaging (78215) $534.41 $890.69 1.3×
Lung perfusion imaging (78580) $604.59 $1,007.65 1.5×
Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) $3,813.98 $6,356.64 10.7×
Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) $3,620.52 $6,034.21 10.2×
Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) $3,578.94 $5,964.91 14.7×
Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) $3,813.98 $6,356.64 10.7×
Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) $1,674.55 $2,790.91 4.7×
Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) $3,403.34 $5,672.24 14.0×
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) $3,221.52 $5,369.20 9.0×
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) $3,572.16 $5,953.60 10.0×
Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) $1,674.55 $2,790.91 4.7×
Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) $1,955.07 $3,258.45 5.5×
Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) $1,955.07 $3,258.45 5.5×
MRA head w/o contrast (70544) $1,394.02 $2,323.37 5.7×
MRA neck w/ contrast (70548) $1,674.55 $2,790.91 4.7×
MRA neck w/o contrast (70547) $1,394.02 $2,323.37 5.7×
MRI abdomen w/contrast (74182) $2,274.83 $3,791.39 6.4×
MRI abdomen w/o contrast (74181) $2,195.95 $3,659.91 9.0×
MRI abdomen w/wo contrast (74183) $2,353.73 $3,922.88 6.6×
MRI any jt lower extrem w/contrast material (73722) $3,455.04 $5,758.39 4.3×
MRI breast c- bilateral (77047) $2,865.73 $4,776.21 11.8×
MRI c-spine w&w/o cont (72156) $3,004.90 $5,008.17 8.4×
MRI cervical spine w/contrast (72142) $2,445.29 $4,075.48 6.9×
MRI chest w/contrast (71551) $1,574.46 $2,624.10 2.0×
MRI chest w/o contrast (71550) $1,220.81 $2,034.69 5.0×
MRI chest w/wo contrast (71552) $1,928.11 $3,213.52 5.4×
MRI joint upr extr w/o&w/dye (73223) $3,465.25 $5,775.42 9.7×
MRI joint upr extrem w/dye (73222) $3,148.08 $5,246.80 3.9×
MRI joint upr extrem w/o dye (73221) $3,310.90 $5,518.18 13.6×
MRI lumbar spine w/contrast (72149) $3,173.32 $5,288.86 8.9×
MRI lumbar spine w/wo contrast (72158) $3,004.90 $5,008.17 8.4×
MRI orbit/face/neck w&w/o cont (70543) $3,070.09 $5,116.82 8.6×
MRI pelvis w & w/o contrast (72197) $2,354.58 $3,924.30 6.6×
MRI pelvis w/contrast (72196) $2,274.24 $3,790.40 6.4×
MRI pelvis w/o contrast (72195) $2,196.99 $3,661.65 9.0×
MRI spine cervical w/o contrast (72141) $2,396.63 $3,994.38 9.8×
MRI t-spine w&w/o cont (72157) $3,004.90 $5,008.17 8.4×
MRI thoracic spine w/contrast (72147) $2,031.13 $3,385.22 5.7×
MRI thoracic spine w/o contrst (72146) $1,982.49 $3,304.15 8.1×
MRI tmj (70336) $1,016.83 $1,694.72 4.2×
MRI upper extremity oth than jt w/o contr matrl (73218) $3,308.76 $5,514.60 13.6×
Myocardial spect multiple studies (78452) $2,274.65 $3,791.08 1.7×
Nm bone 3 phase (78315) $986.49 $1,644.15 2.4×
Nm bone imaging whole body (78306) $986.49 $1,644.15 2.4×
Nm gastric emptying (78264) $828.49 $1,380.81 2.0×
Non-cardiac vascular flow imaging (ie, angiography, venography) Age Under 21 (78445) $386.48 $644.13 0.9×
Nuclear medicine study of bone and/or joint limited area (78300) $986.49 $1,644.15 2.4×
Nuclear medicine study of bone and/or joint multiple areas (78305) $986.49 $1,644.15 2.4×
Ob us limited fetus(s) (76815) $479.93 $799.88 4.5×
Pulmonary ventilation & perfusion imaging (78582) $786.70 $1,311.17 1.4×
Radex abscess/fistula/sinus tract rs&i (76080) $371.60 $619.34 0.7×
Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) $353.06 $588.43 4.0×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $405.64 $676.06 3.8×
Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) $608.52 $1,014.20 5.7×
Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) $811.25 $1,352.09 7.6×
Radex hip unilateral with pelvis 1 view (73501) $164 $273.33 1.8×
Radex hip unilateral with pelvis 2-3 views (73502) $183.20 $305.34 2.1×
Radex hip unilateral with pelvis minimum 4 views (73503) $261.51 $435.85 2.4×
Radex hips bilateral with pelvis 2 views (73521) $326.92 $544.86 3.1×
Radex hips bilateral with pelvis minimum 5 views (73523) $495.25 $825.41 4.6×
Radex spine cervical 2 or 3 views (72040) $382.38 $637.30 4.3×
Radex spine cervical 4 or 5 views (72050) $504.80 $841.33 4.7×
Radex spine cervical 6 or more views (72052) $540.65 $901.09 5.1×
Radex spine thoracolumbar junction min 2 views (72080) $276.91 $461.52 3.1×
Radiologic exam abdomen 3+ views (74021) $201.18 $335.30 1.9×
Radiologic exam chest 3 views (71047) $322.54 $537.57 3.6×
Radiologic exam chest 4+ views (71048) $332.44 $554.07 3.1×
Radiologic exam colon double contrast study (74280) $458.57 $764.29 2.6×
Radiologic exam colon single contrast study (74270) $458.57 $764.29 2.6×
Radiologic exam esophagus single contrast study (74220) $404.81 $674.68 2.3×
Radiologic exam small int single contrast study (74250) $381.34 $635.57 2.1×
Radiologic exam swallow function contrast study (74230) $390.69 $651.15 2.2×
Radiologic exam upr gi trc double contrast study (74246) $367.66 $612.76 2.1×
Radiologic exam upr gi trc single contrast study (74240) $334.22 $557.04 1.9×
Radiologic examination femur minimum 2 views (73552) $276.82 $461.37 3.1×
Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) $158.37 $263.95 1.8×
Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) $380.80 $634.67 4.3×
Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) $632.69 $1,054.48 5.9×
Radiologic examination, elbow; 2 views Age Under 21 (73070) $248.14 $413.56 2.8×
Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) $461.74 $769.57 5.2×
Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) $152.34 $253.90 1.7×
Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) $380.80 $634.67 4.3×
Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) $407.79 $679.65 4.6×
Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) $414.25 $690.41 4.7×
Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) $414.37 $690.62 3.9×
Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) $152.34 $253.90 1.7×
Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) $241.18 $401.96 2.3×
Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) $304.93 $508.22 3.4×
Radiologic examination, pharynx and/or cervical esophagus, including scout neck radiograph(s) and delayed image(s),… (74210) $404.81 $674.68 2.3×
Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) $382.57 $637.62 3.6×
Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) $305.18 $508.64 2.9×
Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) $241.42 $402.36 2.3×
Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) $612.70 $1,021.16 1.7×
Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) $711.40 $1,185.66 8.0×
Radiologic examination, single plane body section (eg, tomography), other than with urography Age Under 21 (76100) $114.74 $191.24 1.1×
Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) $152.34 $253.90 1.7×
Radiologic examination, skull; less than 4 views Age Under 21 (70250) $152.34 $253.90 1.4×
Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) $432.04 $720.06 4.0×
Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) $196.67 $327.79 1.8×
Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) $524.31 $873.85 4.9×
Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) $276.91 $461.52 2.6×
Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) $461.74 $769.57 5.2×
Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) $193.12 $321.86 2.2×
Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) $287.64 $479.40 3.2×
Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) $477.34 $795.57 5.4×
Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) $304.93 $508.22 2.9×
Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) $145.60 $242.66 1.6×
Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) $169.94 $283.23 1.9×
Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) $461.74 $769.57 4.3×
Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) $646.36 $1,077.26 2.7×
Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) $646.36 $1,077.26 2.7×
Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) $337.88 $563.13 1.4×
Rp loclzj tum plnr 1 area single day imaging (78800) $905.57 $1,509.29 2.2×
Rp loclzj tum plnr whole body single day imaging (78802) $905.57 $1,509.29 1.6×
Scapula complete (73010) $156.73 $261.22 1.5×
Screening digital breast tomosynthesis bi (77063) $52.17 $86.95
Thyroid imaging with vascular flow (78013) $263.08 $438.47 0.6×
Thyroid uptake w/blood flow sngle/mult quan meas (78014) $411.59 $685.98 1.0×
Ultrasound breast limited (76642) $402.41 $670.68 4.5×
Ultrasound, abdomen limited (76705) $824.37 $1,373.95 7.7×
Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) $211.82 $353.04 2.0×
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) $751.85 $1,253.09 7.0×
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) $406.77 $677.95 3.8×
Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) $332.78 $554.63 1.9×
Urography, infusion, drip technique and/or bolus technique; with nephrotomography Age Under 21 (74415) $332.78 $554.63 1.9×
Us abdominal aorta real time screen study aaa (76706) $518.59 $864.32 4.9×
Us breast uni real time with image complete (76641) $477.62 $796.04 4.5×
Us chest (76604) $524.06 $873.43 4.9×
Us compl joint r-t w/image documentation (76881) $308.09 $513.48 2.9×
Us encephalogram (76506) $594.58 $990.96 5.6×
Us exam, pelvic, limited (76857) $264.10 $440.17 2.5×
Us inft hips r-t img dynamic req phys/qhp manj (76885) $382.57 $637.61 4.3×
US OB Follow-Up/Repeat (76816) $181.79 $302.98 1.7×
Us ob transvaginal (76817) $287.32 $478.87 2.7×
Us retroperitoneal complete (76770) $684.95 $1,141.59 6.4×
Us retroperitoneal ltd (76775) $291.20 $485.33 2.7×
Us scrotum (76870) $301.57 $502.61 2.8×
Us soft tissue head/neck (76536) $672.40 $1,120.67 6.3×
Us spinal canal (76800) $174.32 $290.53 1.6×
Us transrectal (76872) $358.52 $597.53 3.4×
Vertebral fracture assessment via dxa (77086) $296.30 $493.83 3.3×
X-ray exam hips bi 3-4 views (73522) $247.63 $412.71 2.3×
X-ray exam of finger(s) (73140) $326.22 $543.70 3.7×
X-ray exam of knee 1 or 2 (73560) $338.35 $563.92 3.8×
X-ray exam ribs bil 3 views (71110) $382.38 $637.30 3.6×
X-ray exam ribs uni 2 views (71100) $145.60 $242.66 1.6×
X-ray heel (73650) $169.94 $283.23 1.9×
X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) $304.96 $508.26 2.9×
X-ray retrograde pyelogram (74420) $332.78 $554.63 0.9×
Xr abdomen 1 view (74018) $148.33 $247.21 1.7×
Xr abdomen 2 views (74019) $398.24 $663.74 3.7×
Xr arthrogram ankle (73615) $612.70 $1,021.16 1.7×
Xr arthrogram elbow (73085) $856.75 $1,427.92 2.4×
Xr arthrogram hip (73525) $428.30 $713.83 1.2×
Xr arthrogram wrist (73115) $447.46 $745.76 1.3×
Xr bone age studies (77072) $106.89 $178.15 1.0×
Xr bone survey infant (77076) $859.72 $1,432.86 8.0×
Xr chest 1 view (71045) $263.90 $439.83 3.0×
Xr chest 2 views (71046) $312.07 $520.11 3.5×
Xr eye foreign body (70030) $152.34 $253.90 1.7×
Xr facial bones 3+ views (70150) $241.42 $402.36 2.3×
Xr foot arthritis pa only bilateral - report(ortho pro) (73620) $387.58 $645.96 4.4×
Xr forearm 2 views (73090) $307.64 $512.74 3.5×
Xr hand 2v (73120) $337.65 $562.75 3.2×
Xr hysterosalpingogram (74740) $436.47 $727.45 1.8×
Xr joint survey 1 view (77077) $265.10 $441.84 2.5×
Xr neck soft tissue (70360) $144.75 $241.25 1.6×
Xr o knee w/ merchant view bilat - report(ortho pro) (73562) $435.52 $725.88 4.9×
Xr osseous survey complete (77075) $508.48 $847.46 4.8×
Xr pelvis 1-2 views (72170) $185.47 $309.12 1.7×
Xr pelvis min 3 view (72190) $218.33 $363.88 2.0×
Xr sacrum/coccyx 2+ views (72220) $241.42 $402.36 2.7×
Xr shoulder 1 view (73020) $270.38 $450.63 3.0×
Xr sinuses 3+ views (70220) $304.93 $508.22 3.4×
Xr skull min 4 view (70260) $241.42 $402.36 2.3×
Xr spine 1 view (72020) $162.35 $270.58 1.8×
Xr spine thoracic 3v (72072) $430.91 $718.18 4.0×
Xr sternum 2+ views (71120) $145.60 $242.66 1.6×
Xr surgical specimen (76098) $371.60 $619.34 0.7×
Xr t-spine 2 views (72070) $276.91 $461.52 2.6×
Xr tibia/fibula 2 views (73590) $477.34 $795.57 5.4×
Xr tmj bilateral (70330) $304.93 $508.22 3.4×
Xr wrist 2 views (73100) $269.70 $449.50 3.0×