| 3-D radiotherapy plan dose-volume histograms (77295) |
$31,061.25 |
$31,061.25 |
21.3× |
| Acute gi blood loss imaging (78278) |
$5,017.50 |
$5,017.50 |
11.9× |
| Angiography internal mammary rs&i (75756) |
$14,353.90 |
$14,353.90 |
4.3× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$24,868.25 |
$24,868.25 |
7.5× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$27,191.18 |
$27,191.18 |
4.6× |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
$38,699.38 |
$38,699.38 |
11.6× |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
$20,825.48 |
$20,825.48 |
6.3× |
| Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Age Under 21 (75736) |
$21,718.95 |
$21,718.95 |
3.7× |
| Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation Age Under 21 (75741) |
$17,284.85 |
$17,284.85 |
5.2× |
| Angiography, spinal, selective, radiological supervision and interpretation Age Under 21 (75705) |
$19,108.65 |
$19,108.65 |
3.3× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$10,391.70 |
$10,391.70 |
3.1× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$24,197.25 |
$24,197.25 |
7.3× |
| Ankle 2 views (73600) |
$1,509.75 |
$1,509.75 |
16.4× |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
$38,328.40 |
$38,328.40 |
11.5× |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
$31,157.50 |
$31,157.50 |
9.4× |
| Aortography, thoracic, by serialography, radiological supervision and interpretation Age Under 21 (75605) |
$19,335.52 |
$19,335.52 |
3.3× |
| Basic radiation dosimetry calculation (77300) |
$4,162.40 |
$4,162.40 |
29.4× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$5,510 |
$5,510 |
9.6× |
| Brain imaging, minimum 4 static views; with vascular flow Age Under 21 (78606) |
$10,412.50 |
$10,412.50 |
18.2× |
| Brain imaging, positron emission tomography (PET); metabolic evaluation Age Under 21 (78608) |
$35,879.80 |
$35,879.80 |
23.8× |
| Card MRI w/stress img & dye (75563) |
$28,740.80 |
$28,740.80 |
34.8× |
| Cardiac MRI morphology & function w/o contrast (75557) |
$19,272.55 |
$19,272.55 |
76.6× |
| Cardiac MRI w/stress img (75559) |
$27,669.40 |
$27,669.40 |
48.0× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$20,447.90 |
$20,447.90 |
55.6× |
| Cholecystography, oral contrast Age Under 21 (74290) |
$4,130.50 |
$4,130.50 |
22.3× |
| Clavicle complete (73000) |
$2,657.32 |
$2,657.32 |
28.9× |
| Complex dynamic pharyngeal and speech evaluation by cine or video recording Age Under 21 (70371) |
$5,525.85 |
$5,525.85 |
22.0× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$21,569.62 |
$21,569.62 |
58.6× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$17,222.70 |
$17,222.70 |
93.1× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$17,222.70 |
$17,222.70 |
93.1× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$17,222.70 |
$17,222.70 |
93.1× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$16,712.85 |
$16,712.85 |
90.3× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$17,222.70 |
$17,222.70 |
93.1× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$17,222.70 |
$17,222.70 |
93.1× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$11,297 |
$11,297 |
61.1× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$17,786.72 |
$17,786.72 |
96.1× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$17,640.70 |
$17,640.70 |
160.0× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$15,969.25 |
$15,969.25 |
86.3× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$24,877.05 |
$24,877.05 |
134.4× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$21,049.05 |
$21,049.05 |
113.8× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$18,179.15 |
$18,179.15 |
164.8× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$21,049.05 |
$21,049.05 |
113.8× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$18,179.15 |
$18,179.15 |
164.8× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$24,877.05 |
$24,877.05 |
134.4× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$24,877.05 |
$24,877.05 |
134.4× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$24,877.05 |
$24,877.05 |
134.4× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$24,877.05 |
$24,877.05 |
134.4× |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
$5,445.55 |
$5,445.55 |
38.4× |
| Corpora cavernosography, radiological supervision and interpretation Age Under 21 (74445) |
$10,503.90 |
$10,503.90 |
95.2× |
| Csf shunt evaluation (78645) |
$6,442 |
$6,442 |
11.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$24,877.05 |
$24,877.05 |
67.6× |
| CT abdomen and pelvis without contrast (74176) |
$18,179.15 |
$18,179.15 |
72.2× |
| CT abdomen w & w/o contrast (74170) |
$25,613.50 |
$25,613.50 |
138.4× |
| CT abdomen w/contrast (74160) |
$21,049.05 |
$21,049.05 |
113.8× |
| CT abdomen w/o contrast (74150) |
$18,179.15 |
$18,179.15 |
164.8× |
| CT angio hrt w/3d image (75574) |
$24,140.60 |
$24,140.60 |
65.6× |
| CT cervical spine w/contrast (72126) |
$21,049.05 |
$21,049.05 |
57.2× |
| CT cervical spine w/o contrast (72125) |
$18,179.15 |
$18,179.15 |
164.8× |
| CT chest w/contrast (71260) |
$21,049.05 |
$21,049.05 |
113.8× |
| CT extremity upper w & w/o contrast (73202) |
$17,041.48 |
$17,041.48 |
92.1× |
| CT extremity upper w/o contrast (73200) |
$17,640.70 |
$17,640.70 |
160.0× |
| CT head/brain with contrast (70460) |
$21,049.05 |
$21,049.05 |
113.8× |
| CT head/brain without and with contrast (70470) |
$24,877.05 |
$24,877.05 |
134.4× |
| CT heart no contrast quant eval coronry calcium (75571) |
$3,716.90 |
$3,716.90 |
40.5× |
| CT l-spine w/contrast (72132) |
$21,049.05 |
$21,049.05 |
57.2× |
| CT limited/localized follow up study (76380) |
$7,473.40 |
$7,473.40 |
81.4× |
| CT lower extremity w/dye (73701) |
$20,425.90 |
$20,425.90 |
110.4× |
| CT lumbar spine w/o contrast (72131) |
$18,179.15 |
$18,179.15 |
164.8× |
| CT maxillofacial w/wo contrast (70488) |
$23,184.15 |
$23,184.15 |
125.3× |
| CT neck w/contrast (70491) |
$21,049.05 |
$21,049.05 |
113.8× |
| CT neck w/o contrast (70490) |
$18,179.15 |
$18,179.15 |
164.8× |
| CT pelvis w & w/o contrast (72194) |
$24,877.05 |
$24,877.05 |
134.4× |
| CT pelvis w/o contrast (72192) |
$18,179.15 |
$18,179.15 |
164.8× |
| CT thoracic spine w/contrast (72129) |
$21,049.05 |
$21,049.05 |
113.8× |
| CT thoracic spine w/o contrast (72128) |
$18,179.15 |
$18,179.15 |
164.8× |
| CT thorax w/o contrast (71250) |
$17,222.70 |
$17,222.70 |
156.2× |
| CT upper extremity w/dye (73201) |
$21,672.20 |
$21,672.20 |
58.9× |
| CTA head w contrast (70496) |
$17,222.70 |
$17,222.70 |
93.1× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$4,430.80 |
$4,430.80 |
12.0× |
| Dilation ureters/urethra rs&i (74485) |
$8,199.40 |
$8,199.40 |
3.7× |
| Discography, cervical or thoracic, radiological supervision and interpretation Age Under 21 (72285) |
$7,256.70 |
$7,256.70 |
3.5× |
| Diskography lumbar s&i (72295) |
$8,075.65 |
$8,075.65 |
3.9× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete Age Under 21 (76827) |
$1,114.85 |
$1,114.85 |
10.1× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$1,114.85 |
$1,114.85 |
10.1× |
| Doppler fetal mid cerebral artery (76821) |
$1,784.75 |
$1,784.75 |
16.2× |
| Esophageal motility (78258) |
$8,668 |
$8,668 |
20.6× |
| Fetal biophys profile w/o nst (76819) |
$2,523.95 |
$2,523.95 |
22.9× |
| Fetal biophysical profile non-stress testing (76818) |
$1,526.25 |
$1,526.25 |
13.8× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$4,330.70 |
$4,330.70 |
17.2× |
| Gastroesophageal reflux study (78262) |
$10,489 |
$10,489 |
24.9× |
| Gated heart planar single (78472) |
$9,604.50 |
$9,604.50 |
22.8× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$33,544.50 |
$33,544.50 |
45.7× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$43,842.70 |
$43,842.70 |
59.7× |
| Heart infarct image (78466) |
$9,722 |
$9,722 |
23.1× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$11,238.15 |
$11,238.15 |
3.4× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Age Under… (75889) |
$12,097.25 |
$12,097.25 |
3.6× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$11,363 |
$11,363 |
19.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$9,032.50 |
$9,032.50 |
21.4× |
| Ht muscle image spect sing (78451) |
$17,253.50 |
$17,253.50 |
12.6× |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
$5,809.50 |
$5,809.50 |
13.8× |
| Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) |
$48,282.30 |
$48,282.30 |
33.1× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$34,814 |
$34,814 |
47.4× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$6,098 |
$6,098 |
14.5× |
| Isodose brachytherapy complex 10+ sources (77318) |
$25,481.50 |
$25,481.50 |
64.5× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$25,481.50 |
$25,481.50 |
64.5× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$25,481.50 |
$25,481.50 |
64.5× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$31,701.45 |
$31,701.45 |
80.3× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$22,454.30 |
$22,454.30 |
56.8× |
| Kidney function study, non-imaging radioisotopic study Age Under 21 (78725) |
$8,502 |
$8,502 |
20.2× |
| Kidney imaging morphol - nm kidney cortex (78700) |
$5,223.50 |
$5,223.50 |
12.4× |
| Kidney imaging morphology; with vascular flow Age Under 21 (78701) |
$7,083.50 |
$7,083.50 |
16.8× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$6,650.50 |
$6,650.50 |
11.6× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$20,270.50 |
$20,270.50 |
35.4× |
| Leveen/shunt patency exam (78291) |
$3,735 |
$3,735 |
8.9× |
| Liver and spleen imaging (78215) |
$9,508 |
$9,508 |
22.5× |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
$3,433.50 |
$3,433.50 |
8.1× |
| Liver imaging (78201) |
$5,585 |
$5,585 |
9.8× |
| Liver imaging with flow (78202) |
$11,410 |
$11,410 |
19.9× |
| Lung perf&ventilat diferentl (78598) |
$15,303.50 |
$15,303.50 |
26.7× |
| Lung perfusion imaging (78580) |
$7,926 |
$7,926 |
18.8× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Age Under 21 (75807) |
$8,605.30 |
$8,605.30 |
2.6× |
| Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation Age Under 21 (75805) |
$8,605.30 |
$8,605.30 |
2.6× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$24,954.60 |
$24,954.60 |
67.8× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$20,070.60 |
$20,070.60 |
54.5× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$19,598.70 |
$19,598.70 |
77.9× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$24,277.55 |
$24,277.55 |
66.0× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$20,070.60 |
$20,070.60 |
54.5× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$20,658.55 |
$20,658.55 |
82.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$22,260.70 |
$22,260.70 |
60.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$22,230.45 |
$22,230.45 |
60.4× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$15,302.10 |
$15,302.10 |
41.6× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$18,147.80 |
$18,147.80 |
49.3× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$20,097 |
$20,097 |
54.6× |
| Magnetic resonance elastography (76391) |
$19,509.05 |
$19,509.05 |
77.5× |
| Mandible min 4v (70110) |
$4,062.85 |
$4,062.85 |
36.8× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$80.82 |
$80.82 |
2.6× |
| MRA head w/o contrast (70544) |
$13,065.80 |
$13,065.80 |
51.9× |
| MRA neck w/ contrast (70548) |
$14,190 |
$14,190 |
38.6× |
| MRA neck w/o contrast (70547) |
$11,788.15 |
$11,788.15 |
46.8× |
| MRI abdomen w/o contrast (74181) |
$19,509.05 |
$19,509.05 |
77.5× |
| MRI abdomen w/wo contrast (74183) |
$24,396.90 |
$24,396.90 |
66.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$22,559.35 |
$22,559.35 |
27.3× |
| MRI breast c- bilateral (77047) |
$11,788.15 |
$11,788.15 |
46.8× |
| MRI breast without contrast material unilateral (77046) |
$11,788.15 |
$11,788.15 |
46.8× |
| MRI c-spine w&w/o cont (72156) |
$24,408.45 |
$24,408.45 |
66.3× |
| MRI cervical spine w/contrast (72142) |
$20,070.60 |
$20,070.60 |
54.5× |
| MRI chest w/contrast (71551) |
$21,400.50 |
$21,400.50 |
25.9× |
| MRI chest w/o contrast (71550) |
$20,209.75 |
$20,209.75 |
80.3× |
| MRI chest w/wo contrast (71552) |
$25,560.70 |
$25,560.70 |
69.5× |
| MRI fetal sngl/1st gestation (74712) |
$19,509.05 |
$19,509.05 |
77.5× |
| MRI joint upr extr w/o&w/dye (73223) |
$24,277.55 |
$24,277.55 |
66.0× |
| MRI joint upr extrem w/dye (73222) |
$22,037.40 |
$22,037.40 |
26.6× |
| MRI joint upr extrem w/o dye (73221) |
$19,565.70 |
$19,565.70 |
77.7× |
| MRI lumbar spine w/contrast (72149) |
$21,645.25 |
$21,645.25 |
58.8× |
| MRI lumbar spine w/wo contrast (72158) |
$24,445.85 |
$24,445.85 |
66.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$24,380.40 |
$24,380.40 |
66.2× |
| MRI pelvis w & w/o contrast (72197) |
$24,411.75 |
$24,411.75 |
66.3× |
| MRI pelvis w/contrast (72196) |
$20,070.60 |
$20,070.60 |
54.5× |
| MRI pelvis w/o contrast (72195) |
$19,532.70 |
$19,532.70 |
77.6× |
| MRI spectroscopy (76390) |
$8,556.90 |
$8,556.90 |
93.2× |
| MRI spine cervical w/o contrast (72141) |
$19,454.05 |
$19,454.05 |
77.3× |
| MRI t-spine w&w/o cont (72157) |
$24,552 |
$24,552 |
66.7× |
| MRI thoracic spine w/contrast (72147) |
$23,489.95 |
$23,489.95 |
63.8× |
| MRI thoracic spine w/o contrst (72146) |
$19,355.60 |
$19,355.60 |
76.9× |
| MRI tmj (70336) |
$21,188.20 |
$21,188.20 |
84.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$19,363.30 |
$19,363.30 |
76.9× |
| Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per… (77338) |
$67,564.75 |
$67,564.75 |
171.1× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$17,613.75 |
$17,613.75 |
21.3× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$16,605.60 |
$16,605.60 |
11.0× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$26,552.90 |
$26,552.90 |
17.6× |
| Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first… (78453) |
$21,656.50 |
$21,656.50 |
15.9× |
| Myocardial spect multiple studies (78452) |
$30,606.50 |
$30,606.50 |
22.4× |
| Myocrd img PET metab eval single study (78459) |
$37,219.05 |
$37,219.05 |
27.3× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$24,070.20 |
$24,070.20 |
26.6× |
| Nm adrenal imaging (78075) |
$14,603 |
$14,603 |
10.7× |
| Nm bone 3 phase (78315) |
$13,489.50 |
$13,489.50 |
32.0× |
| Nm bone imaging whole body (78306) |
$14,767.50 |
$14,767.50 |
35.0× |
| Nm bone marrow ltd (78102) |
$7,991.50 |
$7,991.50 |
19.0× |
| Nm bone marrow wb (78104) |
$9,412 |
$9,412 |
22.3× |
| Nm csf cisternogram (78630) |
$13,412 |
$13,412 |
23.4× |
| Nm csf leak detection (78650) |
$6,805 |
$6,805 |
5.0× |
| Nm gastric emptying (78264) |
$7,923 |
$7,923 |
18.8× |
| Nm lung ventilation imaging (78579) |
$6,341.50 |
$6,341.50 |
15.0× |
| Nm lymph system (78195) |
$8,480.50 |
$8,480.50 |
14.8× |
| Nm myocard infarct spect (78469) |
$7,210.50 |
$7,210.50 |
12.6× |
| Non-cardiac vascular flow imaging (ie, angiography, venography) Age Under 21 (78445) |
$8,150.50 |
$8,150.50 |
19.3× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$11,150 |
$11,150 |
26.4× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$12,390.50 |
$12,390.50 |
29.4× |
| Nuclear medicine study of brain, 4 static views or more (78605) |
$6,883.50 |
$6,883.50 |
12.0× |
| Nuclear medicine study of platelet survival (78191) |
$7,126 |
$7,126 |
16.9× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$5,098 |
$5,098 |
12.1× |
| Ob us limited fetus(s) (76815) |
$2,231.62 |
$2,231.62 |
20.2× |
| Ob us nuchal meas 1 gest (76813) |
$1,784.75 |
$1,784.75 |
16.2× |
| Panoramic X-ray of jaws (70355) |
$3,579.95 |
$3,579.95 |
39.0× |
| Parathyroid planar imaging (78070) |
$11,212 |
$11,212 |
26.6× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$13,319.50 |
$13,319.50 |
31.6× |
| Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation Age… (75885) |
$8,148.25 |
$8,148.25 |
2.4× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$39,465.80 |
$39,465.80 |
26.2× |
| PET imaging CT for attenuation limited area (78814) |
$39,465.80 |
$39,465.80 |
26.2× |
| PET imaging for CT attenuation whole body (78816) |
$39,465.80 |
$39,465.80 |
26.2× |
| PET imaging whole body (78813) |
$13,708.75 |
$13,708.75 |
9.1× |
| Positron emission tomography (PET) imaging; limited area (eg, chest, head/neck) Age Under 21 (78811) |
$13,708.75 |
$13,708.75 |
10.0× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Age Under 21 (78812) |
$13,708.75 |
$13,708.75 |
9.1× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$6,432.80 |
$6,432.80 |
1.9× |
| Pulmonary ventilation & perfusion imaging (78582) |
$14,415 |
$14,415 |
25.2× |
| Quant differential pulm perfusion w/wo imaging (78597) |
$8,802.50 |
$8,802.50 |
20.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$5,980.70 |
$5,980.70 |
10.4× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$1,492.15 |
$1,492.15 |
16.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$3,978.15 |
$3,978.15 |
36.1× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$11,924 |
$11,924 |
108.1× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$15,925.80 |
$15,925.80 |
144.4× |
| Radex hip unilateral with pelvis 1 view (73501) |
$2,755.50 |
$2,755.50 |
30.0× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$3,086.60 |
$3,086.60 |
33.6× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$3,416.60 |
$3,416.60 |
31.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$4,610.10 |
$4,610.10 |
41.8× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$13,827 |
$13,827 |
125.4× |
| Radex spine cervical 2 or 3 views (72040) |
$3,022.80 |
$3,022.80 |
32.9× |
| Radex spine cervical 4 or 5 views (72050) |
$4,702.50 |
$4,702.50 |
42.6× |
| Radex spine cervical 6 or more views (72052) |
$5,729.35 |
$5,729.35 |
52.0× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$3,341.25 |
$3,341.25 |
36.4× |
| Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77372) |
$252,911.45 |
$252,911.45 |
32.6× |
| Radiation tx delivery lvl 1 (77402) |
$5,001.15 |
$5,001.15 |
46.5× |
| Radiation tx delivery lvl 2 (77407) |
$8,517.30 |
$8,517.30 |
20.9× |
| Radiation tx delivery lvl 3 (77412) |
$8,680.10 |
$8,680.10 |
14.9× |
| Radiologic exam abdomen 3+ views (74021) |
$4,829.55 |
$4,829.55 |
43.8× |
| Radiologic exam chest 3 views (71047) |
$3,432 |
$3,432 |
37.4× |
| Radiologic exam chest 4+ views (71048) |
$3,843.95 |
$3,843.95 |
34.9× |
| Radiologic exam colon double contrast study (74280) |
$6,981.15 |
$6,981.15 |
37.7× |
| Radiologic exam colon single contrast study (74270) |
$6,630.25 |
$6,630.25 |
35.8× |
| Radiologic exam esophagus double contrast study (74221) |
$4,430.80 |
$4,430.80 |
23.9× |
| Radiologic exam esophagus single contrast study (74220) |
$4,758.32 |
$4,758.32 |
25.7× |
| Radiologic exam small int single contrast study (74250) |
$4,062.85 |
$4,062.85 |
22.0× |
| Radiologic exam swallow function contrast study (74230) |
$5,525.85 |
$5,525.85 |
29.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$5,888.30 |
$5,888.30 |
31.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$5,525.85 |
$5,525.85 |
29.9× |
| Radiologic examination femur 1 view (73551) |
$4,022.70 |
$4,022.70 |
43.8× |
| Radiologic examination femur minimum 2 views (73552) |
$6,034.05 |
$6,034.05 |
65.7× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$2,413.40 |
$2,413.40 |
26.3× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$3,075.05 |
$3,075.05 |
33.5× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$3,699.30 |
$3,699.30 |
33.5× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$2,290.75 |
$2,290.75 |
25.0× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$2,490.95 |
$2,490.95 |
27.1× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$2,595.45 |
$2,595.45 |
28.3× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$2,385.35 |
$2,385.35 |
26.0× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$2,223.10 |
$2,223.10 |
24.2× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$1,945.35 |
$1,945.35 |
21.2× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$3,880.25 |
$3,880.25 |
35.2× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$2,837.45 |
$2,837.45 |
30.9× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$5,157.90 |
$5,157.90 |
46.8× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$2,950.75 |
$2,950.75 |
32.1× |
| Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and… (74470) |
$10,397.20 |
$10,397.20 |
18.0× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$6,981.15 |
$6,981.15 |
63.3× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$5,665.55 |
$5,665.55 |
51.4× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$2,950.75 |
$2,950.75 |
26.8× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$6,112.98 |
$6,112.98 |
16.6× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$2,879.25 |
$2,879.25 |
31.4× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Age Under 21 (76100) |
$6,981.15 |
$6,981.15 |
63.3× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$1,364 |
$1,364 |
14.9× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$2,595.45 |
$2,595.45 |
23.5× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$4,536.40 |
$4,536.40 |
41.1× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$5,142.50 |
$5,142.50 |
46.6× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$8,517.30 |
$8,517.30 |
77.2× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$4,312 |
$4,312 |
39.1× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$2,584.45 |
$2,584.45 |
28.2× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$2,950.75 |
$2,950.75 |
32.1× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$2,726.90 |
$2,726.90 |
29.7× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$2,174.15 |
$2,174.15 |
23.7× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$3,699.30 |
$3,699.30 |
33.5× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$2,950.75 |
$2,950.75 |
32.1× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$2,086.15 |
$2,086.15 |
22.7× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$2,223.10 |
$2,223.10 |
20.2× |
| Radiopharmaceutical dacryocystography Age Under 21 (78660) |
$6,098 |
$6,098 |
14.5× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$2,109.50 |
$2,109.50 |
3.7× |
| Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) |
$11,787 |
$11,787 |
47.9× |
| Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) |
$3,077 |
$3,077 |
12.5× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$6,523 |
$6,523 |
26.5× |
| Red cell volume determination (separate procedure); single sampling Age Under 21 (78120) |
$8,803.50 |
$8,803.50 |
20.9× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$3,804.62 |
$3,804.62 |
15.1× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$5,424 |
$5,424 |
12.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$8,998.50 |
$8,998.50 |
21.3× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$10,516.50 |
$10,516.50 |
18.4× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$10,516.50 |
$10,516.50 |
18.4× |
| Rp loclzj tum spect 2 areas (78831) |
$7,460.50 |
$7,460.50 |
5.5× |
| Rp loclzj tum spect w/CT 1 (78830) |
$7,460.50 |
$7,460.50 |
5.5× |
| Rp loclzj tum spect w/CT 2 (78832) |
$7,460.50 |
$7,460.50 |
4.9× |
| Rp therapy intra-arterial particulate admn (79445) |
$3,690 |
$3,690 |
15.0× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$5,474.70 |
$5,474.70 |
21.8× |
| Scapula complete (73010) |
$2,746.70 |
$2,746.70 |
24.9× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$5,402.38 |
$5,402.38 |
49.0× |
| Simulation intermediate (77285) |
$12,242.45 |
$12,242.45 |
31.0× |
| Special dosimetry (77331) |
$9,447.90 |
$9,447.90 |
66.6× |
| Special physics consult (77370) |
$6,960.52 |
$6,960.52 |
49.1× |
| Special teletherapy port plan (77321) |
$17,644 |
$17,644 |
44.7× |
| Special treatment procedure (77470) |
$83,727.05 |
$83,727.05 |
143.6× |
| Splenoportography, radiological supervision and interpretation Age Under 21 (75810) |
$10,391.70 |
$10,391.70 |
3.1× |
| Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance,… (77373) |
$56,069.20 |
$56,069.20 |
29.7× |
| Testicular imaging with vascular flow Age Under 21 (78761) |
$10,547 |
$10,547 |
25.0× |
| Ther rad simulaj-aided field setting complex (77290) |
$14,333.55 |
$14,333.55 |
36.3× |
| Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium… (74283) |
$4,430.80 |
$4,430.80 |
23.9× |
| Thyroid imaging with vascular flow (78013) |
$12,375.50 |
$12,375.50 |
29.3× |
| Thyroid met imaging body (78018) |
$11,704.50 |
$11,704.50 |
20.4× |
| Thyroid uptake single/multiple quant measurement (78012) |
$2,813.50 |
$2,813.50 |
6.7× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$7,703.50 |
$7,703.50 |
18.3× |
| Tr simulation simple (77280) |
$6,233.15 |
$6,233.15 |
44.0× |
| Treatment device complex (77334) |
$8,680.10 |
$8,680.10 |
22.0× |
| Treatment device intermediate (77333) |
$8,517.30 |
$8,517.30 |
60.1× |
| Treatment device simple (77332) |
$5,001.15 |
$5,001.15 |
35.3× |
| Ultrasound breast limited (76642) |
$2,540.72 |
$2,540.72 |
27.7× |
| Ultrasound, abdomen limited (76705) |
$4,473.42 |
$4,473.42 |
40.6× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$3,596.45 |
$3,596.45 |
32.6× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$5,892.70 |
$5,892.70 |
53.4× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$3,144.35 |
$3,144.35 |
12.5× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$1,844.70 |
$1,844.70 |
16.7× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$4,491.58 |
$4,491.58 |
40.7× |
| Umbilical-artery Doppler (OB) (76820) |
$1,784.75 |
$1,784.75 |
16.2× |
| Unlisted magnetic resonance procedure (eg, diagnostic, interventional) Age Under 21 (76498) |
$8,556.90 |
$8,556.90 |
93.2× |
| Urethrocystography retrograde rs&i (74450) |
$5,525.85 |
$5,525.85 |
22.0× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$10,443.40 |
$10,443.40 |
56.4× |
| Urography antegrade rs&i (74425) |
$12,848 |
$12,848 |
34.9× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Age Under 21 (74415) |
$10,511.60 |
$10,511.60 |
56.8× |
| Us breast uni real time with image complete (76641) |
$2,540.72 |
$2,540.72 |
23.0× |
| Us chest (76604) |
$3,586 |
$3,586 |
32.5× |
| Us compl joint r-t w/image documentation (76881) |
$3,579.68 |
$3,579.68 |
32.5× |
| Us elastography organ (76981) |
$5,902.60 |
$5,902.60 |
53.5× |
| Us encephalogram (76506) |
$2,563.28 |
$2,563.28 |
23.2× |
| Us exam, pelvic, limited (76857) |
$1,786.95 |
$1,786.95 |
16.2× |
| Us guided compression repair (76936) |
$4,791.05 |
$4,791.05 |
21.0× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$3,562.90 |
$3,562.90 |
38.8× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$3,579.68 |
$3,579.68 |
39.0× |
| US OB Follow-Up/Repeat (76816) |
$3,145.45 |
$3,145.45 |
28.5× |
| Us ob transvaginal (76817) |
$5,948.25 |
$5,948.25 |
53.9× |
| Us retroperitoneal complete (76770) |
$4,913.15 |
$4,913.15 |
44.6× |
| Us retroperitoneal ltd (76775) |
$3,064.60 |
$3,064.60 |
27.8× |
| Us scrotum (76870) |
$3,960.82 |
$3,960.82 |
35.9× |
| Us soft tissue head/neck (76536) |
$4,542.72 |
$4,542.72 |
41.2× |
| Us spinal canal (76800) |
$2,257.75 |
$2,257.75 |
20.5× |
| Us transrectal (76872) |
$4,503.12 |
$4,503.12 |
40.8× |
| Venogram sinus/jugular (75860) |
$10,336.70 |
$10,336.70 |
3.1× |
| Venography adrenal unilateral selective rs&i (75840) |
$6,952.55 |
$6,952.55 |
2.1× |
| Venography renal unilateral selective rs&i (75831) |
$24,958.72 |
$24,958.72 |
7.5× |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
$21,209.65 |
$21,209.65 |
6.4× |
| Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) |
$23,346.95 |
$23,346.95 |
14.1× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$8,218.10 |
$8,218.10 |
4.9× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$12,922.80 |
$12,922.80 |
7.8× |
| Venography, superior sagittal sinus, radiological supervision and interpretation Age Under 21 (75870) |
$17,416.30 |
$17,416.30 |
5.2× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$24,026.20 |
$24,026.20 |
4.1× |
| Venous thrombosis imaging - nm extremity veins thrombosis right (78457) |
$5,573 |
$5,573 |
9.7× |
| X-ray exam hips bi 3-4 views (73522) |
$9,219.10 |
$9,219.10 |
83.6× |
| X-ray exam of finger(s) (73140) |
$2,310.55 |
$2,310.55 |
25.2× |
| X-ray exam of knee 1 or 2 (73560) |
$2,292.95 |
$2,292.95 |
25.0× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$4,430.80 |
$4,430.80 |
23.9× |
| X-ray exam ribs bil 3 views (71110) |
$4,430.80 |
$4,430.80 |
40.2× |
| X-ray exam ribs uni 2 views (71100) |
$3,699.30 |
$3,699.30 |
40.3× |
| X-ray heel (73650) |
$2,514.05 |
$2,514.05 |
27.4× |
| X-ray retrograde pyelogram (74420) |
$5,525.85 |
$5,525.85 |
15.0× |
| Xr abdomen 1 view (74018) |
$2,288 |
$2,288 |
24.9× |
| Xr abdomen 2 views (74019) |
$3,560.15 |
$3,560.15 |
32.3× |
| Xr arthrogram ankle (73615) |
$6,510.90 |
$6,510.90 |
17.7× |
| Xr arthrogram elbow (73085) |
$8,647.65 |
$8,647.65 |
23.5× |
| Xr arthrogram hip (73525) |
$9,494.65 |
$9,494.65 |
25.8× |
| Xr arthrogram knee (73580) |
$6,510.90 |
$6,510.90 |
17.7× |
| Xr arthrogram wrist (73115) |
$9,186.10 |
$9,186.10 |
25.0× |
| Xr bone age studies (77072) |
$1,492.15 |
$1,492.15 |
13.5× |
| Xr bone length study (77073) |
$3,406.70 |
$3,406.70 |
30.9× |
| Xr bone survey infant (77076) |
$5,888.30 |
$5,888.30 |
53.4× |
| Xr bone survey ltd (77074) |
$4,062.85 |
$4,062.85 |
36.8× |
| Xr chest 1 view (71045) |
$1,689.05 |
$1,689.05 |
18.4× |
| Xr chest 2 views (71046) |
$2,561.35 |
$2,561.35 |
27.9× |
| Xr eye foreign body (70030) |
$4,237.75 |
$4,237.75 |
46.2× |
| Xr facial bones 3+ views (70150) |
$3,699.30 |
$3,699.30 |
33.5× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$2,290.75 |
$2,290.75 |
25.0× |
| Xr forearm 2 views (73090) |
$2,290.75 |
$2,290.75 |
25.0× |
| Xr hand 2v (73120) |
$1,243.82 |
$1,243.82 |
11.3× |
| Xr hysterosalpingogram (74740) |
$5,525.85 |
$5,525.85 |
22.0× |
| Xr joint survey 1 view (77077) |
$2,173.05 |
$2,173.05 |
19.7× |
| Xr myelogram c-spine (72240) |
$14,372.05 |
$14,372.05 |
17.4× |
| Xr myelogram l-spine (72265) |
$13,223.65 |
$13,223.65 |
16.0× |
| Xr myelogram t-spine (72255) |
$12,455.85 |
$12,455.85 |
15.1× |
| Xr neck soft tissue (70360) |
$2,451.35 |
$2,451.35 |
26.7× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$2,595.45 |
$2,595.45 |
28.3× |
| Xr osseous survey complete (77075) |
$13,181.30 |
$13,181.30 |
119.5× |
| Xr pelvis 1-2 views (72170) |
$2,223.10 |
$2,223.10 |
20.2× |
| Xr pelvis min 3 view (72190) |
$2,950.75 |
$2,950.75 |
26.8× |
| Xr peritoneogram (74190) |
$9,961.60 |
$9,961.60 |
17.3× |
| Xr sacrum/coccyx 2+ views (72220) |
$2,490.95 |
$2,490.95 |
27.1× |
| Xr shoulder 1 view (73020) |
$2,173.05 |
$2,173.05 |
23.7× |
| Xr sialogram (70390) |
$6,213.90 |
$6,213.90 |
24.7× |
| Xr sinuses 3+ views (70220) |
$3,699.30 |
$3,699.30 |
40.3× |
| Xr skull min 4 view (70260) |
$4,430.80 |
$4,430.80 |
40.2× |
| Xr spine 1 view (72020) |
$1,468.50 |
$1,468.50 |
16.0× |
| Xr spine thoracic 3v (72072) |
$3,765.30 |
$3,765.30 |
34.1× |
| Xr sternum 2+ views (71120) |
$3,008.50 |
$3,008.50 |
32.8× |
| Xr surgical specimen (76098) |
$906.40 |
$906.40 |
1.6× |
| Xr t-spine 2 views (72070) |
$3,694.90 |
$3,694.90 |
33.5× |
| Xr tibia/fibula 2 views (73590) |
$2,571.25 |
$2,571.25 |
28.0× |
| Xr tmj bilateral (70330) |
$4,062.85 |
$4,062.85 |
44.3× |
| Xr tmj unilateral (70328) |
$3,326.95 |
$3,326.95 |
36.2× |
| Xr venogram renal bilat (75833) |
$32,247.32 |
$32,247.32 |
9.7× |
| Xr wrist 2 views (73100) |
$1,906.30 |
$1,906.30 |
20.8× |