| 3-D radiotherapy plan dose-volume histograms (77295) |
$43,818.51 |
$43,818.51 |
30.0× |
| Acute gi blood loss imaging (78278) |
$4,615.92 |
$4,615.92 |
10.9× |
| Angiography internal mammary rs&i (75756) |
$12,370.76 |
$12,370.76 |
3.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$12,535.83 |
$12,535.83 |
3.8× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$25,677.05 |
$25,677.05 |
4.4× |
| Angiography, adrenal, bilateral, selective, radiological supervision and interpretation Age Under 21 (75733) |
$4,641.86 |
$4,641.86 |
1.4× |
| Angiography, adrenal, unilateral, selective, radiological supervision and interpretation Age Under 21 (75731) |
$4,570.39 |
$4,570.39 |
1.4× |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
$11,921.19 |
$11,921.19 |
3.6× |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
$11,811.85 |
$11,811.85 |
3.5× |
| Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Age Under 21 (75736) |
$11,761.04 |
$11,761.04 |
2.0× |
| Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation Age Under 21 (75741) |
$11,970.01 |
$11,970.01 |
3.6× |
| Angiography, spinal, selective, radiological supervision and interpretation Age Under 21 (75705) |
$16,557.50 |
$16,557.50 |
2.8× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$57,086.02 |
$57,086.02 |
17.1× |
| Ankle 2 views (73600) |
$1,736.63 |
$1,736.63 |
18.9× |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
$31,148.61 |
$31,148.61 |
9.4× |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
$30,242.41 |
$30,242.41 |
9.1× |
| Aortography, thoracic, by serialography, radiological supervision and interpretation Age Under 21 (75605) |
$11,761.04 |
$11,761.04 |
2.0× |
| Basic radiation dosimetry calculation (77300) |
$3,145.68 |
$3,145.68 |
22.2× |
| Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) |
$5,495.56 |
$5,495.56 |
13.0× |
| Brain imaging, minimum 4 static views; with vascular flow Age Under 21 (78606) |
$10,376.72 |
$10,376.72 |
18.1× |
| Brain imaging, positron emission tomography (PET); metabolic evaluation Age Under 21 (78608) |
$29,915.82 |
$29,915.82 |
19.8× |
| Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or… (78481) |
$12,100.81 |
$12,100.81 |
21.1× |
| Cardiac MRI morphology & function w/o contrast (75557) |
$10,705.08 |
$10,705.08 |
42.5× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$13,158.13 |
$13,158.13 |
35.8× |
| Cholecystography, oral contrast Age Under 21 (74290) |
$2,641.27 |
$2,641.27 |
14.3× |
| Clavicle complete (73000) |
$2,261.36 |
$2,261.36 |
24.6× |
| Complex dynamic pharyngeal and speech evaluation by cine or video recording Age Under 21 (70371) |
$3,928.24 |
$3,928.24 |
15.6× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material Age Under… (74261) |
$6,607.88 |
$6,607.88 |
59.9× |
| Computed tomographic (CT) colonography, screening, including image postprocessing (74263) |
$7,070.16 |
$7,070.16 |
28.1× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$8,106.82 |
$8,106.82 |
22.0× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$10,212.59 |
$10,212.59 |
55.2× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$17,359.49 |
$17,359.49 |
93.8× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$10,245.14 |
$10,245.14 |
55.4× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$14,806.89 |
$14,806.89 |
80.0× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$16,863.85 |
$16,863.85 |
91.1× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$9,819.80 |
$9,819.80 |
53.1× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$9,515.83 |
$9,515.83 |
51.4× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$10,670.87 |
$10,670.87 |
57.7× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$7,362 |
$7,362 |
66.8× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$8,554.35 |
$8,554.35 |
46.2× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$11,417.91 |
$11,417.91 |
61.7× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$8,192.80 |
$8,192.80 |
44.3× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$8,891.42 |
$8,891.42 |
80.6× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$8,179.40 |
$8,179.40 |
44.2× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$8,990.20 |
$8,990.20 |
81.5× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$9,609.30 |
$9,609.30 |
51.9× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$8,271.22 |
$8,271.22 |
44.7× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$10,670.87 |
$10,670.87 |
57.7× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$9,530.07 |
$9,530.07 |
51.5× |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
$4,524.10 |
$4,524.10 |
31.9× |
| Corpora cavernosography, radiological supervision and interpretation Age Under 21 (74445) |
$5,950.60 |
$5,950.60 |
54.0× |
| Csf shunt evaluation (78645) |
$4,756.82 |
$4,756.82 |
8.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$14,967 |
$14,967 |
40.7× |
| CT abdomen and pelvis without contrast (74176) |
$15,552.24 |
$15,552.24 |
61.8× |
| CT abdomen w & w/o contrast (74170) |
$7,869.14 |
$7,869.14 |
42.5× |
| CT abdomen w/contrast (74160) |
$7,778.62 |
$7,778.62 |
42.0× |
| CT abdomen w/o contrast (74150) |
$6,872.37 |
$6,872.37 |
62.3× |
| CT angio hrt w/3d image (75574) |
$7,090.79 |
$7,090.79 |
19.3× |
| CT cervical spine w/contrast (72126) |
$10,524.98 |
$10,524.98 |
28.6× |
| CT cervical spine w/o contrast (72125) |
$9,989.42 |
$9,989.42 |
90.6× |
| CT chest w/contrast (71260) |
$8,271.22 |
$8,271.22 |
44.7× |
| CT extremity upper w & w/o contrast (73202) |
$9,123.21 |
$9,123.21 |
49.3× |
| CT extremity upper w/o contrast (73200) |
$7,855.60 |
$7,855.60 |
71.2× |
| CT head/brain with contrast (70460) |
$7,458.13 |
$7,458.13 |
40.3× |
| CT head/brain without and with contrast (70470) |
$8,103.64 |
$8,103.64 |
43.8× |
| CT heart contrast eval cardiac structure&morph (75572) |
$7,090.79 |
$7,090.79 |
19.3× |
| CT heart no contrast quant eval coronry calcium (75571) |
$2,478.07 |
$2,478.07 |
27.0× |
| CT l-spine w/contrast (72132) |
$9,991.50 |
$9,991.50 |
27.1× |
| CT limited/localized follow up study (76380) |
$2,161.29 |
$2,161.29 |
23.5× |
| CT lower extremity w/dye (73701) |
$7,827.75 |
$7,827.75 |
42.3× |
| CT lumbar spine w/o contrast (72131) |
$9,750.58 |
$9,750.58 |
88.4× |
| CT maxillofacial w/wo contrast (70488) |
$9,887.48 |
$9,887.48 |
53.4× |
| CT neck w/contrast (70491) |
$7,683.79 |
$7,683.79 |
41.5× |
| CT neck w/o contrast (70490) |
$7,424.27 |
$7,424.27 |
67.3× |
| CT pelvis w & w/o contrast (72194) |
$8,112.72 |
$8,112.72 |
43.8× |
| CT pelvis w/o contrast (72192) |
$7,329.43 |
$7,329.43 |
66.5× |
| CT thoracic spine w/contrast (72129) |
$10,114.50 |
$10,114.50 |
54.7× |
| CT thoracic spine w/o contrast (72128) |
$9,785.84 |
$9,785.84 |
88.7× |
| CT thorax lung cancer scr c- (71271) |
$370.47 |
$370.47 |
3.4× |
| CT thorax w/o contrast (71250) |
$7,424.27 |
$7,424.27 |
67.3× |
| CT upper extremity w/dye (73201) |
$8,364.02 |
$8,364.02 |
22.7× |
| CTA head w contrast (70496) |
$16,702.72 |
$16,702.72 |
90.3× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$10,208.25 |
$10,208.25 |
27.7× |
| Dilation ureters/urethra rs&i (74485) |
$5,744.54 |
$5,744.54 |
2.6× |
| Discography, cervical or thoracic, radiological supervision and interpretation Age Under 21 (72285) |
$7,576.74 |
$7,576.74 |
3.7× |
| Diskography lumbar s&i (72295) |
$7,115.35 |
$7,115.35 |
3.5× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete Age Under 21 (76827) |
$2,410.65 |
$2,410.65 |
21.9× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$1,937.08 |
$1,937.08 |
17.6× |
| Doppler fetal mid cerebral artery (76821) |
$528.45 |
$528.45 |
4.8× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$1,306.57 |
$1,306.57 |
11.8× |
| Dxa bone density study axial skeleton (77085) |
$1,306.57 |
$1,306.57 |
11.8× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76825) |
$2,227.36 |
$2,227.36 |
3.9× |
| Fetal biophys profile w/o nst (76819) |
$3,174.51 |
$3,174.51 |
28.8× |
| Fetal biophysical profile non-stress testing (76818) |
$1,568.63 |
$1,568.63 |
14.2× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$3,507.12 |
$3,507.12 |
13.9× |
| Gastroesophageal reflux study (78262) |
$8,274.43 |
$8,274.43 |
19.6× |
| Gated heart planar single (78472) |
$10,152.91 |
$10,152.91 |
24.1× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$31,488.78 |
$31,488.78 |
42.9× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$41,652.22 |
$41,652.22 |
56.7× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$53,128.28 |
$53,128.28 |
72.3× |
| Heart infarct image (78466) |
$1,249.64 |
$1,249.64 |
3.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$4,140.76 |
$4,140.76 |
1.2× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Age Under… (75889) |
$4,140.76 |
$4,140.76 |
1.2× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$14,783.31 |
$14,783.31 |
25.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$14,783.31 |
$14,783.31 |
35.1× |
| Ht muscle image spect sing (78451) |
$10,486.55 |
$10,486.55 |
7.7× |
| Hyperthermia ntrstl prb 5/< (77610) |
$68,882.32 |
$68,882.32 |
118.2× |
| Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) |
$113,845.08 |
$113,845.08 |
78.0× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$24,224.44 |
$24,224.44 |
33.0× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$3,795.31 |
$3,795.31 |
9.0× |
| Intracavitary radiation source application - intermediate (77762) |
$14,580.25 |
$14,580.25 |
25.0× |
| Intracavitary radiation source application - simple (77761) |
$10,925.87 |
$10,925.87 |
18.7× |
| Intraoperative radiation treatment delivery, x-ray, single treatment session (77424) |
$45,551.34 |
$45,551.34 |
5.9× |
| Isodose brachytherapy complex 10+ sources (77318) |
$23,639.58 |
$23,639.58 |
59.9× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$17,418.68 |
$17,418.68 |
44.1× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$13,680.35 |
$13,680.35 |
34.6× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$17,958.88 |
$17,958.88 |
45.5× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$9,787.63 |
$9,787.63 |
24.8× |
| Kidney imaging morphol - nm kidney cortex (78700) |
$6,832.16 |
$6,832.16 |
16.2× |
| Kidney imaging morphology; with vascular flow Age Under 21 (78701) |
$7,477.93 |
$7,477.93 |
17.7× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$12,688.30 |
$12,688.30 |
22.2× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$11,062.65 |
$11,062.65 |
19.3× |
| Leveen/shunt patency exam (78291) |
$8,096.23 |
$8,096.23 |
19.2× |
| Liver and spleen imaging (78215) |
$8,893.01 |
$8,893.01 |
21.1× |
| Liver imaging (78201) |
$8,688.88 |
$8,688.88 |
15.2× |
| Liver imaging with flow (78202) |
$11,007.72 |
$11,007.72 |
19.2× |
| Lung perfusion imaging (78580) |
$8,070.33 |
$8,070.33 |
19.1× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Age Under 21 (75801) |
$2,598.95 |
$2,598.95 |
3.9× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Age Under 21 (75807) |
$6,270.94 |
$6,270.94 |
1.9× |
| Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation Age Under 21 (75805) |
$6,270.94 |
$6,270.94 |
1.9× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$14,771.84 |
$14,771.84 |
40.1× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$15,611.29 |
$15,611.29 |
42.4× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$27,234.43 |
$27,234.43 |
108.2× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$27,234.43 |
$27,234.43 |
74.0× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$15,832.20 |
$15,832.20 |
62.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$15,124.58 |
$15,124.58 |
41.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$27,234.43 |
$27,234.43 |
74.0× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$16,969.09 |
$16,969.09 |
46.1× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$16,950.67 |
$16,950.67 |
46.1× |
| Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part… (70554) |
$17,426.24 |
$17,426.24 |
69.2× |
| Mandible min 4v (70110) |
$2,719.70 |
$2,719.70 |
24.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$78.36 |
$78.36 |
2.6× |
| MRA head w/o contrast (70544) |
$11,633.49 |
$11,633.49 |
46.2× |
| MRA neck w/o contrast (70547) |
$11,623.23 |
$11,623.23 |
46.2× |
| MRI abdomen w/contrast (74182) |
$16,929.41 |
$16,929.41 |
46.0× |
| MRI abdomen w/o contrast (74181) |
$16,766.61 |
$16,766.61 |
66.6× |
| MRI abdomen w/wo contrast (74183) |
$23,936.53 |
$23,936.53 |
65.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$15,124.58 |
$15,124.58 |
18.3× |
| MRI c-spine w&w/o cont (72156) |
$19,965.44 |
$19,965.44 |
54.3× |
| MRI cervical spine w/contrast (72142) |
$16,937.78 |
$16,937.78 |
46.0× |
| MRI chest w/contrast (71551) |
$14,039.03 |
$14,039.03 |
17.0× |
| MRI chest w/o contrast (71550) |
$15,087.41 |
$15,087.41 |
59.9× |
| MRI chest w/wo contrast (71552) |
$21,372.26 |
$21,372.26 |
58.1× |
| MRI joint upr extr w/o&w/dye (73223) |
$13,490.68 |
$13,490.68 |
36.7× |
| MRI joint upr extrem w/dye (73222) |
$14,771.84 |
$14,771.84 |
17.9× |
| MRI joint upr extrem w/o dye (73221) |
$27,234.43 |
$27,234.43 |
108.2× |
| MRI lumbar spine w/contrast (72149) |
$16,937.78 |
$16,937.78 |
46.0× |
| MRI lumbar spine w/wo contrast (72158) |
$21,733.77 |
$21,733.77 |
59.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$19,152.41 |
$19,152.41 |
52.0× |
| MRI pelvis w & w/o contrast (72197) |
$20,921.37 |
$20,921.37 |
56.8× |
| MRI pelvis w/contrast (72196) |
$18,683.20 |
$18,683.20 |
50.8× |
| MRI pelvis w/o contrast (72195) |
$17,089.54 |
$17,089.54 |
67.9× |
| MRI spectroscopy (76390) |
$5,292.22 |
$5,292.22 |
57.6× |
| MRI spine cervical w/o contrast (72141) |
$16,929.71 |
$16,929.71 |
67.3× |
| MRI t-spine w&w/o cont (72157) |
$20,923.99 |
$20,923.99 |
56.9× |
| MRI thoracic spine w/contrast (72147) |
$16,937.78 |
$16,937.78 |
46.0× |
| MRI thoracic spine w/o contrst (72146) |
$17,739.96 |
$17,739.96 |
70.5× |
| MRI tmj (70336) |
$15,508.71 |
$15,508.71 |
61.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$27,217.67 |
$27,217.67 |
108.1× |
| Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per… (77338) |
$54,697.37 |
$54,697.37 |
138.5× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$7,415.02 |
$7,415.02 |
9.0× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78432) |
$30,088.13 |
$30,088.13 |
18.8× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$22,139.61 |
$22,139.61 |
14.7× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78430) |
$23,611.89 |
$23,611.89 |
15.7× |
| Myocardial spect multiple studies (78452) |
$19,939.02 |
$19,939.02 |
14.6× |
| Myocrd img PET 2rtracer CT (78433) |
$30,088.13 |
$30,088.13 |
12.9× |
| Myocrd img PET metab eval single study (78459) |
$31,033.23 |
$31,033.23 |
22.7× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$30,088.13 |
$30,088.13 |
19.9× |
| Myocrd img PET rst&strs CT (78431) |
$23,611.89 |
$23,611.89 |
10.2× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$3,378.51 |
$3,378.51 |
3.7× |
| Nm adrenal imaging (78075) |
$8,667.13 |
$8,667.13 |
6.3× |
| Nm bone 3 phase (78315) |
$7,484.91 |
$7,484.91 |
17.7× |
| Nm bone imaging whole body (78306) |
$11,068.85 |
$11,068.85 |
26.2× |
| Nm bone marrow wb (78104) |
$10,061.74 |
$10,061.74 |
23.9× |
| Nm csf cisternogram (78630) |
$7,662.48 |
$7,662.48 |
13.4× |
| Nm csf leak detection (78650) |
$8,460.94 |
$8,460.94 |
6.2× |
| Nm gastric emptying (78264) |
$8,274.43 |
$8,274.43 |
19.6× |
| Nm lymph system (78195) |
$7,933.82 |
$7,933.82 |
13.9× |
| Nm myocard infarct spect (78469) |
$6,103.77 |
$6,103.77 |
10.7× |
| Non-cardiac vascular flow imaging (ie, angiography, venography) Age Under 21 (78445) |
$2,115.74 |
$2,115.74 |
5.0× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$5,371.22 |
$5,371.22 |
12.7× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$7,715.97 |
$7,715.97 |
18.3× |
| Ob us limited fetus(s) (76815) |
$2,271.12 |
$2,271.12 |
20.6× |
| Ob us nuchal meas 1 gest (76813) |
$1,521.20 |
$1,521.20 |
13.8× |
| Panoramic X-ray of jaws (70355) |
$1,650.78 |
$1,650.78 |
18.0× |
| Parathyrd planar w/spect&CT (78072) |
$10,868.40 |
$10,868.40 |
19.0× |
| Parathyroid planar imaging (78070) |
$10,518.66 |
$10,518.66 |
24.9× |
| Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation Age… (75885) |
$4,140.76 |
$4,140.76 |
1.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$32,907.04 |
$32,907.04 |
21.8× |
| PET imaging CT for attenuation limited area (78814) |
$5,573.78 |
$5,573.78 |
3.7× |
| PET imaging for CT attenuation whole body (78816) |
$32,907.04 |
$32,907.04 |
21.8× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$4,177.76 |
$4,177.76 |
1.3× |
| Pulmonary ventilation & perfusion imaging (78582) |
$15,315.88 |
$15,315.88 |
26.7× |
| Quant differential pulm perfusion w/wo imaging (78597) |
$3,904.09 |
$3,904.09 |
9.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$4,909.89 |
$4,909.89 |
8.5× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$3,624.85 |
$3,624.85 |
39.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$5,437.31 |
$5,437.31 |
49.3× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$5,447.84 |
$5,447.84 |
49.4× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$8,171.80 |
$8,171.80 |
74.1× |
| Radex hip unilateral with pelvis 1 view (73501) |
$2,037.69 |
$2,037.69 |
22.2× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$2,859.47 |
$2,859.47 |
31.1× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$4,336.86 |
$4,336.86 |
39.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$4,050.57 |
$4,050.57 |
36.7× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$10,197.43 |
$10,197.43 |
92.5× |
| Radex spine cervical 2 or 3 views (72040) |
$2,594.93 |
$2,594.93 |
28.3× |
| Radex spine cervical 4 or 5 views (72050) |
$3,806.57 |
$3,806.57 |
34.5× |
| Radex spine cervical 6 or more views (72052) |
$3,233.15 |
$3,233.15 |
29.3× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$2,642.92 |
$2,642.92 |
28.8× |
| Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77371) |
$314,161.34 |
$314,161.34 |
40.4× |
| Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77372) |
$399,191.36 |
$399,191.36 |
51.4× |
| Radiation tx delivery lvl 1 (77402) |
$3,551.58 |
$3,551.58 |
33.0× |
| Radiation tx delivery lvl 3 (77412) |
$8,253.14 |
$8,253.14 |
14.2× |
| Radiologic exam abdomen 3+ views (74021) |
$2,594.03 |
$2,594.03 |
23.5× |
| Radiologic exam chest 3 views (71047) |
$2,385.69 |
$2,385.69 |
26.0× |
| Radiologic exam chest 4+ views (71048) |
$3,069.40 |
$3,069.40 |
27.8× |
| Radiologic exam colon double contrast study (74280) |
$4,274.34 |
$4,274.34 |
23.1× |
| Radiologic exam colon single contrast study (74270) |
$3,700.29 |
$3,700.29 |
20.0× |
| Radiologic exam esophagus double contrast study (74221) |
$940.81 |
$940.81 |
5.1× |
| Radiologic exam esophagus single contrast study (74220) |
$2,928.36 |
$2,928.36 |
15.8× |
| Radiologic exam small int single contrast study (74250) |
$4,012.29 |
$4,012.29 |
21.7× |
| Radiologic exam swallow function contrast study (74230) |
$3,928.24 |
$3,928.24 |
21.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$5,345.40 |
$5,345.40 |
28.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$3,549.39 |
$3,549.39 |
19.2× |
| Radiologic examination femur 1 view (73551) |
$2,223.19 |
$2,223.19 |
24.2× |
| Radiologic examination femur minimum 2 views (73552) |
$3,334.81 |
$3,334.81 |
36.3× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$1,640.82 |
$1,640.82 |
17.9× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$2,932.69 |
$2,932.69 |
31.9× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$2,206.38 |
$2,206.38 |
20.0× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$2,549.23 |
$2,549.23 |
27.8× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$2,898.80 |
$2,898.80 |
31.6× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$2,009.48 |
$2,009.48 |
21.9× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$3,023.74 |
$3,023.74 |
32.9× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$1,813.06 |
$1,813.06 |
19.8× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$1,847.72 |
$1,847.72 |
20.1× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$4,229.62 |
$4,229.62 |
38.4× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$1,806.44 |
$1,806.44 |
16.4× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$2,086.85 |
$2,086.85 |
22.7× |
| Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and… (74470) |
$1,647.30 |
$1,647.30 |
2.9× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$2,939.83 |
$2,939.83 |
26.7× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$2,427.74 |
$2,427.74 |
22.0× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$1,882.80 |
$1,882.80 |
17.1× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$4,831.24 |
$4,831.24 |
13.1× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$3,077.42 |
$3,077.42 |
33.5× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Age Under 21 (76100) |
$3,794.32 |
$3,794.32 |
34.4× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$1,740.28 |
$1,740.28 |
19.0× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$2,357.72 |
$2,357.72 |
21.4× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$2,874.66 |
$2,874.66 |
26.1× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$3,744.51 |
$3,744.51 |
34.0× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$6,597.39 |
$6,597.39 |
59.8× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$3,411.27 |
$3,411.27 |
30.9× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$2,883.98 |
$2,883.98 |
31.4× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$1,889.50 |
$1,889.50 |
20.6× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$2,939.06 |
$2,939.06 |
32.0× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$1,714.86 |
$1,714.86 |
18.7× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$2,676.30 |
$2,676.30 |
24.3× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$2,048.20 |
$2,048.20 |
22.3× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$2,229.23 |
$2,229.23 |
24.3× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$1,768.83 |
$1,768.83 |
16.0× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$2,934.29 |
$2,934.29 |
5.1× |
| Radiopharmaceutical therapy, by intra-articular administration Age Under 21 (79440) |
$21,274.61 |
$21,274.61 |
86.4× |
| Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) |
$25,028.44 |
$25,028.44 |
101.7× |
| Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) |
$11,714.35 |
$11,714.35 |
47.6× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$11,714.35 |
$11,714.35 |
47.6× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion (79403) |
$9,050.49 |
$9,050.49 |
36.8× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$1,308.53 |
$1,308.53 |
5.2× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$13,459.16 |
$13,459.16 |
23.5× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$14,316.03 |
$14,316.03 |
25.0× |
| Rp loclzj tum spect 2 areas (78831) |
$6,604.92 |
$6,604.92 |
4.8× |
| Rp loclzj tum spect w/CT 1 (78830) |
$6,604.92 |
$6,604.92 |
4.8× |
| Rp loclzj tum spect w/CT 2 (78832) |
$7,492.56 |
$7,492.56 |
5.0× |
| Rp therapy intra-arterial particulate admn (79445) |
$1,155.80 |
$1,155.80 |
4.7× |
| Scapula complete (73010) |
$3,159.47 |
$3,159.47 |
28.6× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$2,391.61 |
$2,391.61 |
21.7× |
| Simulation intermediate (77285) |
$9,250.31 |
$9,250.31 |
23.4× |
| Special dosimetry (77331) |
$7,133.15 |
$7,133.15 |
50.3× |
| Special physics consult (77370) |
$10,672.13 |
$10,672.13 |
75.3× |
| Special teletherapy port plan (77321) |
$12,987.36 |
$12,987.36 |
32.9× |
| Special treatment procedure (77470) |
$23,219.85 |
$23,219.85 |
39.8× |
| Splenoportography, radiological supervision and interpretation Age Under 21 (75810) |
$3,767.88 |
$3,767.88 |
1.1× |
| Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance,… (77373) |
$99,797.84 |
$99,797.84 |
52.9× |
| Surface application of low dose rate radionuclide source (77789) |
$2,944.64 |
$2,944.64 |
27.4× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Age Under 21 (70332) |
$1,827.62 |
$1,827.62 |
7.3× |
| Ther rad simulaj-aided field setting complex (77290) |
$12,194.58 |
$12,194.58 |
30.9× |
| Thyroid imaging with vascular flow (78013) |
$5,144.34 |
$5,144.34 |
12.2× |
| Thyroid met imaging body (78018) |
$7,037.31 |
$7,037.31 |
12.3× |
| Thyroid uptake single/multiple quant measurement (78012) |
$3,092.83 |
$3,092.83 |
7.3× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$5,798.13 |
$5,798.13 |
13.7× |
| Tr simulation simple (77280) |
$5,175.94 |
$5,175.94 |
36.5× |
| Treatment device complex (77334) |
$9,700.70 |
$9,700.70 |
24.6× |
| Treatment device intermediate (77333) |
$7,074.19 |
$7,074.19 |
49.9× |
| Treatment device simple (77332) |
$3,772.87 |
$3,772.87 |
26.6× |
| Ultrasound breast limited (76642) |
$1,142.11 |
$1,142.11 |
12.4× |
| Ultrasound, abdomen limited (76705) |
$3,027.01 |
$3,027.01 |
27.4× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$2,815.74 |
$2,815.74 |
25.5× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$2,173.90 |
$2,173.90 |
19.7× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$3,662.97 |
$3,662.97 |
14.6× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$2,847.56 |
$2,847.56 |
25.8× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$6,169.43 |
$6,169.43 |
55.9× |
| Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) Age Under 21 (76873) |
$4,467.73 |
$4,467.73 |
40.5× |
| Umbilical-artery Doppler (OB) (76820) |
$528.45 |
$528.45 |
4.8× |
| Unlisted magnetic resonance procedure (eg, diagnostic, interventional) Age Under 21 (76498) |
$17,056.88 |
$17,056.88 |
185.8× |
| Ureteral reflux study (78740) |
$12,688.30 |
$12,688.30 |
30.1× |
| Urethrocystography retrograde rs&i (74450) |
$3,619.17 |
$3,619.17 |
14.4× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$4,658.90 |
$4,658.90 |
25.2× |
| Urography antegrade rs&i (74425) |
$1,921.06 |
$1,921.06 |
5.2× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Age Under 21 (74415) |
$7,660.22 |
$7,660.22 |
41.4× |
| Us abdominal aorta real time screen study aaa (76706) |
$2,905.62 |
$2,905.62 |
26.3× |
| Us breast uni real time with image complete (76641) |
$1,947.33 |
$1,947.33 |
17.7× |
| Us chest (76604) |
$2,767.98 |
$2,767.98 |
25.1× |
| Us compl joint r-t w/image documentation (76881) |
$2,505.66 |
$2,505.66 |
22.7× |
| Us encephalogram (76506) |
$2,847 |
$2,847 |
25.8× |
| Us exam, pelvic, limited (76857) |
$2,134.50 |
$2,134.50 |
19.4× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$2,387.86 |
$2,387.86 |
26.0× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$1,996.63 |
$1,996.63 |
21.7× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$355.67 |
$355.67 |
3.2× |
| US OB Follow-Up/Repeat (76816) |
$1,953.82 |
$1,953.82 |
17.7× |
| Us ob transvaginal (76817) |
$1,523.98 |
$1,523.98 |
13.8× |
| Us retroperitoneal complete (76770) |
$3,862.99 |
$3,862.99 |
35.0× |
| Us retroperitoneal ltd (76775) |
$3,020.36 |
$3,020.36 |
27.4× |
| Us scrotum (76870) |
$2,810.44 |
$2,810.44 |
25.5× |
| Us soft tissue head/neck (76536) |
$3,165.66 |
$3,165.66 |
28.7× |
| Us spinal canal (76800) |
$2,141.76 |
$2,141.76 |
19.4× |
| Us transrectal (76872) |
$2,259.94 |
$2,259.94 |
20.5× |
| Venogram sinus/jugular (75860) |
$6,258.63 |
$6,258.63 |
1.9× |
| Venography adrenal unilateral selective rs&i (75840) |
$6,018.03 |
$6,018.03 |
1.8× |
| Venography renal unilateral selective rs&i (75831) |
$6,690.97 |
$6,690.97 |
2.0× |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
$19,975.31 |
$19,975.31 |
6.0× |
| Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) |
$5,111.17 |
$5,111.17 |
3.1× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$5,660.19 |
$5,660.19 |
3.4× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$3,503.50 |
$3,503.50 |
2.1× |
| Venography, superior sagittal sinus, radiological supervision and interpretation Age Under 21 (75870) |
$3,914.52 |
$3,914.52 |
1.2× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$4,140.69 |
$4,140.69 |
0.7× |
| Venous thrombosis imaging - nm extremity veins thrombosis right (78457) |
$11,062.65 |
$11,062.65 |
19.3× |
| X-ray exam hips bi 3-4 views (73522) |
$6,798.29 |
$6,798.29 |
61.6× |
| X-ray exam of finger(s) (73140) |
$1,526.27 |
$1,526.27 |
16.6× |
| X-ray exam of knee 1 or 2 (73560) |
$1,847.72 |
$1,847.72 |
20.1× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$2,315.97 |
$2,315.97 |
12.5× |
| X-ray exam ribs bil 3 views (71110) |
$2,862.82 |
$2,862.82 |
26.0× |
| X-ray exam ribs uni 2 views (71100) |
$1,895.32 |
$1,895.32 |
20.6× |
| X-ray heel (73650) |
$2,214.34 |
$2,214.34 |
24.1× |
| X-ray retrograde pyelogram (74420) |
$6,256.95 |
$6,256.95 |
17.0× |
| Xr abdomen 1 view (74018) |
$1,884.42 |
$1,884.42 |
20.5× |
| Xr abdomen 2 views (74019) |
$2,075.23 |
$2,075.23 |
18.8× |
| Xr arthrogram ankle (73615) |
$2,021.03 |
$2,021.03 |
5.5× |
| Xr arthrogram elbow (73085) |
$1,827.62 |
$1,827.62 |
5.0× |
| Xr arthrogram hip (73525) |
$1,662.19 |
$1,662.19 |
4.5× |
| Xr arthrogram knee (73580) |
$1,827.62 |
$1,827.62 |
5.0× |
| Xr arthrogram wrist (73115) |
$3,704.59 |
$3,704.59 |
10.1× |
| Xr bone age studies (77072) |
$1,462.74 |
$1,462.74 |
13.3× |
| Xr bone length study (77073) |
$1,492.71 |
$1,492.71 |
13.5× |
| Xr bone survey infant (77076) |
$5,414.62 |
$5,414.62 |
49.1× |
| Xr chest 1 view (71045) |
$1,740.50 |
$1,740.50 |
19.0× |
| Xr chest 2 views (71046) |
$1,908.57 |
$1,908.57 |
20.8× |
| Xr eye foreign body (70030) |
$1,805.05 |
$1,805.05 |
19.7× |
| Xr facial bones 3+ views (70150) |
$3,033.07 |
$3,033.07 |
27.5× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$2,820.41 |
$2,820.41 |
30.7× |
| Xr forearm 2 views (73090) |
$2,560.81 |
$2,560.81 |
27.9× |
| Xr hand 2v (73120) |
$2,449.62 |
$2,449.62 |
22.2× |
| Xr hysterosalpingogram (74740) |
$3,734.54 |
$3,734.54 |
14.8× |
| Xr myelogram c-spine (72240) |
$7,124.39 |
$7,124.39 |
8.6× |
| Xr myelogram l-spine (72265) |
$5,851.09 |
$5,851.09 |
7.1× |
| Xr myelogram t-spine (72255) |
$5,691.59 |
$5,691.59 |
6.9× |
| Xr neck soft tissue (70360) |
$1,785.75 |
$1,785.75 |
19.5× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$2,103 |
$2,103 |
22.9× |
| Xr osseous survey complete (77075) |
$12,344.20 |
$12,344.20 |
111.9× |
| Xr pelvis 1-2 views (72170) |
$1,926.74 |
$1,926.74 |
17.5× |
| Xr pelvis min 3 view (72190) |
$2,250.13 |
$2,250.13 |
20.4× |
| Xr peritoneogram (74190) |
$4,459.08 |
$4,459.08 |
7.7× |
| Xr sacrum/coccyx 2+ views (72220) |
$2,205.29 |
$2,205.29 |
24.0× |
| Xr shoulder 1 view (73020) |
$2,799.22 |
$2,799.22 |
30.5× |
| Xr sialogram (70390) |
$2,506.77 |
$2,506.77 |
10.0× |
| Xr sinuses 3+ views (70220) |
$2,652.05 |
$2,652.05 |
28.9× |
| Xr skull min 4 view (70260) |
$2,792.44 |
$2,792.44 |
25.3× |
| Xr spine 1 view (72020) |
$2,037.29 |
$2,037.29 |
22.2× |
| Xr spine thoracic 3v (72072) |
$3,698.99 |
$3,698.99 |
33.5× |
| Xr sternum 2+ views (71120) |
$2,071.45 |
$2,071.45 |
22.6× |
| Xr surgical specimen (76098) |
$1,200.75 |
$1,200.75 |
2.1× |
| Xr t-spine 2 views (72070) |
$2,644.30 |
$2,644.30 |
24.0× |
| Xr tibia/fibula 2 views (73590) |
$2,962.39 |
$2,962.39 |
32.3× |
| Xr tmj bilateral (70330) |
$4,220.28 |
$4,220.28 |
46.0× |
| Xr tmj unilateral (70328) |
$3,343.58 |
$3,343.58 |
36.4× |
| Xr venogram renal bilat (75833) |
$6,991.13 |
$6,991.13 |
2.1× |
| Xr wrist 2 views (73100) |
$2,536.50 |
$2,536.50 |
27.6× |