| Abdomen 2 views (74019) |
$25.20 |
$140 |
0.2× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,174.86 |
$6,527 |
2.9× |
| Angiography extremity bilateral rs&i (75716) |
$1,664.46 |
$9,247 |
0.5× |
| Angiography extremity unilateral rs&i (75710) |
$1,522.08 |
$8,456 |
0.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$1,786.32 |
$9,924 |
0.6× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,786.32 |
$9,924 |
0.6× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,786.32 |
$9,924 |
0.6× |
| Ankle 2 views (73600) |
$105.57 |
$586.50 |
1.2× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$1,607.76 |
$8,932 |
0.5× |
| Aortography abdominal serialography rs&i (75625) |
$1,565.28 |
$8,696 |
0.5× |
| Arthrogram hip (73525) |
$451.62 |
$2,509 |
1.3× |
| Arthrogram shoulder (73040) |
$451.62 |
$2,509 |
1.3× |
| Arthrogram wrist (73115) |
$451.62 |
$2,509 |
1.3× |
| Arthrography knee lt (73580) |
$425.88 |
$2,366 |
1.2× |
| Bone &/Joint Imaging Limited Area (78300) |
$640.98 |
$3,561 |
1.6× |
| Bone &/joint imaging whole body (78306) |
$1,071.18 |
$5,951 |
2.6× |
| Bone age studies (77072) |
$149.04 |
$828 |
1.4× |
| Bone Imaging 3 Phase (78315) |
$1,260.36 |
$7,002 |
3.1× |
| Bone survey complete (77075) |
$721.08 |
$4,006 |
6.7× |
| Cervical spine 2 or 3 views (72040) |
$34.20 |
$190 |
0.4× |
| Chest 1 view (71045) |
$24.84 |
$138 |
0.3× |
| Chest 3 views (71047) |
$218.25 |
$1,212.50 |
2.5× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$292.32 |
$1,624 |
1.6× |
| Clavicle complete (73000) |
$64.71 |
$359.50 |
0.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,120.68 |
$6,226 |
10.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,361.60 |
$13,120 |
6.6× |
| CT abdomen and pelvis without contrast (74176) |
$1,858.95 |
$10,327.50 |
7.6× |
| CT abdomen w contrast (74160) |
$260.10 |
$1,445 |
1.4× |
| CT abdomen w wo contrast (74170) |
$1,288.89 |
$7,160.50 |
7.2× |
| CT abdomen w/o contrast (74150) |
$1,017.27 |
$5,651.50 |
9.5× |
| CT angiography upper extremity lt (73206) |
$397.62 |
$2,209 |
2.2× |
| CT c-spine w/o contrast (72125) |
$1,062.09 |
$5,900.50 |
9.9× |
| CT cervical spine w&w/o contrast (72127) |
$772.74 |
$4,293 |
4.3× |
| CT cervical spine with contrast (72126) |
$2,049.30 |
$11,385 |
5.7× |
| CT chest w/wo contrast (71270) |
$1,390.77 |
$7,726.50 |
7.8× |
| CT chest with contrast (71260) |
$1,286.19 |
$7,145.50 |
7.2× |
| CT head/brain with contrast (70460) |
$1,017.36 |
$5,652 |
5.7× |
| CT head/brain without and with contrast (70470) |
$1,245.06 |
$6,917 |
6.9× |
| CT iac w contrast (70481) |
$1,266.75 |
$7,037.50 |
7.1× |
| CT lower ext w/o (73700) |
$1,034.01 |
$5,744.50 |
9.7× |
| CT lower extremity w wo contrast (73702) |
$2,003.04 |
$11,128 |
11.2× |
| CT lower extremity with contrast (73701) |
$1,865.34 |
$10,363 |
10.4× |
| CT lumbar spine w & w/o contrast (72133) |
$2,236.41 |
$12,424.50 |
12.5× |
| CT lumbar spine w/o contrast (72131) |
$1,079.01 |
$5,994.50 |
10.1× |
| CT lumbar spine with contrast (72132) |
$2,065.41 |
$11,474.50 |
5.8× |
| CT maxillofacial w contrast (70487) |
$829.53 |
$4,608.50 |
4.6× |
| CT maxillofacial w/o contrast (70486) |
$758.52 |
$4,214 |
7.1× |
| CT maxillofacial w/wo contrast (70488) |
$1,913.67 |
$10,631.50 |
10.7× |
| CT neck soft tissue w contrast (70491) |
$884.43 |
$4,913.50 |
4.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,362.87 |
$7,571.50 |
7.6× |
| CT orbits w/o contrast (70480) |
$712.89 |
$3,960.50 |
6.7× |
| CT pelvis w & w/o contrast (72194) |
$1,017.45 |
$5,652.50 |
5.7× |
| CT pelvis w/o contrast (72192) |
$778.95 |
$4,327.50 |
7.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$978.84 |
$5,438 |
5.5× |
| CT soft tissue neck w/o contrast (70490) |
$838.89 |
$4,660.50 |
7.8× |
| CT thoracic spine w/contrast (72129) |
$1,727.46 |
$9,597 |
9.6× |
| CT thoracic spine w/o contrast (72128) |
$895.23 |
$4,973.50 |
8.4× |
| CT thoracic spine w/wo contrast (72130) |
$1,905.48 |
$10,586 |
10.6× |
| CT thorax w/o contrast (71250) |
$1,156.77 |
$6,426.50 |
10.8× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,053.62 |
$11,409 |
11.4× |
| CT upper extremity w/o contrast rt (73200) |
$1,741.14 |
$9,673 |
16.3× |
| CT upper extremity with contrast (73201) |
$581.40 |
$3,230 |
1.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$418.50 |
$2,325 |
2.3× |
| Cta Abdomen (74175) |
$322.02 |
$1,789 |
1.8× |
| CTA abdomen pelvis (74174) |
$883.08 |
$4,906 |
2.5× |
| CTA chest (71275) |
$347.58 |
$1,931 |
1.9× |
| Cta Head (70496) |
$398.88 |
$2,216 |
2.2× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$955.08 |
$5,306 |
2.7× |
| CTA lwr ext w&w/o contrast (73706) |
$387.90 |
$2,155 |
2.2× |
| Cta Neck (70498) |
$449.28 |
$2,496 |
2.5× |
| Cta Pelvis (72191) |
$444.42 |
$2,469 |
2.5× |
| Cystography minimum 3 views rs&i (74430) |
$321.30 |
$1,785 |
0.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$138.96 |
$772 |
1.3× |
| Dxa bone density study axial skeleton (77085) |
$118.08 |
$656 |
1.1× |
| Esophageal motility (78258) |
$408.78 |
$2,271 |
1.0× |
| Esophagus (74220) |
$309.24 |
$1,718 |
1.7× |
| Fetal biophysical profile non-stress testing (76818) |
$199.08 |
$1,106 |
1.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$159.03 |
$883.50 |
1.5× |
| Fluoroscopy up to 1 hr (76000) |
$257.04 |
$1,428 |
1.1× |
| Foot 2 views (73620) |
$57.96 |
$322 |
0.7× |
| Forearm 2 views (73090) |
$103.95 |
$577.50 |
1.2× |
| Gated Heart Planar Single (78472) |
$655.20 |
$3,640 |
1.6× |
| Hand 2 views (73120) |
$139.68 |
$776 |
1.3× |
| Hand 3 views (73130) |
$66.78 |
$371 |
0.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,517.76 |
$8,432 |
3.7× |
| Ht muscle image spect sing (78451) |
$2,205.36 |
$12,252 |
1.7× |
| Humerus Min 2 Views Left (73060) |
$55.08 |
$306 |
0.6× |
| Hysterosalpingogram (74740) |
$279.90 |
$1,555 |
1.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,169.46 |
$6,497 |
2.1× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$596.16 |
$3,312 |
1.1× |
| Knee 3 views (73562) |
$73.08 |
$406 |
0.8× |
| Liver imaging static only (78201) |
$1,376.64 |
$7,648 |
2.5× |
| Lung Ventilation Imaging (78579) |
$793.62 |
$4,409 |
1.9× |
| Lymphoscintigraphy (78195) |
$1,216.62 |
$6,759 |
2.2× |
| Meckels Diverticulum (78290) |
$571.14 |
$3,173 |
1.4× |
| MRA head w & w/o contrast (70546) |
$1,265.04 |
$7,028 |
3.5× |
| MRA head w/o contrast (70544) |
$1,249.02 |
$6,939 |
5.1× |
| MRA neck w contrast (70548) |
$2,074.32 |
$11,524 |
5.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,020.23 |
$11,223.50 |
5.7× |
| MRA neck w/o contrast (70547) |
$1,249.02 |
$6,939 |
5.1× |
| MRI abdomen w contrast (74182) |
$609.39 |
$3,385.50 |
1.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,034.64 |
$5,748 |
2.9× |
| MRI abdomen w/o contrast (74181) |
$364.86 |
$2,027 |
1.5× |
| MRI any jnt lwr ext with con lt (73722) |
$913.14 |
$5,073 |
1.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,432.44 |
$7,958 |
1.8× |
| MRI c-spine with contrast (72142) |
$2,735.10 |
$15,195 |
7.7× |
| MRI cervical spine w/o contrast (72141) |
$795.87 |
$4,421.50 |
3.3× |
| MRI chest w/o & w/contrast material (71552) |
$1,653.84 |
$9,188 |
4.6× |
| MRI chest w/o contrast (71550) |
$1,880.37 |
$10,446.50 |
7.7× |
| MRI chest with contrast (71551) |
$1,503.72 |
$8,354 |
1.9× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,512.27 |
$8,401.50 |
4.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,397.15 |
$13,317.50 |
6.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,476.72 |
$8,204 |
6.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,590.30 |
$8,835 |
6.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,889.10 |
$10,495 |
5.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,620.99 |
$9,005.50 |
4.5× |
| MRI pelvis w/o contrast (72195) |
$1,364.58 |
$7,581 |
5.6× |
| MRI scan of arm joint before and after contrast (73223) |
$1,410.84 |
$7,838 |
4.0× |
| MRI scan of leg joint before and after contrast (73723) |
$2,707.38 |
$15,041 |
7.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,152.63 |
$6,403.50 |
3.2× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,092.24 |
$6,068 |
3.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,155.96 |
$6,422 |
3.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$948.51 |
$5,269.50 |
2.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,620.54 |
$9,003 |
4.5× |
| MRI thoracic spine w/o contrast (72146) |
$1,364.22 |
$7,579 |
5.6× |
| MRI upper ext joint w/o contrast (73221) |
$2,382.84 |
$13,238 |
9.8× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,578.59 |
$14,325.50 |
7.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,382.84 |
$13,238 |
9.8× |
| Myocardial Spect Multiple Studies (78452) |
$3,121.38 |
$17,341 |
2.4× |
| Neck soft tissue (70360) |
$34.38 |
$191 |
0.4× |
| Nm gastric emptying study (78264) |
$1,517.94 |
$8,433 |
3.7× |
| Parathyroid imaging (78070) |
$2,494.98 |
$13,861 |
6.1× |
| Pelvis 1 or 2 views (72170) |
$25.74 |
$143 |
0.2× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,373.03 |
$13,183.50 |
6.7× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,354.14 |
$7,523 |
2.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$132.21 |
$734.50 |
1.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$232.20 |
$1,290 |
2.2× |
| Radex hips bilateral with pelvis 2 views (73521) |
$292.50 |
$1,625 |
2.7× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$464.40 |
$2,580 |
4.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$172.08 |
$956 |
1.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$22.50 |
$125 |
0.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$33.84 |
$188 |
0.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$31.14 |
$173 |
0.3× |
| Radiologic exam colon single contrast study (74270) |
$624.78 |
$3,471 |
3.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$770.22 |
$4,279 |
4.3× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$54.81 |
$304.50 |
0.6× |
| Ribs bilateral 3 views (71110) |
$32.40 |
$180 |
0.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$562.32 |
$3,124 |
1.0× |
| Sacroiliac Joints < 3 Views (72200) |
$217.98 |
$1,211 |
2.0× |
| Scapula complete (73010) |
$126.36 |
$702 |
1.2× |
| Screening digital breast tomosynthesis (77063) |
$33.48 |
$186 |
1.4× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$155.70 |
$865 |
1.5× |
| Small bowel series (74250) |
$471.06 |
$2,617 |
2.6× |
| Speech evaluation complex (70371) |
$290.34 |
$1,613 |
1.2× |
| Spine thoracic 3 views (72072) |
$159.93 |
$888.50 |
1.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$790.38 |
$4,391 |
1.9× |
| Ultrasound, abdomen limited (76705) |
$316.44 |
$1,758 |
3.0× |
| Unlisted Ultrasound Procedure (76999) |
$383.76 |
$2,132 |
4.3× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$701.82 |
$3,899 |
3.9× |
| Us abdl aorta screen aaa (76706) |
$92.88 |
$516 |
0.9× |
| Us breast unilateral complete (76641) |
$172.62 |
$959 |
1.6× |
| Us breast unilateral limited (76642) |
$172.62 |
$959 |
1.9× |
| Us chest (76604) |
$320.94 |
$1,783 |
3.0× |
| Us compl joint r-t w/image documentation (76881) |
$343.98 |
$1,911 |
3.2× |
| Us ob detailed single fetus (76811) |
$355.23 |
$1,973.50 |
1.5× |
| Us ob transvaginal (76817) |
$345.06 |
$1,917 |
3.2× |
| Us pelvic non ob complete (76856) |
$278.91 |
$1,549.50 |
2.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$418.68 |
$2,326 |
3.9× |
| Us pregnancy ltd (76815) |
$184.41 |
$1,024.50 |
1.7× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$99.18 |
$551 |
0.9× |
| Us retroperitoneal complete (76770) |
$83.16 |
$462 |
0.8× |
| Us retroperitoneal limited (76775) |
$223.56 |
$1,242 |
2.1× |
| Us scrotum and contents (76870) |
$223.47 |
$1,241.50 |
2.1× |
| Us soft tissue head/neck (76536) |
$220.32 |
$1,224 |
2.1× |
| Us transrectal (76872) |
$350.10 |
$1,945 |
3.3× |
| Us xtr non-vasc lmtd (76882) |
$163.80 |
$910 |
1.5× |
| Vascular flow imaging (78445) |
$331.38 |
$1,841 |
0.8× |
| Venography caval inferior serialography rs&i (75825) |
$1,349.10 |
$7,495 |
0.4× |
| Venography extremity unilateral rs&i (75820) |
$855.90 |
$4,755 |
0.5× |
| Wrist 2 views (73100) |
$56.79 |
$315.50 |
0.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$404.28 |
$2,246 |
3.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$106.29 |
$590.50 |
1.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$69.84 |
$388 |
0.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$797.94 |
$4,433 |
4.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$63 |
$350 |
0.7× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$199.26 |
$1,107 |
2.2× |
| X-ray exam entire spi 4/5 vw (72083) |
$464.40 |
$2,580 |
4.3× |
| X-ray exam hip uni 1 view (73501) |
$184.68 |
$1,026 |
2.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$26.64 |
$148 |
0.3× |
| X-ray exam hip uni 4/> views (73503) |
$257.04 |
$1,428 |
2.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$292.50 |
$1,625 |
2.7× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$585 |
$3,250 |
5.5× |
| X-ray exam of femur 1 (73551) |
$26.82 |
$149 |
0.3× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$36.90 |
$205 |
0.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$30.78 |
$171 |
0.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$130.77 |
$726.50 |
1.5× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$117.63 |
$653.50 |
1.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$35.64 |
$198 |
0.4× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$241.20 |
$1,340 |
2.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$31.14 |
$173 |
0.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$37.08 |
$206 |
0.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$59.94 |
$333 |
0.6× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$31.68 |
$176 |
0.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$212.76 |
$1,182 |
2.0× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$1,117.08 |
$6,206 |
3.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$27 |
$150 |
0.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$173.79 |
$965.50 |
1.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$396.36 |
$2,202 |
3.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$50.94 |
$283 |
0.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$29.34 |
$163 |
0.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$52.83 |
$293.50 |
0.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$207.18 |
$1,151 |
2.3× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$30.42 |
$169 |
0.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$406.80 |
$2,260 |
3.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$36.54 |
$203 |
0.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$182.52 |
$1,014 |
2.1× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$32.04 |
$178 |
0.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$28.08 |
$156 |
0.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$356.04 |
$1,978 |
3.3× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$107.73 |
$598.50 |
1.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$68.13 |
$378.50 |
0.8× |
| Xr c-spine 6 or more views (72052) |
$419.40 |
$2,330 |
3.9× |
| Xr finger(s) 2+ views (73140) |
$53.28 |
$296 |
0.6× |
| Xr shoulder 1 view (73020) |
$179.64 |
$998 |
2.0× |
| Xr spine cervical 4 or 5 views (72050) |
$290.34 |
$1,613 |
2.7× |
| Xr tibia/fibula 2 views (73590) |
$52.11 |
$289.50 |
0.6× |
| Xr tmj bilateral (70330) |
$315.54 |
$1,753 |
3.5× |
| Xray knee 1 or 2 views rt (73560) |
$60.93 |
$338.50 |
0.7× |