| Abdomen 2 views (74019) |
$47.60 |
$68 |
0.4× |
| Acute gi blood loss imaging (78278) |
$991.90 |
$1,417 |
2.4× |
| Ankle 2 views (73600) |
$32.20 |
$46 |
0.4× |
| Arthrogram hip (73525) |
$67.90 |
$97 |
0.2× |
| Arthrogram knee (73580) |
$65.10 |
$93 |
0.2× |
| Arthrogram shoulder (73040) |
$63.70 |
$91 |
0.2× |
| Arthrogram wrist (73115) |
$65.10 |
$93 |
0.2× |
| Bone &/Joint Imaging Limited Area (78300) |
$970.90 |
$1,387 |
2.3× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$982.10 |
$1,403 |
2.3× |
| Bone &/joint imaging whole body (78306) |
$171.50 |
$245 |
0.4× |
| Bone age studies (77072) |
$23.10 |
$33 |
0.2× |
| Bone Imaging 3 Phase (78315) |
$116.90 |
$167 |
0.3× |
| Bone survey complete (77075) |
$63.70 |
$91 |
0.6× |
| Bowel imaging (78290) |
$972.65 |
$1,389.50 |
2.3× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$737.10 |
$1,053 |
1.8× |
| Cervical spine 2 or 3 views (72040) |
$43.40 |
$62 |
0.5× |
| Chest 1 view (71045) |
$37.80 |
$54 |
0.4× |
| Chest xray 3 views (71047) |
$47.60 |
$68 |
0.5× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$74.20 |
$106 |
0.4× |
| Clavicle complete (73000) |
$32.20 |
$46 |
0.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$203 |
$290 |
1.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,780.05 |
$3,971.50 |
7.6× |
| CT abdomen and pelvis without contrast (74176) |
$345.80 |
$494 |
1.4× |
| CT abdomen w contrast (74160) |
$255.50 |
$365 |
1.4× |
| CT abdomen w wo contrast (74170) |
$280 |
$400 |
1.5× |
| CT abdomen w/o contrast (74150) |
$238.70 |
$341 |
2.2× |
| CT c-spine w/contrast (72126) |
$242.20 |
$346 |
0.7× |
| CT c-spine w/o contrast (72125) |
$215.60 |
$308 |
2.0× |
| CT cervical spine w&w/o contrast (72127) |
$264.60 |
$378 |
1.4× |
| CT chest w contrast (71260) |
$248.50 |
$355 |
1.4× |
| CT chest w/wo contrast (71270) |
$275.80 |
$394 |
1.5× |
| CT head/brain with contrast (70460) |
$208.60 |
$298 |
1.1× |
| CT head/brain without and with contrast (70470) |
$255.50 |
$365 |
1.4× |
| CT iac w contrast (70481) |
$160.30 |
$229 |
0.9× |
| CT limited/localized follow up study (76380) |
$872.20 |
$1,246 |
9.6× |
| CT lower ext w/o (73700) |
$199.50 |
$285 |
1.8× |
| CT lower extremity w wo contrast (73702) |
$242.20 |
$346 |
1.3× |
| CT lower extremity w/contrast material (73701) |
$231 |
$330 |
1.3× |
| CT lumbar spine w/contrast (72132) |
$242.20 |
$346 |
0.7× |
| CT lumbar spine w/o contrast (72131) |
$199.50 |
$285 |
1.8× |
| CT maxillofacial w contrast (70487) |
$224 |
$320 |
1.2× |
| CT maxillofacial wo contrast (70486) |
$950.60 |
$1,358 |
8.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$291.90 |
$417 |
1.6× |
| CT orbits w/o contrast (70480) |
$255.50 |
$365 |
2.3× |
| CT pelvis w/o contrast (72192) |
$219.10 |
$313 |
2.0× |
| CT pelvis w/wo contrast (72194) |
$242.20 |
$346 |
1.3× |
| CT scan of arm combo (73202) |
$242.20 |
$346 |
1.3× |
| CT soft tissue neck w contrast (70491) |
$275.80 |
$394 |
1.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$323.40 |
$462 |
1.8× |
| CT soft tissue neck w/o contrast (70490) |
$260.40 |
$372 |
2.4× |
| CT thoracic spine w/contrast (72129) |
$242.20 |
$346 |
1.3× |
| CT thoracic spine w/o contrast (72128) |
$199.50 |
$285 |
1.8× |
| CT thorax w/o contrast (71250) |
$231 |
$330 |
2.1× |
| CT upper ext wo (73200) |
$199.50 |
$285 |
1.8× |
| CT upper extremity with contrast (73201) |
$232.40 |
$332 |
0.6× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$45.50 |
$65 |
0.2× |
| Cta Abdomen (74175) |
$208.60 |
$298 |
1.1× |
| CTA abdomen pelvis (74174) |
$399 |
$570 |
1.1× |
| CTA chest (71275) |
$362.60 |
$518 |
2.0× |
| Cta Head (70496) |
$1,095.85 |
$1,565.50 |
6.0× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$2,047.50 |
$2,925 |
5.6× |
| Cta Neck (70498) |
$203.70 |
$291 |
1.1× |
| Cystography minimum 3 views rs&i (74430) |
$280.70 |
$401 |
0.8× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$60.20 |
$86 |
0.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$40.60 |
$58 |
0.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$40.60 |
$58 |
0.4× |
| Esophagus (74220) |
$91.70 |
$131 |
0.5× |
| Facial bones min 3 views (70150) |
$56 |
$80 |
0.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$90.30 |
$129 |
0.8× |
| Fluoroscopy up to 1 hr (76000) |
$100.80 |
$144 |
0.4× |
| Foot 2 views (73620) |
$31.50 |
$45 |
0.3× |
| Forearm 2 views (73090) |
$32.20 |
$46 |
0.4× |
| Hand 2 views (73120) |
$32.20 |
$46 |
0.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$179.90 |
$257 |
0.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$829.15 |
$1,184.50 |
2.0× |
| Hysterosalpingogram (74740) |
$802.20 |
$1,146 |
3.2× |
| Kidney imaging morphology (78700) |
$829.15 |
$1,184.50 |
2.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,330.35 |
$1,900.50 |
2.3× |
| Knee 3 views (73562) |
$40.60 |
$58 |
0.4× |
| Lung ventilation imaging (78579) |
$617.40 |
$882 |
1.5× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$326.90 |
$467 |
0.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$188.30 |
$269 |
0.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$429.80 |
$614 |
1.2× |
| Mammary ductogram or galactogram single (77053) |
$709.80 |
$1,014 |
2.8× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$112.70 |
$161 |
1.2× |
| Mr safety determination physician/other qhp (76016) |
$103.60 |
$148 |
1.1× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$21.70 |
$31 |
0.7× |
| MRA head w & w/o contrast (70546) |
$208.60 |
$298 |
0.6× |
| MRA head w/o contrast (70544) |
$141.40 |
$202 |
0.6× |
| MRA head with contrast (70545) |
$171.50 |
$245 |
0.5× |
| MRA neck w contrast (70548) |
$175 |
$250 |
0.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$358.40 |
$512 |
1.0× |
| MRA neck w/o contrast (70547) |
$141.40 |
$202 |
0.6× |
| MRI abdomen w contrast (74182) |
$3,544.80 |
$5,064 |
9.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$439.60 |
$628 |
1.2× |
| MRI abdomen w/o contrast (74181) |
$291.90 |
$417 |
1.2× |
| MRI any jt lower extrem w/contrast material (73722) |
$270.90 |
$387 |
0.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$249.20 |
$356 |
0.7× |
| MRI c-spine with contrast (72142) |
$208.60 |
$298 |
0.6× |
| MRI cervical spine w/o contrast (72141) |
$206.50 |
$295 |
0.8× |
| MRI chest w/o & w/contrast material (71552) |
$263.20 |
$376 |
0.7× |
| MRI chest w/o contrast (71550) |
$168.70 |
$241 |
0.7× |
| MRI chest with contrast (71551) |
$3,110.10 |
$4,443 |
3.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$270.90 |
$387 |
0.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$426.30 |
$609 |
1.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$188.30 |
$269 |
0.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$267.40 |
$382 |
1.1× |
| MRI orbit face neck w contrast (70542) |
$187.60 |
$268 |
0.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$426.30 |
$609 |
1.2× |
| MRI pelvis w/contrast (72196) |
$296.10 |
$423 |
0.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$439.60 |
$628 |
1.2× |
| MRI pelvis w/o contrast (72195) |
$168.70 |
$241 |
0.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$291.90 |
$417 |
0.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$296.10 |
$423 |
0.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$455 |
$650 |
1.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$207.20 |
$296 |
0.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$296.10 |
$423 |
0.8× |
| MRI temporomandibular joint (70336) |
$171.50 |
$245 |
0.7× |
| MRI thoracic spine w/o contrast (72146) |
$264.60 |
$378 |
1.1× |
| MRI up ext w/o contrast (73218) |
$270.90 |
$387 |
1.1× |
| MRI upper ext joint w/o contrast (73221) |
$270.90 |
$387 |
1.1× |
| MRI, joint upper extrem combo (73223) |
$251.30 |
$359 |
0.7× |
| Myelogram Lumbar (72265) |
$444.50 |
$635 |
0.5× |
| Myocardial Spect Multiple Studies (78452) |
$2,238.95 |
$3,198.50 |
1.7× |
| Myocardial spect single study at rest or stress (78451) |
$411.60 |
$588 |
0.3× |
| Neck soft tissue (70360) |
$32.20 |
$46 |
0.4× |
| Nm gastric emptying study (78264) |
$809.20 |
$1,156 |
1.9× |
| Nm gastroesophageal reflux study (78262) |
$1,102.85 |
$1,575.50 |
2.6× |
| Nm kidney scan w/flow (78701) |
$830.90 |
$1,187 |
2.0× |
| Osseous survey limited (77074) |
$970.20 |
$1,386 |
8.9× |
| Parathyroid Planar Imaging (78070) |
$351.75 |
$502.50 |
0.8× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$473.90 |
$677 |
1.1× |
| Pelvis 1 or 2 views (72170) |
$37.80 |
$54 |
0.3× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$651 |
$930 |
1.1× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$37.80 |
$54 |
0.4× |
| Radex Calcaneus Minimum 2 Views (73650) |
$32.20 |
$46 |
0.4× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$37.80 |
$54 |
0.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$53.20 |
$76 |
0.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$64.40 |
$92 |
0.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$73.50 |
$105 |
0.7× |
| Radex fingr minimum 2 views (73140) |
$27.30 |
$39 |
0.3× |
| Radex Foot Compl Minimum 3 Views (73630) |
$32.20 |
$46 |
0.4× |
| Radex Hand Minimum 3 Views (73130) |
$37.80 |
$54 |
0.4× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$40.60 |
$58 |
0.4× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$396.20 |
$566 |
3.6× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$173.95 |
$248.50 |
1.6× |
| Radex Humerus Minimum 2 Views (73060) |
$32.20 |
$46 |
0.4× |
| Radex Kne 1/2 Views (73560) |
$139.30 |
$199 |
1.5× |
| Radex Kne Compl 4/More Views (73564) |
$47.60 |
$68 |
0.4× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$53.20 |
$76 |
0.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$36.40 |
$52 |
0.4× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$42 |
$60 |
0.4× |
| Radex Sho Compl Minimum 2 Views (73030) |
$40.60 |
$58 |
0.4× |
| Radex Sinuses Paransl < 3 Views (70210) |
$135.45 |
$193.50 |
1.5× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$158.20 |
$226 |
1.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$27.30 |
$39 |
0.3× |
| Radex Toe Minimum 2 Views (73660) |
$27.30 |
$39 |
0.3× |
| Radex upper extremity infant minimum 2 views (73092) |
$18.20 |
$26 |
0.2× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$42 |
$60 |
0.5× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$85.40 |
$122 |
0.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$37.80 |
$54 |
0.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$63.70 |
$91 |
0.6× |
| Radiologic exam chest 2 views (71046) |
$43.40 |
$62 |
0.5× |
| Radiologic exam colon single contrast study (74270) |
$91.70 |
$131 |
0.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$107.10 |
$153 |
0.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$140 |
$200 |
0.8× |
| Radiologic examination femur 1 view (73551) |
$18.20 |
$26 |
0.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$32.20 |
$46 |
0.4× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$39.90 |
$57 |
0.4× |
| Radiological examination surgical specimen (76098) |
$59.50 |
$85 |
0.1× |
| Ribs bilateral 3 views (71110) |
$40.60 |
$58 |
0.4× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,276.80 |
$1,824 |
3.0× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$78.40 |
$112 |
0.1× |
| Scapula (73010) |
$21 |
$30 |
0.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$56 |
$80 |
2.4× |
| Shoulder 1 view (73020) |
$32.20 |
$46 |
0.4× |
| Small bowel series (74250) |
$56 |
$80 |
0.3× |
| Spine thoracic 3 views (72072) |
$43.40 |
$62 |
0.4× |
| Tbs technical calculation only (77091) |
$66.50 |
$95 |
0.7× |
| Thoracolumbar 2 views (72080) |
$45.50 |
$65 |
0.5× |
| Thyroid imaging w/blood flow (78013) |
$1,015.35 |
$1,450.50 |
2.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$273.35 |
$390.50 |
0.7× |
| Ultrasound breast complete (76641) |
$86.10 |
$123 |
0.8× |
| Ultrasound, abdomen limited (76705) |
$119.70 |
$171 |
1.1× |
| Umbilical-artery Doppler (OB) (76820) |
$63.70 |
$91 |
0.6× |
| Unlisted magnetic resonance procedure (76498) |
$2,816.80 |
$4,024 |
30.9× |
| Unlisted ultrasound procedure (76999) |
$555.80 |
$794 |
6.1× |
| Ureteral reflux study (78740) |
$397.95 |
$568.50 |
1.0× |
| Urethrocystogram voiding (74455) |
$40.60 |
$58 |
0.2× |
| Us breast unilateral limited (76642) |
$136.50 |
$195 |
1.5× |
| Us chest (76604) |
$107.80 |
$154 |
1.0× |
| Us compl joint r-t w/image documentation (76881) |
$74.20 |
$106 |
0.7× |
| Us elastography parenchyma (76981) |
$88.90 |
$127 |
0.8× |
| Us infant hips w manipulation (76885) |
$86.10 |
$123 |
0.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$100.10 |
$143 |
0.9× |
| Us ob limited (76815) |
$131.60 |
$188 |
1.2× |
| Us ob transvaginal (76817) |
$152.60 |
$218 |
1.4× |
| Us pelvic non ob complete (76856) |
$136.50 |
$195 |
1.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$100.10 |
$143 |
0.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$420.35 |
$600.50 |
3.8× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$112.70 |
$161 |
1.0× |
| Us retroperitoneal complete (76770) |
$146.30 |
$209 |
1.3× |
| Us retroperitoneal limited (76775) |
$116.90 |
$167 |
1.1× |
| Us scrotum and contents (76870) |
$128.10 |
$183 |
1.2× |
| Us soft tissue head/neck (76536) |
$112.70 |
$161 |
1.0× |
| Us transrectal (76872) |
$264.60 |
$378 |
2.4× |
| Us, eye b-scan (76512) |
$318.50 |
$455 |
2.9× |
| Venogram extremity bilateral (75822) |
$145.60 |
$208 |
0.1× |
| Venogram Extremity Unilateral (75820) |
$938 |
$1,340 |
0.6× |
| Wrist 2 views (73100) |
$37.80 |
$54 |
0.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$84.70 |
$121 |
0.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$25.20 |
$36 |
0.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$141.40 |
$202 |
0.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$32.20 |
$46 |
0.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$197.40 |
$282 |
2.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$456.40 |
$652 |
4.2× |
| X-ray exam of femur 2/> (73552) |
$40.60 |
$58 |
0.4× |
| X-ray eye for foreign body (70030) |
$38.50 |
$55 |
0.4× |
| X-ray IV pyelogram (ivp) (74400) |
$763.70 |
$1,091 |
4.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$21 |
$30 |
0.2× |
| X-ray leg, infant (73592) |
$18.20 |
$26 |
0.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$43.40 |
$62 |
0.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$52.50 |
$75 |
0.5× |
| X-ray nose-rectum child f.b. (76010) |
$34.30 |
$49 |
0.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$36.40 |
$52 |
0.3× |
| X-ray retrograde pyelogram (74420) |
$72.10 |
$103 |
0.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$43.40 |
$62 |
0.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$36.40 |
$52 |
0.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$47.60 |
$68 |
0.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$23.10 |
$33 |
0.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$37.80 |
$54 |
0.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$28.70 |
$41 |
0.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$72.10 |
$103 |
0.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$234.50 |
$335 |
2.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$18.20 |
$26 |
0.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$23.10 |
$33 |
0.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$43.40 |
$62 |
0.4× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$25.20 |
$36 |
0.2× |
| Xr bone length studies (77073) |
$56 |
$80 |
0.5× |
| Xr c-spine 4 or 5 views (72050) |
$47.60 |
$68 |
0.4× |
| Xr c-spine 6 or more views (72052) |
$53.90 |
$77 |
0.5× |
| Xr urogram antegrade (74425) |
$72.10 |
$103 |
0.2× |