| Abdomen 2 views (74019) |
$79.47 |
$105.96 |
0.8× |
| Acute gi blood loss imaging (78278) |
$279.36 |
$372.48 |
0.7× |
| Ankle 2 views (73600) |
$106.03 |
$141.37 |
1.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$210.02 |
$280.04 |
0.5× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$223.06 |
$297.42 |
0.6× |
| Bone &/joint imaging whole body (78306) |
$260.24 |
$346.98 |
0.7× |
| Bone age studies (77072) |
$65.08 |
$86.78 |
0.6× |
| Bone Imaging 3 Phase (78315) |
$296.44 |
$395.26 |
0.8× |
| Bone survey complete (77075) |
$162.80 |
$217.08 |
1.6× |
| Bowel imaging (78290) |
$61.80 |
$82.40 |
0.2× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$78.02 |
$104.03 |
0.2× |
| Cervical spine 2 or 3 views (72040) |
$69.43 |
$92.58 |
0.8× |
| Chest 1 view (71045) |
$63.25 |
$84.33 |
0.8× |
| Chest xray 3 views (71047) |
$118.58 |
$158.11 |
1.4× |
| Clavicle complete (73000) |
$90.38 |
$120.51 |
1.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$158.36 |
$211.15 |
1.6× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$145.23 |
$193.64 |
0.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,263.81 |
$1,685.08 |
3.8× |
| CT abdomen and pelvis without contrast (74176) |
$1,150.25 |
$1,533.67 |
5.0× |
| CT abdomen w contrast (74160) |
$477.60 |
$636.80 |
2.8× |
| CT abdomen w wo contrast (74170) |
$455.88 |
$607.83 |
2.7× |
| CT abdomen w/o contrast (74150) |
$378.04 |
$504.06 |
3.8× |
| CT angio lwr extr w/o&w/dye (73706) |
$599.56 |
$799.41 |
3.6× |
| CT angiography upper extremity lt (73206) |
$1,045 |
$1,393.33 |
6.2× |
| CT c-spine w/o contrast (72125) |
$424.49 |
$565.99 |
4.2× |
| CT chest w contrast (71260) |
$411.55 |
$548.73 |
2.4× |
| CT chest w/wo contrast (71270) |
$454.72 |
$606.28 |
2.7× |
| CT head/brain with contrast (70460) |
$353.13 |
$470.84 |
2.1× |
| CT head/brain without and with contrast (70470) |
$431.73 |
$575.64 |
2.6× |
| CT iac w contrast (70481) |
$292.78 |
$390.38 |
1.7× |
| CT lower ext w/o (73700) |
$260.04 |
$346.72 |
2.6× |
| CT lower extremity w wo contrast (73702) |
$291.81 |
$389.08 |
1.7× |
| CT lower extremity w/contrast material (73701) |
$270.28 |
$360.37 |
1.6× |
| CT lumbar spine w/contrast (72132) |
$318.66 |
$424.88 |
1.0× |
| CT lumbar spine w/o contrast (72131) |
$413.96 |
$551.96 |
4.1× |
| CT maxillofacial w contrast (70487) |
$269.02 |
$358.70 |
1.6× |
| CT maxillofacial w/wo contrast (70488) |
$306.88 |
$409.17 |
1.8× |
| CT maxillofacial wo contrast (70486) |
$201.52 |
$268.70 |
2.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$347.04 |
$462.73 |
2.1× |
| CT orbits w/o contrast (70480) |
$264.39 |
$352.52 |
2.6× |
| CT pelvis w/o contrast (72192) |
$137.60 |
$183.47 |
1.4× |
| CT pelvis w/wo contrast (72194) |
$260.14 |
$346.86 |
1.5× |
| CT scan of arm combo (73202) |
$304.85 |
$406.46 |
1.8× |
| CT soft tissue neck w contrast (70491) |
$282.16 |
$376.21 |
1.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$299.54 |
$399.38 |
1.8× |
| CT soft tissue neck w/o contrast (70490) |
$188.01 |
$250.68 |
1.9× |
| CT thoracic spine w/o contrast (72128) |
$390.21 |
$520.28 |
3.9× |
| CT thorax w/o contrast (71250) |
$376.50 |
$502 |
3.8× |
| CT upper ext wo (73200) |
$242.76 |
$323.68 |
2.4× |
| CT upper extremity with contrast (73201) |
$247.97 |
$330.63 |
0.7× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$814.50 |
$1,086.01 |
4.8× |
| Cta Abdomen (74175) |
$626.30 |
$835.07 |
3.7× |
| CTA chest (71275) |
$627.08 |
$836.10 |
3.7× |
| Cta Head (70496) |
$594.73 |
$792.97 |
3.5× |
| Cta Neck (70498) |
$595.50 |
$794 |
3.5× |
| Cta Pelvis (72191) |
$626.30 |
$835.07 |
3.7× |
| Cystography minimum 3 views rs&i (74430) |
$579.38 |
$772.50 |
1.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$128.82 |
$171.76 |
1.3× |
| Esophagus (74220) |
$104.29 |
$139.05 |
0.6× |
| Facial bones min 3 views (70150) |
$163.96 |
$218.62 |
1.6× |
| Fetal biophysical profile non-stress testing (76818) |
$201.34 |
$268.44 |
2.0× |
| Fetal Echo (76825) |
$772.50 |
$1,030 |
1.5× |
| Fluoroscopy up to 1 hr (76000) |
$386.25 |
$515 |
1.7× |
| Foot 2 views (73620) |
$144.56 |
$192.74 |
1.7× |
| Forearm 2 views (73090) |
$97.34 |
$129.78 |
1.2× |
| Gastric mucosa imaging (78261) |
$399 |
$532 |
1.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$237.84 |
$317.12 |
0.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$237.84 |
$317.12 |
0.6× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$359.12 |
$478.82 |
0.7× |
| Knee 3 views (73562) |
$134.22 |
$178.96 |
1.6× |
| Liver & spleen imaging static only (78215) |
$195.83 |
$261.11 |
0.5× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$998.26 |
$1,331.02 |
1.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$998.26 |
$1,331.02 |
3.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$998.26 |
$1,331.02 |
3.0× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$37.47 |
$49.96 |
0.4× |
| MRA head w & w/o contrast (70546) |
$580.24 |
$773.66 |
1.7× |
| MRA head w/o contrast (70544) |
$464.85 |
$619.80 |
2.0× |
| MRA head with contrast (70545) |
$998.26 |
$1,331.02 |
3.0× |
| MRA neck w contrast (70548) |
$539.68 |
$719.58 |
1.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$547.80 |
$730.40 |
1.6× |
| MRA neck w/o contrast (70547) |
$468.90 |
$625.21 |
2.0× |
| MRI abdomen w contrast (74182) |
$998.26 |
$1,331.02 |
3.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$998.26 |
$1,331.02 |
3.0× |
| MRI abdomen w/o contrast (74181) |
$856.70 |
$1,142.27 |
3.7× |
| MRI any jt lower extrem w/contrast material (73722) |
$998.26 |
$1,331.02 |
1.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$178.45 |
$237.93 |
0.5× |
| MRI bone marrow blood supply (77084) |
$856.70 |
$1,142.27 |
3.7× |
| MRI c-spine with contrast (72142) |
$963.11 |
$1,284.15 |
2.9× |
| MRI cervical spine w/o contrast (72141) |
$517 |
$689.33 |
2.3× |
| MRI chest w/o & w/contrast material (71552) |
$588.36 |
$784.48 |
1.8× |
| MRI chest w/o contrast (71550) |
$856.70 |
$1,142.27 |
3.7× |
| MRI chest with contrast (71551) |
$998.26 |
$1,331.02 |
1.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$998.26 |
$1,331.02 |
3.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$998.26 |
$1,331.02 |
3.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$856.70 |
$1,142.27 |
3.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$483.10 |
$644.14 |
2.1× |
| MRI orbit face neck w contrast (70542) |
$553.40 |
$737.86 |
1.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$588.36 |
$784.48 |
1.8× |
| MRI pelvis w/contrast (72196) |
$541.72 |
$722.29 |
1.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$541.72 |
$722.29 |
1.6× |
| MRI pelvis w/o contrast (72195) |
$85.17 |
$113.56 |
0.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$937.14 |
$1,249.52 |
2.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$548.76 |
$731.68 |
1.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$949.30 |
$1,265.74 |
2.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$963.11 |
$1,284.15 |
2.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$949.30 |
$1,265.74 |
2.8× |
| MRI temporomandibular joint (70336) |
$856.70 |
$1,142.27 |
3.7× |
| MRI thoracic spine w/o contrast (72146) |
$177.29 |
$236.39 |
0.8× |
| MRI up ext w/o contrast (73218) |
$927.48 |
$1,236.64 |
4.1× |
| MRI upper ext joint w/o contrast (73221) |
$856.70 |
$1,142.27 |
3.7× |
| MRI, joint upper extrem combo (73223) |
$998.26 |
$1,331.02 |
3.0× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) |
$48.67 |
$64.89 |
0.1× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,158.75 |
$1,545 |
0.9× |
| Myocardial Spect Multiple Studies (78452) |
$933.08 |
$1,244.11 |
0.8× |
| Myocardial spect single study at rest or stress (78451) |
$1,528.78 |
$2,038.37 |
1.2× |
| Neck soft tissue (70360) |
$51.37 |
$68.50 |
0.6× |
| Nm cardiac blood pool multiple (78473) |
$712.82 |
$950.43 |
1.9× |
| Nm gastric emptying study (78264) |
$367.32 |
$489.77 |
1.0× |
| Nm gastroesophageal reflux study (78262) |
$269.70 |
$359.60 |
0.7× |
| Nm kidney scan w/flow (78701) |
$40.56 |
$54.08 |
0.1× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$386.25 |
$515 |
1.0× |
| Osseous survey limited (77074) |
$285.05 |
$380.07 |
2.8× |
| Parathyroid Planar Imaging (78070) |
$219.68 |
$292.90 |
0.6× |
| Pelvis 1 or 2 views (72170) |
$67.20 |
$89.61 |
0.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$208.86 |
$278.48 |
0.5× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$395.62 |
$527.49 |
0.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$44.61 |
$59.48 |
0.1× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$40.56 |
$54.08 |
0.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$58.52 |
$78.02 |
0.7× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$121.67 |
$162.23 |
1.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$25.88 |
$34.51 |
0.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$213.21 |
$284.28 |
2.1× |
| Radex fingr minimum 2 views (73140) |
$86.71 |
$115.62 |
1.0× |
| Radex Foot Compl Minimum 3 Views (73630) |
$40.56 |
$54.08 |
0.5× |
| Radex Hand Minimum 3 Views (73130) |
$97.34 |
$129.78 |
1.2× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$38.63 |
$51.50 |
0.5× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$202.59 |
$270.12 |
2.0× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$173.82 |
$231.75 |
1.7× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$231.75 |
$309 |
2.3× |
| Radex Humerus Minimum 2 Views (73060) |
$69.33 |
$92.44 |
0.8× |
| Radex Kne 1/2 Views (73560) |
$40.94 |
$54.59 |
0.5× |
| Radex Kne Compl 4/More Views (73564) |
$161.07 |
$214.76 |
1.6× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$81.21 |
$108.28 |
0.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$67.20 |
$89.61 |
0.8× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$115.10 |
$153.47 |
1.1× |
| Radex Sho Compl Minimum 2 Views (73030) |
$65.47 |
$87.30 |
0.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$84.59 |
$112.78 |
1.0× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$23.18 |
$30.90 |
0.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$128.43 |
$171.24 |
1.5× |
| Radex Toe Minimum 2 Views (73660) |
$80.15 |
$106.86 |
1.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$91.06 |
$121.41 |
0.9× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$97.34 |
$129.78 |
1.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$124.57 |
$166.09 |
1.5× |
| Radiologic exam chest 2 views (71046) |
$97.24 |
$129.66 |
1.2× |
| Radiologic exam colon single contrast study (74270) |
$186.66 |
$248.88 |
1.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$289.49 |
$385.99 |
1.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$265.26 |
$353.68 |
1.6× |
| Radiologic examination tibia & fibula 2 views (73590) |
$118.77 |
$158.36 |
1.4× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$579.38 |
$772.50 |
1.1× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$106.12 |
$141.50 |
1.1× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) |
$145.23 |
$193.64 |
1.7× |
| Radiological examination surgical specimen (76098) |
$772.50 |
$402.48 |
1.5× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$224.12 |
$298.83 |
0.4× |
| Sacroiliac Joints < 3 Views (72200) |
$104.87 |
$139.82 |
1.0× |
| Scapula (73010) |
$38.63 |
$51.50 |
0.4× |
| Sella turcica (70240) |
$63.16 |
$84.20 |
0.8× |
| Shoulder 1 view (73020) |
$17 |
$22.66 |
0.2× |
| Small bowel series (74250) |
$122.15 |
$162.87 |
0.7× |
| Speech evaluation complex (70371) |
$306.30 |
$408.40 |
1.3× |
| Spine thoracic 3 views (72072) |
$81.60 |
$108.80 |
0.8× |
| Spleen imaging only (78185) |
$383.35 |
$511.14 |
1.0× |
| Testicular Imaging With Vascular Flow (78761) |
$298.76 |
$398.35 |
0.8× |
| Thyroid imaging w/blood flow (78013) |
$347.63 |
$463.50 |
0.9× |
| Thyroid uptake measurement (78012) |
$386.25 |
$515 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$404.12 |
$538.82 |
1.1× |
| Tomogram (76100) |
$112.68 |
$150.25 |
1.1× |
| Ultrasound breast complete (76641) |
$155.08 |
$206.78 |
1.5× |
| Ultrasound Exam Aaa Screen (76706) |
$157.78 |
$210.38 |
1.6× |
| Ultrasound, abdomen limited (76705) |
$249.90 |
$333.21 |
2.5× |
| Urethrocystogram voiding (74455) |
$131.90 |
$175.88 |
0.6× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$280.42 |
$373.89 |
1.7× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$216.01 |
$288.02 |
1.3× |
| Us breast unilateral limited (76642) |
$63.35 |
$84.46 |
0.8× |
| Us chest (76604) |
$157.50 |
$210 |
1.6× |
| Us compl joint r-t w/image documentation (76881) |
$157.78 |
$210.38 |
1.6× |
| Us elastography parenchyma (76981) |
$57.94 |
$77.25 |
0.6× |
| Us encephalogram (76506) |
$236.96 |
$315.95 |
2.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$282.74 |
$376.98 |
2.8× |
| Us ob detailed single fetus (76811) |
$249.71 |
$332.95 |
1.1× |
| Us ob limited (76815) |
$121.09 |
$161.45 |
1.2× |
| Us ob transvaginal (76817) |
$127.56 |
$170.08 |
1.3× |
| Us pelvic non ob complete (76856) |
$195.34 |
$260.46 |
1.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$204.52 |
$272.69 |
2.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$127.27 |
$169.70 |
1.3× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$100.23 |
$133.64 |
1.0× |
| Us retroperitoneal complete (76770) |
$68.95 |
$91.93 |
0.7× |
| Us retroperitoneal limited (76775) |
$115.88 |
$154.50 |
1.2× |
| Us scrotum and contents (76870) |
$213.21 |
$284.28 |
2.1× |
| Us soft tissue head/neck (76536) |
$230.40 |
$307.20 |
2.3× |
| Us transrectal (76872) |
$175.07 |
$233.42 |
1.7× |
| Venogram Extremity Unilateral (75820) |
$77.44 |
$103.26 |
0.1× |
| Venography venous sinus/jugular cath rs&i (75860) |
$81.11 |
$108.15 |
0.0× |
| Wrist 2 views (73100) |
$102.36 |
$136.48 |
1.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$118.10 |
$157.46 |
1.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$64.80 |
$86.40 |
0.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$246.52 |
$328.70 |
1.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$106.03 |
$141.37 |
1.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$72.32 |
$96.44 |
0.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$202.78 |
$270.38 |
2.0× |
| X-ray exam of femur 2/> (73552) |
$38.63 |
$51.50 |
0.5× |
| X-ray eye for foreign body (70030) |
$52.53 |
$70.04 |
0.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$67.12 |
$89.48 |
0.8× |
| X-ray IV pyelogram (ivp) (74400) |
$138.38 |
$184.50 |
0.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$134.22 |
$178.96 |
1.6× |
| X-ray leg, infant (73592) |
$45.77 |
$61.03 |
0.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$77.06 |
$102.74 |
0.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$185.40 |
$247.20 |
1.8× |
| X-ray optic foramen (70190) |
$107.76 |
$143.69 |
1.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$84.88 |
$113.17 |
0.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$90.96 |
$121.28 |
0.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$116.36 |
$155.14 |
1.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$56.78 |
$75.70 |
0.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$106.03 |
$141.37 |
1.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$114.62 |
$152.82 |
1.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$100.72 |
$134.29 |
1.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$77.35 |
$103.13 |
0.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$114.72 |
$152.96 |
1.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$63.06 |
$84.08 |
0.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$76.76 |
$102.36 |
0.9× |
| Xr c-spine 4 or 5 views (72050) |
$65.28 |
$87.04 |
0.7× |
| Xr c-spine 6 or more views (72052) |
$161.07 |
$214.76 |
1.6× |
| Xr urogram antegrade (74425) |
$270.38 |
$360.50 |
0.8× |