| Abdomen 2 views (74019) |
— |
$1,505 |
— |
| Acute gi blood loss imaging (78278) |
— |
$5,230.80 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$6,519.75 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$6,519.75 |
— |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
— |
$6,519.75 |
— |
| Angiography pulmonary bilateral slctv rs&i (75743) |
— |
$6,519.75 |
— |
| Angiography pulmonary unilateral slctv rs&i (75741) |
— |
$6,519.75 |
— |
| Angiography visceral slctv/supraslctv rs&i (75726) |
— |
$12,116.97 |
— |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
— |
$3,508.87 |
— |
| Ankle 2 views (73600) |
— |
$1,606.80 |
— |
| Aortogram thoracic (75605) |
— |
$6,519.75 |
— |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
— |
$6,519.75 |
— |
| Aortography abdominal serialography rs&i (75625) |
— |
$6,519.75 |
— |
| Arthrogram ankle (73615) |
— |
$5,389.15 |
— |
| Arthrogram elbow (73085) |
— |
$4,821.54 |
— |
| Arthrogram hip (73525) |
— |
$5,731.08 |
— |
| Arthrogram knee (73580) |
— |
$5,389.15 |
— |
| Arthrogram shoulder (73040) |
— |
$5,109.93 |
— |
| Arthrogram wrist (73115) |
— |
$4,821.54 |
— |
| Bone &/Joint Imaging Limited Area (78300) |
— |
$3,367.36 |
— |
| Bone &/joint imaging whole body (78306) |
— |
$6,560.30 |
— |
| Bone age studies (77072) |
— |
$787.91 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$7,436.94 |
— |
| Bone survey complete (77075) |
— |
$3,554.77 |
— |
| Bone survey infant (77076) |
— |
$1,587.29 |
— |
| Cervical spine 2 or 3 views (72040) |
— |
$1,158.15 |
— |
| Chest 1 view (71045) |
— |
$739.72 |
— |
| Chest xray 3 views (71047) |
— |
$1,299.67 |
— |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
— |
$2,426.45 |
— |
| Clavicle complete (73000) |
— |
$1,789.63 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$16,496.36 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$9,402.89 |
— |
| CT abdomen w contrast (74160) |
— |
$7,443.06 |
— |
| CT abdomen w wo contrast (74170) |
— |
$8,246.27 |
— |
| CT abdomen w/o contrast (74150) |
— |
$4,700.68 |
— |
| CT angio lwr extr w/o&w/dye (73706) |
— |
$8,510.18 |
— |
| CT angiography upper extremity lt (73206) |
— |
$8,510.18 |
— |
| CT c-spine w/contrast (72126) |
— |
$7,443.06 |
— |
| CT c-spine w/o contrast (72125) |
— |
$4,700.68 |
— |
| CT cervical spine w&w/o contrast (72127) |
— |
$8,246.27 |
— |
| CT chest w contrast (71260) |
— |
$7,443.06 |
— |
| CT chest w/wo contrast (71270) |
— |
$8,246.27 |
— |
| CT head/brain with contrast (70460) |
— |
$7,443.06 |
— |
| CT head/brain without and with contrast (70470) |
— |
$8,246.27 |
— |
| CT heart w/o contrast quant eval coronary calcium (75571) |
— |
$76.50 |
— |
| CT iac w contrast (70481) |
— |
$7,443.06 |
— |
| CT limited/localized follow up study (76380) |
— |
$2,540.43 |
— |
| CT lower ext w/o (73700) |
— |
$4,700.68 |
— |
| CT lower extremity w wo contrast (73702) |
— |
$8,246.27 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$7,443.06 |
— |
| CT lumbar spine w & w/o contrast (72133) |
— |
$8,246.27 |
— |
| CT lumbar spine w/contrast (72132) |
— |
$7,443.06 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$4,700.68 |
— |
| CT maxillofacial w contrast (70487) |
— |
$7,443.06 |
— |
| CT maxillofacial w/wo contrast (70488) |
— |
$8,246.27 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$4,700.68 |
— |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
— |
$8,246.27 |
— |
| CT orbits w/o contrast (70480) |
— |
$4,700.68 |
— |
| CT pelvis w/o contrast (72192) |
— |
$4,700.68 |
— |
| CT pelvis w/wo contrast (72194) |
— |
$8,246.27 |
— |
| CT scan of arm combo (73202) |
— |
$8,246.27 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$7,443.06 |
— |
| CT soft tissue neck w/o & w/contrast material (70492) |
— |
$8,246.27 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$4,700.68 |
— |
| CT thoracic spine w/contrast (72129) |
— |
$7,443.06 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$4,700.68 |
— |
| CT thoracic spine w/wo contrast (72130) |
— |
$8,246.27 |
— |
| CT thorax w/o contrast (71250) |
— |
$4,700.68 |
— |
| CT upper ext wo (73200) |
— |
$4,700.68 |
— |
| CT upper extremity with contrast (73201) |
— |
$7,443.06 |
— |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
— |
$8,510.18 |
— |
| Cta Abdomen (74175) |
— |
$8,510.18 |
— |
| CTA abdomen pelvis (74174) |
— |
$17,016.54 |
— |
| CTA chest (71275) |
— |
$8,510.18 |
— |
| Cta Head (70496) |
— |
$8,510.18 |
— |
| Cta Neck (70498) |
— |
$8,510.18 |
— |
| Cta Pelvis (72191) |
— |
$8,510.18 |
— |
| Cystography minimum 3 views rs&i (74430) |
— |
$4,380.93 |
— |
| Dxa bone density study 1/> sites axial skel (77080) |
— |
$857.52 |
— |
| Esophagus (74220) |
— |
$2,009.55 |
— |
| Facial bones min 3 views (70150) |
— |
$1,822.90 |
— |
| Fetal biophysical profile non-stress testing (76818) |
— |
$1,976.66 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$1,976.66 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$2,721.48 |
— |
| Foot 2 views (73620) |
— |
$904.18 |
— |
| Forearm 2 views (73090) |
— |
$1,361.63 |
— |
| Hand 2 views (73120) |
— |
$995.98 |
— |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
— |
$605.67 |
— |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
— |
$6,389.71 |
— |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
— |
$4,670.85 |
— |
| Hepatobiliary syst imaging including gallbladder (78226) |
— |
$4,670.85 |
— |
| Hysterosalpingogram (74740) |
— |
$4,377.86 |
— |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
— |
$4,485.73 |
— |
| Kidney img morphology vascular flow 1 w/rx (78708) |
— |
$6,560.30 |
— |
| Knee 3 views (73562) |
— |
$1,344.80 |
— |
| Lung perfusion differential (78597) |
— |
$3,115.68 |
— |
| Lymphoscintigraphy (78195) |
— |
$6,541.94 |
— |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
— |
$6,647.50 |
— |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
— |
$6,647.50 |
— |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
— |
$8,377.85 |
— |
| MRA head w & w/o contrast (70546) |
— |
$8,377.85 |
— |
| MRA head w/o contrast (70544) |
— |
$5,415.15 |
— |
| MRA head with contrast (70545) |
— |
$6,647.50 |
— |
| MRA neck w contrast (70548) |
— |
$6,647.50 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$8,377.85 |
— |
| MRA neck w/o contrast (70547) |
— |
$5,415.15 |
— |
| MRI abdomen w contrast (74182) |
— |
$6,647.50 |
— |
| MRI abdomen w/o & w/contrast material (74183) |
— |
$8,377.85 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$5,415.15 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$6,647.50 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$8,377.85 |
— |
| MRI breast w/o contrast bilateral (77047) |
— |
$5,415.15 |
— |
| MRI breast wo contrast unilateral (77046) |
— |
$5,415.15 |
— |
| MRI c-spine with contrast (72142) |
— |
$6,647.50 |
— |
| MRI cervical spine w/o contrast (72141) |
— |
$5,415.15 |
— |
| MRI chest w/o & w/contrast material (71552) |
— |
$8,377.85 |
— |
| MRI chest w/o contrast (71550) |
— |
$5,415.15 |
— |
| MRI chest with contrast (71551) |
— |
$6,647.50 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$6,647.50 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$7,948.70 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$7,290.84 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$5,415.15 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$6,647.50 |
— |
| MRI orbit/face/neck w&w/o cont (70543) |
— |
$8,377.85 |
— |
| MRI pelvis w/contrast (72196) |
— |
$6,647.50 |
— |
| MRI pelvis w/o & w/contrast material (72197) |
— |
$8,377.85 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$5,415.15 |
— |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
— |
$8,377.85 |
— |
| MRI spinal canal lumbar w/contrast material (72149) |
— |
$6,647.50 |
— |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
— |
$8,377.85 |
— |
| MRI spinal canal thoracic w/contrast matrl (72147) |
— |
$6,647.50 |
— |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
— |
$8,377.85 |
— |
| MRI temporomandibular joint (70336) |
— |
$5,415.15 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$5,415.15 |
— |
| MRI up ext w/o contrast (73218) |
— |
$5,415.15 |
— |
| MRI upper ext joint w/o contrast (73221) |
— |
$5,415.15 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$8,377.85 |
— |
| Myocardial Perfusion Planar Multiple Studies (78454) |
— |
$8,413.03 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$13,797.58 |
— |
| Myocardial spect single study at rest or stress (78451) |
— |
$8,243.21 |
— |
| Neck soft tissue (70360) |
— |
$1,361.63 |
— |
| Nm gastric emptying study (78264) |
— |
$3,052.95 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$2,662.83 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$989.09 |
— |
| PET image w/CT, skull-thigh (78815) |
— |
$8,892.66 |
— |
| PET imaging for CT attenuation whole body (78816) |
— |
$8,892.66 |
— |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
— |
$3,061.80 |
— |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
— |
$6,081.43 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$4,041.28 |
— |
| Radex Ankle Compl Minimum 3 Views (73610) |
— |
$1,934.58 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$917.95 |
— |
| Radex Elbw Compl Minimum 3 Views (73080) |
— |
$2,043.98 |
— |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
— |
$995.98 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
— |
$1,991.96 |
— |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
— |
$1,991.96 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$1,106.90 |
— |
| Radex Foot Compl Minimum 3 Views (73630) |
— |
$1,279.78 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$1,312.67 |
— |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
— |
$530.12 |
— |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
— |
$1,594.18 |
— |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
— |
$1,152.80 |
— |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
— |
$2,305.59 |
— |
| Radex Humerus Minimum 2 Views (73060) |
— |
$2,130.80 |
— |
| Radex Kne 1/2 Views (73560) |
— |
$975.32 |
— |
| Radex Kne Compl 4/More Views (73564) |
— |
$1,458.02 |
— |
| Radex Mndbl Compl Minimum 4 Views (70110) |
— |
$2,134.24 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$1,146.68 |
— |
| Radex Pelvis Compl Minimum 3 Views (72190) |
— |
$1,471.79 |
— |
| Radex Sho Compl Minimum 2 Views (73030) |
— |
$1,288.96 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$1,080.12 |
— |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
— |
$1,468.73 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$1,382.28 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$1,106.90 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$1,788.48 |
— |
| Radex Wrst Compl Minimum 3 Views (73110) |
— |
$1,295.84 |
— |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
— |
$1,991.96 |
— |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
— |
$1,468.73 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$1,577.35 |
— |
| Radiologic exam chest 2 views (71046) |
— |
$940.14 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$3,391.84 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$3,455.15 |
— |
| Radiologic exam upr gi trc single contrast study (74240) |
— |
$3,344.76 |
— |
| Radiologic examination femur 1 view (73551) |
— |
$686.93 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$1,240 |
— |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
— |
$1,395.29 |
— |
| Radiological examination surgical specimen (76098) |
— |
$940.14 |
— |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
— |
$3,130.22 |
— |
| Rp loclzj tum plnr whole body single day imaging (78802) |
— |
$5,435.81 |
— |
| Rp loclzj tum spect 1 area single day imaging (78803) |
— |
$9,193.29 |
— |
| Sacroiliac Joints < 3 Views (72200) |
— |
$1,152.80 |
— |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
— |
$2,792.10 |
— |
| Scapula (73010) |
— |
$1,120.67 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$1,014.34 |
— |
| Shoulder 1 view (73020) |
— |
$649.45 |
— |
| Sialogram (70390) |
— |
$3,934.19 |
— |
| Small bowel series (74250) |
— |
$2,354.55 |
— |
| Spine thoracic 3 views (72072) |
— |
$1,861.15 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$3,362.77 |
— |
| Ultrasound breast complete (76641) |
— |
$5,553.61 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$3,139.40 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$2,426.45 |
— |
| Unlisted ultrasound procedure (76999) |
— |
$952.38 |
— |
| Urethrocystogram voiding (74455) |
— |
$7,290.07 |
— |
| Urethrocystography retrograde rs&i (74450) |
— |
$7,290.07 |
— |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
— |
$7,290.07 |
— |
| Us breast unilateral limited (76642) |
— |
$2,082.60 |
— |
| Us chest (76604) |
— |
$1,562.05 |
— |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
— |
$1,302.73 |
— |
| Us compl joint r-t w/image documentation (76881) |
— |
$2,327.01 |
— |
| Us encephalogram (76506) |
— |
$1,617.89 |
— |
| Us infant hips w manipulation (76885) |
— |
$1,966.71 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$1,161.97 |
— |
| Us ob detailed single fetus (76811) |
— |
$3,003.23 |
— |
| Us ob limited (76815) |
— |
$1,382.28 |
— |
| Us ob transvaginal (76817) |
— |
$1,562.05 |
— |
| Us pelvic non ob complete (76856) |
— |
$2,768.39 |
— |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
— |
$1,321.09 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$1,562.05 |
— |
| Us retroperitoneal complete (76770) |
— |
$3,139.40 |
— |
| Us retroperitoneal limited (76775) |
— |
$3,078.20 |
— |
| Us scrotum and contents (76870) |
— |
$1,785.42 |
— |
| Us soft tissue head/neck (76536) |
— |
$3,003.23 |
— |
| Us spinal canal and contents (76800) |
— |
$1,382.28 |
— |
| Us transrectal (76872) |
— |
$1,382.28 |
— |
| Venogram extremity bilateral (75822) |
— |
$1,869.56 |
— |
| Venogram Extremity Unilateral (75820) |
— |
$2,092.17 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$6,917.53 |
— |
| Venography caval superior serialography rs&i (75827) |
— |
$2,219.92 |
— |
| Venography renal unilateral selective rs&i (75831) |
— |
$2,785.22 |
— |
| Venography venous sinus/jugular cath rs&i (75860) |
— |
$4,431.70 |
— |
| Venous sampling by catheter (75893) |
— |
$4,492.61 |
— |
| Wrist 2 views (73100) |
— |
$1,036.52 |
— |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
— |
$2,244.72 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$958.50 |
— |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
— |
$4,592.06 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$1,539.48 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$1,062.53 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$1,152.80 |
— |
| X-ray exam of femur 2/> (73552) |
— |
$2,058.89 |
— |
| X-ray eye for foreign body (70030) |
— |
$934.02 |
— |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
— |
$635.68 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$5,716.54 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$975.32 |
— |
| X-ray leg, infant (73592) |
— |
$1,788.48 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$1,468.73 |
— |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
— |
$2,131.94 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$1,080.12 |
— |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
— |
$1,353.98 |
— |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
— |
$1,360.10 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$1,822.90 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$1,315.73 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$1,152.80 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$1,695.92 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$1,695.92 |
— |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
— |
$1,146.68 |
— |
| X-Ray Spine One View - Xr Spine (72020) |
— |
$339.64 |
— |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
— |
$820.04 |
— |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
— |
$1,240 |
— |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
— |
$2,278.82 |
— |
| Xr bone length studies (77073) |
— |
$1,324.91 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$2,364.49 |
— |
| Xr c-spine 6 or more views (72052) |
— |
$2,280.35 |
— |
| Xr chest 4+ views (71048) |
— |
$1,299.67 |
— |
| Xr urogram antegrade (74425) |
— |
$6,776.78 |
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