| Abdomen 2 views (74019) |
$141.75 |
$315 |
1.5× |
| Acute gastrointestinal blood loss imaging (78278) |
$488.57 |
$1,085.70 |
1.3× |
| Acute venous thrombus image (78456) |
$488.57 |
$1,085.70 |
0.4× |
| Angiography extremity bilateral rs&i (75716) |
$233.89 |
$519.75 |
0.1× |
| Arthrogram elbow (73085) |
$141.75 |
$315 |
0.4× |
| Arthrogram hip (73525) |
$321.77 |
$715.05 |
1.0× |
| Arthrogram shoulder (73040) |
$141.75 |
$315 |
0.4× |
| Arthrogram wrist (73115) |
$141.75 |
$315 |
0.4× |
| Arthrography knee lt (73580) |
$160.65 |
$357 |
0.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$488.57 |
$1,085.70 |
1.3× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$488.57 |
$1,085.70 |
1.3× |
| Bone &/joint imaging whole body (78306) |
$488.57 |
$1,085.70 |
1.3× |
| Bone age studies (77072) |
$141.75 |
$315 |
1.5× |
| Bone Imaging 3 Phase (78315) |
$488.57 |
$1,085.70 |
1.3× |
| Bone survey complete (77075) |
$179.55 |
$399 |
1.9× |
| Brain image w/flow 4 + views (78606) |
$488.57 |
$1,085.70 |
1.0× |
| Brain imaging < 4 static views w vascular flow (78601) |
$488.57 |
$1,085.70 |
1.3× |
| Brain Imaging Minimum 4 Static Views (78605) |
$488.57 |
$1,085.70 |
1.0× |
| Cervical spine 2 or 3 views (72040) |
$141.75 |
$315 |
1.8× |
| Chest 1 view (71045) |
$141.75 |
$315 |
1.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$141.75 |
$315 |
0.9× |
| Clavicle complete (73000) |
$141.75 |
$315 |
1.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$945 |
$2,100 |
3.0× |
| CT abdomen and pelvis without contrast (74176) |
$945 |
$2,100 |
4.4× |
| CT abdomen w contrast (74160) |
$945 |
$2,100 |
5.9× |
| CT abdomen w wo contrast (74170) |
$945 |
$2,100 |
5.9× |
| CT abdomen w/o contrast (74150) |
$945 |
$2,100 |
10.0× |
| CT angio hrt w/3d image (75574) |
$945 |
$2,100 |
3.0× |
| CT angiography upper extremity lt (73206) |
$945 |
$2,100 |
5.9× |
| CT c-spine w/o contrast (72125) |
$945 |
$2,100 |
10.0× |
| CT cervical spine w&w/o contrast (72127) |
$945 |
$2,100 |
5.9× |
| CT chest w/wo contrast (71270) |
$945 |
$2,100 |
5.9× |
| CT chest with contrast (71260) |
$945 |
$2,100 |
5.9× |
| CT head/brain with contrast (70460) |
$945 |
$2,100 |
5.9× |
| CT head/brain without and with contrast (70470) |
$945 |
$2,100 |
5.9× |
| CT heart contrast eval cardiac structure&morph (75572) |
$945 |
$2,100 |
3.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$189 |
$420 |
2.4× |
| CT lower ext w/o (73700) |
$945 |
$2,100 |
10.0× |
| CT lower extremity w wo contrast (73702) |
$945 |
$2,100 |
5.9× |
| CT lower extremity with contrast (73701) |
$945 |
$2,100 |
5.9× |
| CT lumbar spine w/o contrast (72131) |
$945 |
$2,100 |
10.0× |
| CT lumbar spine with contrast (72132) |
$945 |
$2,100 |
3.0× |
| CT maxillofacial w/o contrast (70486) |
$945 |
$2,100 |
10.0× |
| CT maxillofacial w/wo contrast (70488) |
$945 |
$2,100 |
5.9× |
| CT neck soft tissue w contrast (70491) |
$945 |
$2,100 |
5.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$945 |
$2,100 |
5.9× |
| CT orbits w/o contrast (70480) |
$945 |
$2,100 |
10.0× |
| CT pelvis w & w/o contrast (72194) |
$945 |
$2,100 |
5.9× |
| CT pelvis w/o contrast (72192) |
$945 |
$2,100 |
10.0× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$945 |
$2,100 |
12.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$945 |
$2,100 |
5.9× |
| CT soft tissue neck w/o contrast (70490) |
$945 |
$2,100 |
10.0× |
| CT thoracic spine w/o contrast (72128) |
$945 |
$2,100 |
10.0× |
| CT thorax w/o contrast (71250) |
$945 |
$2,100 |
10.0× |
| CT upper extremity w/o contrast rt (73200) |
$945 |
$2,100 |
10.0× |
| CT upper extremity with contrast (73201) |
$945 |
$2,100 |
3.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$945 |
$2,100 |
5.9× |
| Cta Abdomen (74175) |
$945 |
$2,100 |
5.9× |
| CTA abdomen pelvis (74174) |
$945 |
$2,100 |
3.0× |
| CTA chest (71275) |
$945 |
$2,100 |
5.9× |
| Cta Head (70496) |
$945 |
$2,100 |
5.9× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$945 |
$2,100 |
3.0× |
| CTA lwr ext w&w/o contrast (73706) |
$945 |
$2,100 |
5.9× |
| Cta Neck (70498) |
$945 |
$2,100 |
5.9× |
| Cta Pelvis (72191) |
$945 |
$2,100 |
5.9× |
| Cystography minimum 3 views rs&i (74430) |
$141.75 |
$315 |
0.4× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$992.25 |
$2,205 |
10.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$113.40 |
$252 |
1.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$37.80 |
$84 |
0.5× |
| Echo exam of fetal heart (76825) |
$644.96 |
$1,433.25 |
1.3× |
| Echoencephalography real time imaging (76506) |
$236.25 |
$525 |
2.5× |
| Esophagus (74220) |
$141.75 |
$315 |
0.9× |
| Fetal biophysical profile non-stress testing (76818) |
$236.25 |
$525 |
2.5× |
| Fluoroscopy up to 1 hr (76000) |
$141.75 |
$315 |
0.7× |
| Forearm 2 views (73090) |
$141.75 |
$315 |
1.8× |
| Gated Heart Planar Single (78472) |
$488.57 |
$1,085.70 |
1.3× |
| Hand 3 views (73130) |
$141.75 |
$315 |
1.8× |
| Heart Infarct Image (78466) |
$240.98 |
$535.50 |
0.7× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$661.50 |
$1,470 |
1.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$488.57 |
$1,085.70 |
1.3× |
| Ht muscle image spect sing (78451) |
$488.57 |
$1,085.70 |
0.4× |
| Humerus Min 2 Views Left (73060) |
$141.75 |
$315 |
1.8× |
| Hysterosalpingogram (74740) |
$141.75 |
$315 |
0.7× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$488.57 |
$1,085.70 |
1.0× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$488.57 |
$1,085.70 |
1.0× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$488.57 |
$1,085.70 |
1.0× |
| Knee 3 views (73562) |
$141.75 |
$315 |
1.8× |
| Liver & spleen imaging static only (78215) |
$488.57 |
$1,085.70 |
1.3× |
| Liver imaging static only (78201) |
$488.57 |
$1,085.70 |
1.0× |
| Lung perfusion differential (78597) |
$488.57 |
$1,085.70 |
1.3× |
| Lung Ventilation Imaging (78579) |
$488.57 |
$1,085.70 |
1.3× |
| Lymphoscintigraphy (78195) |
$472.50 |
$1,050 |
1.0× |
| Mammary ductogram or galactogram single (77053) |
$141.75 |
$315 |
0.7× |
| Meckels Diverticulum (78290) |
$488.57 |
$1,085.70 |
1.3× |
| MRA head w & w/o contrast (70546) |
$992.25 |
$2,205 |
3.1× |
| MRA head w/o contrast (70544) |
$992.25 |
$2,205 |
4.6× |
| MRA head with contrast (70545) |
$992.25 |
$2,205 |
3.1× |
| MRA neck w contrast (70548) |
$992.25 |
$2,205 |
3.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$992.25 |
$2,205 |
3.1× |
| MRA neck w/o contrast (70547) |
$992.25 |
$2,205 |
4.6× |
| MRI abdomen w contrast (74182) |
$992.25 |
$2,205 |
3.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$992.25 |
$2,205 |
3.1× |
| MRI abdomen w/o contrast (74181) |
$992.25 |
$2,205 |
4.6× |
| MRI any jnt lwr ext with con lt (73722) |
$992.25 |
$2,205 |
1.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$992.25 |
$2,205 |
1.4× |
| MRI breast w/o contrast bilateral (77047) |
$992.25 |
$2,205 |
4.6× |
| MRI breast w/o contrast unilat (77046) |
$992.25 |
$2,205 |
4.6× |
| MRI c-spine with contrast (72142) |
$992.25 |
$2,205 |
3.1× |
| MRI cervical spine w/o contrast (72141) |
$992.25 |
$2,205 |
4.6× |
| MRI chest w/o & w/contrast material (71552) |
$992.25 |
$2,205 |
3.1× |
| MRI chest w/o contrast (71550) |
$992.25 |
$2,205 |
4.6× |
| MRI chest with contrast (71551) |
$992.25 |
$2,205 |
1.4× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$992.25 |
$2,205 |
3.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$992.25 |
$2,205 |
3.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$992.25 |
$2,205 |
4.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$992.25 |
$2,205 |
4.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$992.25 |
$2,205 |
3.1× |
| MRI orbit/face/neck w/contrast (70542) |
$992.25 |
$2,205 |
3.1× |
| MRI pelvis w contrast (72196) |
$992.25 |
$2,205 |
3.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$992.25 |
$2,205 |
3.1× |
| MRI pelvis w/o contrast (72195) |
$992.25 |
$2,205 |
4.6× |
| MRI scan of arm joint before and after contrast (73223) |
$992.25 |
$2,205 |
3.1× |
| MRI scan of leg joint before and after contrast (73723) |
$992.25 |
$2,205 |
3.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$992.25 |
$2,205 |
3.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$992.25 |
$2,205 |
3.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$992.25 |
$2,205 |
3.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$992.25 |
$2,205 |
3.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$992.25 |
$2,205 |
3.1× |
| MRI thoracic spine w/o contrast (72146) |
$992.25 |
$2,205 |
4.6× |
| MRI tmj (70336) |
$992.25 |
$2,205 |
4.6× |
| MRI upper ext joint w/o contrast (73221) |
$992.25 |
$2,205 |
4.6× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$992.25 |
$2,205 |
3.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$992.25 |
$2,205 |
4.6× |
| Myelogram Cervical (72240) |
$310.43 |
$689.85 |
0.4× |
| Myelogram Lumbar (72265) |
$310.43 |
$689.85 |
0.4× |
| Myelogram thoracic (72255) |
$310.43 |
$689.85 |
0.4× |
| Myelography 2 or more regions (72270) |
$310.43 |
$689.85 |
0.4× |
| Myocardial Spect Multiple Studies (78452) |
$649.69 |
$1,443.75 |
0.6× |
| Neck soft tissue (70360) |
$141.75 |
$315 |
1.8× |
| Nm gastric emptying study (78264) |
$488.57 |
$1,085.70 |
1.3× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$602.44 |
$1,338.75 |
0.5× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$488.57 |
$1,085.70 |
0.4× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$236.25 |
$525 |
2.5× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$236.25 |
$525 |
2.5× |
| Parathyroid imaging (78070) |
$488.57 |
$1,085.70 |
1.3× |
| Pelvis 1 or 2 views (72170) |
$141.75 |
$315 |
1.5× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$992.25 |
$2,205 |
3.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$488.57 |
$1,085.70 |
1.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$141.75 |
$315 |
0.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$141.75 |
$315 |
1.5× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$141.75 |
$315 |
1.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$141.75 |
$315 |
1.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$141.75 |
$315 |
1.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$141.75 |
$315 |
1.5× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$141.75 |
$315 |
1.8× |
| Radiologic exam colon single contrast study (74270) |
$203.18 |
$451.50 |
1.3× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$141.75 |
$315 |
0.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$210.26 |
$467.25 |
1.3× |
| Radiologic exam upr gi trc single contrast study (74240) |
$109.62 |
$243.60 |
0.7× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$141.75 |
$315 |
1.8× |
| Radiological examination surgical specimen (76098) |
$141.75 |
$315 |
0.3× |
| Ribs bilateral 3 views (71110) |
$141.75 |
$315 |
1.5× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,762.40 |
$3,916.44 |
3.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$488.57 |
$1,085.70 |
1.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$488.57 |
$1,085.70 |
0.4× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$236.25 |
$525 |
1.1× |
| Scapula complete (73010) |
$141.75 |
$315 |
1.5× |
| Screening digital breast tomosynthesis (77063) |
$42.53 |
$94.50 |
1.8× |
| Sella turcica (70240) |
$141.75 |
$315 |
1.8× |
| Small bowel series (74250) |
$141.75 |
$315 |
0.9× |
| Thyroid Imaging With Vascular Flow (78013) |
$488.57 |
$1,085.70 |
1.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$488.57 |
$1,085.70 |
1.3× |
| Tomogram (76100) |
$945 |
$2,100 |
10.0× |
| Ultrasound, abdomen limited (76705) |
$236.25 |
$525 |
2.5× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$488.57 |
$1,085.70 |
1.3× |
| Urethrocystography voiding (74455) |
$141.75 |
$315 |
0.7× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$148.37 |
$329.70 |
0.9× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$186.64 |
$414.75 |
1.2× |
| Us abdl aorta screen aaa (76706) |
$236.25 |
$525 |
2.5× |
| Us breast unilateral complete (76641) |
$236.25 |
$525 |
2.5× |
| Us breast unilateral limited (76642) |
$236.25 |
$525 |
3.0× |
| Us chest (76604) |
$236.25 |
$525 |
2.5× |
| Us ob transvaginal (76817) |
$236.25 |
$525 |
2.5× |
| Us pelvic non ob complete (76856) |
$236.25 |
$525 |
2.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$236.25 |
$525 |
2.5× |
| Us pregnancy ltd (76815) |
$236.25 |
$525 |
2.5× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$200.02 |
$444.50 |
2.1× |
| Us retroperitoneal complete (76770) |
$236.25 |
$525 |
2.5× |
| Us scrotum and contents (76870) |
$236.25 |
$525 |
2.5× |
| Us soft tissue head/neck (76536) |
$236.25 |
$525 |
2.5× |
| Us spinal canal and contents (76800) |
$236.25 |
$525 |
2.5× |
| Us transrectal (76872) |
$236.25 |
$525 |
2.5× |
| Us xtr non-vasc lmtd (76882) |
$236.25 |
$525 |
2.5× |
| Vascular flow imaging (78445) |
$488.57 |
$1,085.70 |
1.3× |
| Venography caval inferior serialography rs&i (75825) |
$414.86 |
$921.90 |
0.1× |
| Venography extremity unilateral rs&i (75820) |
$146.48 |
$325.50 |
0.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$141.75 |
$315 |
1.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$141.75 |
$315 |
1.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$141.75 |
$315 |
1.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$278.78 |
$619.50 |
1.8× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$141.75 |
$315 |
1.8× |
| X-ray exam entire spi 4/5 vw (72083) |
$141.75 |
$315 |
1.5× |
| X-ray exam hip uni 1 view (73501) |
$141.75 |
$315 |
1.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$141.75 |
$315 |
1.8× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$141.75 |
$315 |
1.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$141.75 |
$315 |
1.8× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$141.75 |
$315 |
1.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$141.75 |
$315 |
1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$141.75 |
$315 |
1.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$141.75 |
$315 |
1.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$141.75 |
$315 |
1.5× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$141.75 |
$315 |
1.5× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$141.75 |
$315 |
1.8× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$118.80 |
$264 |
1.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$141.75 |
$315 |
1.5× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$170.10 |
$378 |
0.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$141.75 |
$315 |
1.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$144 |
$320 |
1.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$141.75 |
$315 |
1.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$141.75 |
$315 |
1.8× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$141.75 |
$315 |
1.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$141.75 |
$315 |
1.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$141.75 |
$315 |
1.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$141.75 |
$315 |
1.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$141.75 |
$315 |
1.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$141.75 |
$315 |
1.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$141.75 |
$315 |
1.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$141.75 |
$315 |
1.8× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$141.75 |
$315 |
1.8× |
| Xr arthrogram ankle (73615) |
$141.75 |
$315 |
0.4× |
| Xr c-spine 6 or more views (72052) |
$141.75 |
$315 |
1.5× |
| Xr chest 4+ views (71048) |
$283.50 |
$630 |
3.0× |
| Xr Cholecystography Oral Contrast (74290) |
$141.75 |
$315 |
0.9× |
| Xr finger(s) 2+ views (73140) |
$141.75 |
$315 |
1.8× |
| Xr shoulder 1 view (73020) |
$141.75 |
$315 |
1.8× |
| Xr spine cervical 4 or 5 views (72050) |
$141.75 |
$315 |
1.5× |
| Xr tibia/fibula 2 views (73590) |
$141.75 |
$315 |
1.8× |
| Xr tmj bilateral (70330) |
$141.75 |
$315 |
1.8× |
| Xray knee 1 or 2 views rt (73560) |
$141.75 |
$315 |
1.8× |