| 3-Dimensional radiotherapy plan including dose-volume histograms (77295) |
$4,821.90 |
$8,767.09 |
3.3× |
| Acute gi blood loss imaging (78278) |
$1,440.27 |
$2,618.67 |
3.4× |
| Angio extremity unilateral (75710) |
$4,686.98 |
$8,521.79 |
1.4× |
| Angiogram extremity bilateral (75716) |
$5,252.98 |
$9,550.87 |
1.6× |
| Ankle 2 views (73600) |
$395.48 |
$719.05 |
4.4× |
| Arthrography knee lt (73580) |
$1,217.22 |
$2,213.13 |
3.3× |
| Arthrography wrist lt (73115) |
$2,013.67 |
$3,661.22 |
5.5× |
| Barium enema (74270) |
$533.37 |
$969.77 |
2.9× |
| Basic dosimetry (77300) |
$589.48 |
$1,071.79 |
4.2× |
| Bone age studies (77072) |
$274.16 |
$498.48 |
2.5× |
| Bone imaging limited area (78300) |
$1,062.67 |
$1,932.12 |
2.5× |
| Bone marrow imaging whole body (78104) |
$1,256.77 |
$2,285.03 |
3.0× |
| Bone survey complete (77075) |
$701.62 |
$1,275.67 |
6.4× |
| Bowel imaging (78290) |
$1,161.35 |
$2,111.54 |
2.8× |
| Brachytx isodose pln cplx w/dosimetry cal (77318) |
$1,392.97 |
$2,532.67 |
3.6× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$764.79 |
$1,390.53 |
1.3× |
| Brain image w/flow 4 + views (78606) |
$1,207.83 |
$2,196.05 |
2.1× |
| Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) |
$617.38 |
$1,122.50 |
1.5× |
| Card MRI w/stress img & dye (75563) |
$2,877.27 |
$5,231.40 |
3.5× |
| Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and… (78473) |
$3,256.50 |
$5,920.91 |
7.8× |
| Cardiac MRI w/stress img (75559) |
$2,877.27 |
$5,231.40 |
5.0× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$2,877.27 |
$5,231.40 |
7.9× |
| Cardiac shunt detection (78428) |
$954.20 |
$1,734.90 |
2.3× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Age Under 21 (78635) |
$764.79 |
$1,390.53 |
1.3× |
| Cerebrospinal fluid leakage (78650) |
$2,012.06 |
$3,658.29 |
1.5× |
| Cholecystography, oral contrast Other Diagnostic Radiology FS (74290) |
$466.50 |
$848.18 |
2.5× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$421.65 |
$766.63 |
2.3× |
| Cisternogram (78630) |
$829.42 |
$1,508.03 |
1.5× |
| Cisternography, positive contrast, radiological supervision and interpretation Other Diagnostic Radiology FS (70015) |
$1,708.59 |
$3,106.52 |
2.1× |
| Clavicle complete (73000) |
$478.52 |
$870.04 |
5.3× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Age Under 21 (77078) |
$204.71 |
$372.20 |
2.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$2,500.48 |
$4,546.33 |
13.7× |
| Continuing medical physics consltj pr wk (77336) |
$868.26 |
$1,578.65 |
6.2× |
| Corpora cavernosography (74445) |
$1,211.91 |
$2,203.48 |
11.1× |
| Csf shunt evaluation (78645) |
$764.79 |
$1,390.53 |
1.3× |
| CT - st neck w&wo contr (70492) |
$1,761.60 |
$3,202.90 |
9.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,640.21 |
$10,254.93 |
15.5× |
| CT abdomen and pelvis without contrast (74176) |
$3,776.52 |
$6,866.40 |
15.2× |
| CT abdomen w wo contrast (74170) |
$3,220.83 |
$5,856.06 |
17.6× |
| CT abdomen w/contrast (74160) |
$2,894.25 |
$5,262.27 |
15.8× |
| CT abdomen w/o contrast (74150) |
$2,700.97 |
$4,910.85 |
24.7× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$4,947.89 |
$8,996.17 |
13.6× |
| CT angio abdom w/o & w/dye (74175) |
$2,775.95 |
$5,047.18 |
15.2× |
| CT angio abdominal arteries (75635) |
$7,075.67 |
$12,864.86 |
38.6× |
| CT angio hrt w/3d image (75574) |
$2,925.08 |
$5,318.32 |
8.0× |
| CT angiograph pelv w/o&w/dye (72191) |
$2,890.09 |
$5,254.70 |
15.8× |
| CT cervical spine w/contrast (72126) |
$2,672.65 |
$4,859.36 |
7.3× |
| CT cervical spine w/o contrast (72125) |
$2,210.27 |
$4,018.67 |
20.2× |
| CT chest w/contrast (71260) |
$1,648.74 |
$2,997.71 |
9.0× |
| CT extremity upper w & w/o contrast (73202) |
$2,563.51 |
$4,660.93 |
14.0× |
| CT head/brain with contrast (70460) |
$2,571.44 |
$4,675.34 |
14.0× |
| CT head/brain without and with contrast (70470) |
$2,927.02 |
$5,321.85 |
16.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$2,925.08 |
$5,318.32 |
8.0× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$492.38 |
$895.23 |
5.4× |
| CT hrt w/3d image congen (75573) |
$2,925.08 |
$5,318.32 |
8.0× |
| CT limited/localized follow up study (76380) |
$947.25 |
$1,722.28 |
10.4× |
| CT lower ext w/wo contrast (73702) |
$2,026.14 |
$3,683.89 |
11.1× |
| CT lower extremity w contrast (73701) |
$1,903.68 |
$3,461.23 |
10.4× |
| CT lower extremity w/o contrast unilateral (73700) |
$1,775.37 |
$3,227.95 |
16.3× |
| CT lumbar spine w/contrast (72132) |
$2,708.46 |
$4,924.48 |
7.4× |
| CT lumbar spine w/o contrast (72131) |
$2,240.25 |
$4,073.19 |
20.5× |
| CT lumbar spine w/o then w/ con (72133) |
$3,301.64 |
$6,002.99 |
18.0× |
| CT maxillofacial area w/o contrast (70486) |
$1,826.84 |
$3,321.53 |
16.7× |
| CT maxillofacial w/contrast (70487) |
$2,104.13 |
$3,825.69 |
11.5× |
| CT maxillofacial w/o then w/ con (70488) |
$2,865.86 |
$5,210.65 |
15.6× |
| CT orbit sella ear w/o con (70480) |
$2,323.51 |
$4,224.56 |
21.3× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$2,971.07 |
$5,401.94 |
16.2× |
| CT pelvis w & w/o contrast (72194) |
$2,808.44 |
$5,106.26 |
15.3× |
| CT pelvis w/o contrast (72192) |
$2,517.68 |
$4,577.60 |
23.1× |
| CT soft tissue neck w/contrast (70491) |
$1,414.99 |
$2,572.70 |
7.7× |
| CT soft tissue neck w/o contrast (70490) |
$1,209.47 |
$2,199.03 |
11.1× |
| CT spine cervical w/wo contrast (72127) |
$3,237.50 |
$5,886.36 |
17.7× |
| CT thoracic spine w/contrast (72129) |
$3,240 |
$5,890.90 |
17.7× |
| CT thoracic spine w/o contrast (72128) |
$2,441.04 |
$4,438.25 |
22.4× |
| CT thoracic spine w/o then w/ con (72130) |
$3,596.57 |
$6,539.22 |
19.6× |
| CT thorax lung cancer scr c- (71271) |
$162.02 |
$294.59 |
1.5× |
| CT thorax w/o contrast (71250) |
$1,539.60 |
$2,799.27 |
14.1× |
| CT thorax w/o then w/ contrast (71270) |
$1,694.57 |
$3,081.03 |
9.3× |
| CT upper extremity w/dye (73201) |
$2,246.09 |
$4,083.80 |
6.2× |
| CT upper extremity w/o contrast rt (73200) |
$1,951.16 |
$3,547.56 |
17.9× |
| CTA chest w/wo contrast (71275) |
$2,350.19 |
$4,273.07 |
12.8× |
| CTA head w contrast (70496) |
$3,275.26 |
$5,955.02 |
17.9× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$392.15 |
$713 |
1.1× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$2,565.17 |
$4,663.95 |
14.0× |
| Cta Neck (70498) |
$3,275.26 |
$5,955.02 |
17.9× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$3,389.96 |
$6,163.56 |
18.5× |
| Diskography lumbar (72295) |
$2,106.17 |
$3,829.40 |
1.0× |
| Doppler echo fetal spectral display complete (76827) |
$952.24 |
$1,731.35 |
8.7× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$372.87 |
$677.95 |
3.4× |
| Doppler fetal mid cerebral artery (76821) |
$418.38 |
$760.69 |
3.8× |
| Dxa bone density study axial skeleton (77085) |
$162.02 |
$294.59 |
1.5× |
| Echo exam of eye (76529) |
$258.36 |
$469.75 |
2.8× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$952.24 |
$1,731.35 |
3.8× |
| Esophageal motility (78258) |
$915.87 |
$1,665.22 |
2.2× |
| Esophogram (74220) |
$305.02 |
$554.58 |
1.7× |
| Fetal biophysical profile non-stress testing (76818) |
$1,276.18 |
$2,320.32 |
11.7× |
| Fetal biophysical profile w/o nst (76819) |
$1,202.78 |
$2,186.87 |
11.0× |
| Fetal echo complete (76825) |
$952.24 |
$1,731.35 |
1.7× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$848.18 |
$1,542.14 |
3.4× |
| Full mouth X-ray of teeth (70320) |
$390.38 |
$709.79 |
1.6× |
| Functional MRI brain by phys/psych (70555) |
$805.77 |
$1,465.03 |
3.2× |
| Functional MRI brain by tech (70554) |
$805.77 |
$1,465.03 |
3.2× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$764.79 |
$1,390.53 |
1.3× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit Age Under 21 (78265) |
$589.22 |
$1,071.30 |
1.4× |
| Gastric emptying study (78264) |
$1,010.47 |
$1,837.22 |
2.4× |
| Gastric mucosa imaging (78261) |
$1,083.05 |
$1,969.19 |
2.6× |
| Gastroesophageal reflux study (78262) |
$947.67 |
$1,723.04 |
2.3× |
| Gated heart planar single (78472) |
$1,891.27 |
$3,438.67 |
4.5× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,231.53 |
$2,239.14 |
1.7× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$1,231.53 |
$2,239.14 |
1.7× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$1,231.53 |
$2,239.14 |
1.7× |
| Heart infarct image (78466) |
$1,382.37 |
$2,513.40 |
3.3× |
| Hepatobil syst image w/drug (78227) |
$764.79 |
$1,390.53 |
1.3× |
| Hepatobiliary system imaging (78226) |
$589.22 |
$1,071.30 |
1.4× |
| Humerus min 2 views (73060) |
$515.17 |
$936.68 |
5.7× |
| Hysterosalpingography (74740) |
$1,264.92 |
$2,299.86 |
5.1× |
| Imrt planning (77301) |
$4,069.10 |
$7,398.36 |
2.8× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$18,710.32 |
$34,018.76 |
25.7× |
| Intracavitary radiation source applic complex (77763) |
$18,710.32 |
$34,018.76 |
25.7× |
| Intracavitary radiation source applic intermed (77762) |
$18,710.32 |
$34,018.76 |
32.4× |
| Intracavitary radiation source applic simple (77761) |
$18,710.32 |
$34,018.76 |
32.4× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$1,080.40 |
$1,964.36 |
2.8× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$724.65 |
$1,317.54 |
1.9× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$1,021.27 |
$1,856.85 |
2.6× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$982.78 |
$1,786.88 |
2.5× |
| Ivp (74400) |
$1,219.25 |
$2,216.82 |
6.7× |
| Ivp w tomography (74415) |
$572.52 |
$1,040.95 |
3.1× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$1,337.51 |
$2,431.83 |
2.4× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,630.29 |
$2,964.16 |
2.9× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,589.52 |
$2,890.03 |
2.8× |
| Kidney w vascular flow (78701) |
$1,124.65 |
$2,044.82 |
2.7× |
| Liver & spleen; static only (78215) |
$866.12 |
$1,574.76 |
2.1× |
| Liver & spleen; w vasc flow (78216) |
$994.98 |
$1,809.05 |
2.4× |
| Liver imaging w/vascular flow (78202) |
$1,017.81 |
$1,850.57 |
1.8× |
| Lung perf&ventilat diferentl (78598) |
$764.79 |
$1,390.53 |
1.3× |
| Lung perfusion differential (78597) |
$589.22 |
$1,071.30 |
1.4× |
| Lung ventilat&perfus imaging (78582) |
$764.79 |
$1,390.53 |
1.3× |
| Lung ventilation imaging (78579) |
$589.22 |
$1,071.30 |
1.4× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$4,924.63 |
$8,953.88 |
13.5× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$5,045.99 |
$9,174.53 |
13.9× |
| Mammary ductogram multiple ducts (77054) |
$882.43 |
$1,604.41 |
3.5× |
| Mammary ductogram single (77053) |
$778.85 |
$1,416.09 |
3.1× |
| Mlc device(s) for imrt (77338) |
$930.21 |
$1,691.29 |
2.4× |
| MRA head w & w/o contrast (70546) |
$3,029.78 |
$5,508.69 |
8.3× |
| MRA head w/contrast (70545) |
$2,506.20 |
$4,556.72 |
6.9× |
| MRA head w/o contrast (70544) |
$2,249.29 |
$4,089.62 |
9.0× |
| MRA neck w/contrast (70548) |
$2,506.20 |
$4,556.72 |
6.9× |
| MRA neck w/o contrast (70547) |
$2,131.86 |
$3,876.11 |
8.6× |
| MRA neck w/wo contrast (70549) |
$3,170.05 |
$5,763.73 |
8.7× |
| MRI abdomen w/contrast (74182) |
$2,694.26 |
$4,898.66 |
7.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,232.53 |
$5,877.32 |
8.9× |
| MRI abdomen w/o contrast (74181) |
$2,497.55 |
$4,541 |
10.0× |
| MRI any jnt lwr ext with con lt (73722) |
$4,104.52 |
$7,462.76 |
5.0× |
| MRI bone marrow (77084) |
$4,038.94 |
$7,343.53 |
16.2× |
| MRI breast without contrast bilateral (77047) |
$1,422 |
$2,585.45 |
5.7× |
| MRI breast without contrast material unilateral (77046) |
$1,422 |
$2,585.45 |
5.7× |
| MRI cardiac w/o contrast (75557) |
$2,826.38 |
$5,138.88 |
11.3× |
| MRI cervical spine w/o contrast (72141) |
$2,596.40 |
$4,720.72 |
10.4× |
| MRI cervical spine with contrast (72142) |
$2,986.88 |
$5,430.69 |
8.2× |
| MRI chest w & w/o contrast (71552) |
$6,788.01 |
$12,341.84 |
18.6× |
| MRI chest w/contrast (71551) |
$5,359.16 |
$9,743.93 |
6.5× |
| MRI chest w/o contrast (71550) |
$4,915.83 |
$8,937.87 |
19.7× |
| MRI elastography (76391) |
$283.20 |
$514.91 |
1.1× |
| MRI fetal sngl/1st gestation (74712) |
$504.99 |
$918.16 |
2.0× |
| MRI joint upper ext w/contrast (73222) |
$5,466.82 |
$9,939.67 |
6.7× |
| MRI joint upr extr w/o&w/dye (73223) |
$6,559 |
$11,925.46 |
18.0× |
| MRI joint upr extrem w/o dye (73221) |
$4,752.39 |
$8,640.71 |
19.1× |
| Mri Lower Extremity W/O Dye (73718) |
$3,659.23 |
$6,653.14 |
14.7× |
| MRI lumbar spine with contrast (72149) |
$3,090.62 |
$5,619.31 |
8.5× |
| MRI lumbar w/wo contrast (72158) |
$3,910.74 |
$7,110.43 |
10.7× |
| MRI lwr ext w/o jnts with con rt (73719) |
$4,205.32 |
$7,646.04 |
11.5× |
| MRI orbit/face/neck w/contrast (70542) |
$3,195.34 |
$5,809.70 |
8.8× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$3,483.23 |
$6,333.14 |
9.6× |
| MRI orbit/face/neck w/o contrast (70540) |
$2,631.79 |
$4,785.07 |
10.6× |
| MRI pelvis w/ contrast (72196) |
$4,492.06 |
$8,167.39 |
12.3× |
| MRI pelvis w/o contrast (72195) |
$4,116.27 |
$7,484.12 |
16.5× |
| MRI pelvis w/wo contrast (72197) |
$5,685.05 |
$10,336.46 |
15.6× |
| MRI spectroscopy (76390) |
$4,202.38 |
$7,640.69 |
46.2× |
| MRI spine cervical wo/w contrast (72156) |
$4,012.52 |
$7,295.49 |
11.0× |
| MRI spine thoracic w/contrast (72147) |
$3,256.99 |
$5,921.80 |
8.9× |
| MRI thoracic spine w wo contrast (72157) |
$4,009.58 |
$7,290.15 |
11.0× |
| MRI thoracic spine w/o contrast (72146) |
$2,831.27 |
$5,147.77 |
11.4× |
| MRI tmj (70336) |
$2,411.43 |
$4,384.41 |
9.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$4,141.70 |
$7,530.37 |
16.6× |
| Mri Upper Extremity W/Dye (73219) |
$4,871.78 |
$8,857.79 |
13.4× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$5,851.43 |
$10,638.96 |
16.1× |
| Myelogram thoracic (72255) |
$1,562.60 |
$2,841.09 |
1.9× |
| Myelography 2 or more regions (72270) |
$2,381.80 |
$4,330.54 |
2.9× |
| Myelography lumbosacral (72265) |
$1,680.04 |
$3,054.62 |
2.1× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$3,949.72 |
$7,181.31 |
2.6× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$7,593.62 |
$13,806.58 |
5.1× |
| Myocardial spect single study at rest or stress (78451) |
$5,164.09 |
$9,389.25 |
3.8× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$2,257.77 |
$4,105.03 |
1.5× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$1,610.40 |
$2,928 |
1.1× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$2,484.90 |
$4,518 |
1.1× |
| Nm adrenal imaging (78075) |
$2,012.06 |
$3,658.29 |
1.5× |
| Nm bone 3 phase (78315) |
$1,121.39 |
$2,038.89 |
2.7× |
| Nm bone imaging whole body (78306) |
$1,196.42 |
$2,175.30 |
2.9× |
| Nm bone marrow scan limited (78102) |
$767.43 |
$1,395.33 |
1.8× |
| Nm bone marrow scan multiple (78103) |
$1,149.93 |
$2,090.78 |
2.8× |
| Nm bone multi (78305) |
$1,140.14 |
$2,072.98 |
2.7× |
| Nm heart perfusion spect stress rest (78452) |
$6,739.73 |
$12,254.06 |
5.0× |
| Nm kidney function (78725) |
$949.31 |
$1,726.01 |
2.3× |
| Nm kidney imaging morphology (78700) |
$826.97 |
$1,503.58 |
2.0× |
| Nm liver image static only (78201) |
$823.71 |
$1,497.65 |
1.5× |
| Nm lymph system (78195) |
$1,212.73 |
$2,204.96 |
2.1× |
| Nm myocard infarct spect (78469) |
$1,768.11 |
$3,214.75 |
3.1× |
| Nm thyroid ca mets limited (78015) |
$704.64 |
$1,281.16 |
1.7× |
| Nm thyroid imaging only (78013) |
$603.50 |
$1,097.28 |
1.4× |
| Nose to rectum for fb child (76010) |
$281.13 |
$511.14 |
3.1× |
| Nuclear medicine study of brain, 4 static views or more (78605) |
$764.79 |
$1,390.53 |
1.3× |
| Nuclear medicine study of brain, less than 4 static views (78600) |
$632.05 |
$1,149.19 |
1.5× |
| Nuclear medicine study of heart muscle following heart attack with measurement of internal blood volume ejected with… (78468) |
$1,267.37 |
$2,304.31 |
2.2× |
| Nuclear medicine study of heart pumping function by labeling red blood cells with measurement of internal blood volume… (78494) |
$2,133.49 |
$3,879.07 |
5.1× |
| Nuclear medicine study of salivary gland with serial images (78231) |
$672.01 |
$1,221.84 |
1.6× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$1,429.66 |
$2,599.39 |
3.4× |
| Nuclear medicine study to assess blood clot in vein using radiolabeled peptide (78456) |
$2,012.06 |
$3,658.29 |
1.5× |
| Nuclear medicine study to assess protein loss into the digestive tract (78282) |
$613.29 |
$1,115.08 |
1.5× |
| Nuclear rx IV admin (79101) |
$2,460.74 |
$4,474.08 |
10.1× |
| Ob us < 14 wks single fetus (76801) |
$224.96 |
$409.02 |
2.1× |
| Ob us nuchal meas 1 gest (76813) |
$310.23 |
$564.06 |
2.8× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$258.36 |
$469.75 |
2.4× |
| Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter Age Under… (76510) |
$139.66 |
$253.93 |
1.0× |
| Oral radiopharm rx (79005) |
$992.37 |
$1,804.30 |
4.1× |
| Parathyrd planar w/spect&CT (78072) |
$624.05 |
$1,134.63 |
1.1× |
| Parathyroid imaging (78070) |
$689.96 |
$1,254.47 |
1.7× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,182.56 |
$2,150.10 |
2.8× |
| Peritoneal-venous shunt patency test (78291) |
$910.16 |
$1,654.83 |
2.2× |
| PET brain metabolic eval (78608) |
$7,401.14 |
$13,456.62 |
5.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$10,358.18 |
$18,833.05 |
6.9× |
| PET imaging CT for attenuation limited area (78814) |
$10,358.18 |
$18,833.05 |
6.9× |
| PET imaging for CT attenuation whole body (78816) |
$10,358.18 |
$18,833.05 |
6.9× |
| PET imaging limited area chest head/neck (78811) |
$9,726.94 |
$17,685.34 |
7.2× |
| PET imaging whole body (78813) |
$8,457.61 |
$15,377.47 |
5.7× |
| Platelet survival study (78191) |
$1,075.72 |
$1,955.85 |
2.6× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Age Under 21 (78812) |
$8,457.61 |
$15,377.47 |
5.7× |
| Pulmonary perfusion imaging particulate (78580) |
$589.22 |
$1,071.30 |
1.4× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$1,045.55 |
$1,901 |
1.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$678.54 |
$1,233.71 |
1.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$360.73 |
$655.88 |
4.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$768.76 |
$1,397.74 |
7.0× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$1,082.19 |
$1,967.62 |
9.9× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$1,442.93 |
$2,623.50 |
13.2× |
| Radex hip unilateral with pelvis 1 view (73501) |
$294.80 |
$536 |
3.2× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$476.38 |
$866.15 |
5.2× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$721.46 |
$1,311.74 |
6.6× |
| Radex hips bilateral with pelvis 2 views (73521) |
$631.28 |
$1,147.78 |
5.8× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$811.64 |
$1,475.71 |
7.4× |
| Radex spine cervical 2 or 3 views (72040) |
$745.77 |
$1,355.95 |
8.2× |
| Radex spine cervical 4 or 5 views (72050) |
$687.58 |
$1,250.14 |
6.3× |
| Radex spine cervical 6 or more views (72052) |
$728.51 |
$1,324.56 |
6.7× |
| Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) |
$523.94 |
$952.61 |
5.8× |
| Radiation delivery stereotactic cranial linear (77372) |
$21,487.83 |
$39,068.78 |
2.8× |
| Radiation tx delivery lvl 1 (77402) |
$191.48 |
$348.15 |
1.8× |
| Radiation tx delivery lvl 2 (77407) |
$911.43 |
$1,657.15 |
2.3× |
| Radiation tx delivery lvl 3 (77412) |
$1,159.25 |
$2,107.72 |
2.0× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$915.05 |
$1,663.73 |
8.4× |
| Radiologic exam phrnx&/crv esoph contrast study (74210) |
$273.38 |
$497.06 |
1.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$486.88 |
$885.24 |
2.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$453.45 |
$824.45 |
2.5× |
| Radiologic Examination Femur 1 View - Xr Femur 1 Vw Right (73551) |
$450.91 |
$819.84 |
5.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$567.17 |
$1,031.22 |
6.2× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$868.14 |
$1,578.43 |
8.0× |
| Radiologic examination, mastoids; less than 3 views per side Other Diagnostic Radiology FS (70120) |
$195.70 |
$355.81 |
1.8× |
| Radiologic examination, salivary gland for calculus Other Diagnostic Radiology FS (70380) |
$203.89 |
$370.70 |
2.2× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Other Diagnostic… (76100) |
$371.08 |
$674.69 |
3.4× |
| Radiologic examination, spine; thoracic, minimum of 4 views Other Diagnostic Radiology FS (72074) |
$472.58 |
$859.24 |
4.3× |
| Radiologic examination, teeth; partial examination, less than full mouth Other Diagnostic Radiology FS (70310) |
$354 |
$643.64 |
1.4× |
| Radiologic examination, teeth; single view Other Diagnostic Radiology FS (70300) |
$145.05 |
$263.72 |
1.6× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Other Diagnostic… (70370) |
$371.08 |
$674.69 |
4.1× |
| Radiopharmaceutical dacryocystography Age Under 21 (78660) |
$677.73 |
$1,232.23 |
1.6× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration UNSCHEDULED (79300) |
$891.73 |
$1,621.32 |
3.7× |
| Radiopharmaceutical therapy, by intra-articular administration Age Under 21 (79440) |
$931.15 |
$1,693 |
3.8× |
| Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) |
$3,209.28 |
$5,835.05 |
13.2× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion UNSCHEDULED (79403) |
$1,565.86 |
$2,847.02 |
6.4× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$398.59 |
$724.71 |
1.0× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$398.59 |
$724.71 |
1.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$883.25 |
$1,605.90 |
2.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,291.02 |
$2,347.31 |
3.1× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$2,310.46 |
$4,200.83 |
4.1× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,012.06 |
$3,658.29 |
3.5× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,577.96 |
$4,687.20 |
4.5× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,012.06 |
$3,658.29 |
1.5× |
| Rp loclzj tum spect CT 2area/sep acquisj img (78832) |
$2,257.77 |
$4,105.03 |
1.5× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,012.06 |
$3,658.29 |
1.5× |
| Rp therapy intra-arterial particulate admn (79445) |
$2,286.16 |
$4,156.65 |
9.4× |
| Saline infused sonohysterogram (76831) |
$403.21 |
$733.11 |
1.6× |
| Salivary gland funct study (78232) |
$657.33 |
$1,195.15 |
1.6× |
| Salivary gland imaging (78230) |
$617.38 |
$1,122.50 |
1.5× |
| Screening digital breast tomosynthesis; bilateral (77063) |
$260.98 |
$474.51 |
11.2× |
| Shoulder arthrogram (73040) |
$1,576.19 |
$2,865.80 |
4.3× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$336.82 |
$612.40 |
3.1× |
| Simulation complex (77290) |
$3,831.61 |
$6,966.57 |
9.8× |
| Simulation intermediate (77285) |
$2,994.33 |
$5,444.23 |
7.7× |
| Simulation simple (77280) |
$2,040.65 |
$3,710.27 |
14.5× |
| Small bowel series (74250) |
$273.38 |
$497.06 |
1.5× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,423.96 |
$2,589.01 |
3.6× |
| Special dosimetry (77331) |
$321.02 |
$583.68 |
2.3× |
| Special physics consult (77370) |
$1,666.12 |
$3,029.30 |
11.9× |
| Special treatment procedure (77470) |
$1,683.95 |
$3,061.73 |
2.9× |
| Speech evaluation complex (70371) |
$643.47 |
$1,169.95 |
2.6× |
| Spleen imaging only (78185) |
$1,172.77 |
$2,132.30 |
2.8× |
| Stereotactic body radiation delivery (77373) |
$4,504.63 |
$8,190.24 |
2.4× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Other Diagnostic Radiology FS (70332) |
$1,135.93 |
$2,065.33 |
4.6× |
| Testicular imaging w/flow (78761) |
$886.51 |
$1,611.83 |
2.1× |
| Therapeutic enema barium or air (74283) |
$862.04 |
$1,567.35 |
4.7× |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Age Under 21 (78016) |
$747.86 |
$1,359.75 |
1.8× |
| Thyroid met imaging body (78018) |
$957.46 |
$1,740.84 |
1.7× |
| Thyroid uptake single/multiple quant measurement (78012) |
$1,052.88 |
$1,914.33 |
2.5× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,311.41 |
$2,384.38 |
3.1× |
| Treatment device intermediate (77333) |
$796.92 |
$1,448.95 |
5.7× |
| Treatment devices complex (77334) |
$1,681.14 |
$3,056.62 |
4.3× |
| Treatment devices simple (77332) |
$653.30 |
$1,187.82 |
4.7× |
| Ultrasound breast limited (76642) |
$177.14 |
$322.08 |
1.9× |
| Ultrasound, abdomen limited (76705) |
$901.35 |
$1,638.81 |
8.3× |
| Ultrasound, elastography; first target lesion (76982) |
$249.56 |
$453.75 |
2.3× |
| Umbilical-artery Doppler (OB) (76820) |
$376.78 |
$685.06 |
3.5× |
| Unlisted CT procedure (76497) |
$2,178.61 |
$3,961.10 |
24.0× |
| Unlisted diagnostic radiographic procedure (76499) |
$1,019.44 |
$1,853.53 |
11.2× |
| Unlisted fluoroscopic procedure (76496) |
$366.99 |
$667.26 |
4.0× |
| Unlisted magnetic resonance procedure (76498) |
$647.87 |
$1,177.95 |
7.1× |
| Unlisted procedure, clinical brachytherapy (77799) |
$1,220.26 |
$2,218.66 |
11.5× |
| Ureteral reflux study (78740) |
$589.22 |
$1,071.30 |
1.4× |
| Urethrocystography retrograde rs&i (74450) |
$515.43 |
$937.15 |
2.1× |
| Urethrocystography voiding (74455) |
$781.30 |
$1,420.55 |
3.1× |
| Urography antegrade (74425) |
$558.52 |
$1,015.49 |
1.5× |
| Urography retrograde w/wo kub (74420) |
$625.53 |
$1,137.33 |
1.7× |
| Urography, infusion, drip technique and/or bolus technique; Other Diagnostic Radiology FS (74410) |
$349.05 |
$634.64 |
1.9× |
| Us abdominal aorta real time screen study aaa (76706) |
$310.23 |
$564.06 |
2.8× |
| Us breast uni real time with image complete (76641) |
$355.26 |
$645.92 |
3.3× |
| Us chest (76604) |
$474.66 |
$863.01 |
4.3× |
| Us compl joint r-t w/image documentation (76881) |
$224.96 |
$409.02 |
2.1× |
| Us elastography parenchyma (76981) |
$249.56 |
$453.75 |
2.3× |
| Us encephalogram (76506) |
$613.62 |
$1,115.68 |
5.6× |
| Us gi endoscopic (76975) |
$651.79 |
$1,185.08 |
2.6× |
| Us guided compression repair (76936) |
$1,018.62 |
$1,852.04 |
4.5× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$611.67 |
$1,112.12 |
6.7× |
| Us kidney transplanted (76776) |
$489.34 |
$889.70 |
4.5× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$335.68 |
$610.33 |
3.1× |
| Us ob detailed single fetus (76811) |
$420.83 |
$765.14 |
1.7× |
| Us ob followup per fetus (76816) |
$351.34 |
$638.80 |
3.2× |
| Us ob limited 1 or more fetuses (76815) |
$416.92 |
$758.03 |
3.8× |
| Us obstetric transvaginal (76817) |
$224.96 |
$409.02 |
2.1× |
| Us pelvic limited or f/u non-ob (76857) |
$462.91 |
$841.65 |
4.2× |
| Us pelvis complete (76856) |
$592.09 |
$1,076.52 |
5.4× |
| Us retroperitoneal complete (76770) |
$706.60 |
$1,284.72 |
6.5× |
| Us retroperitoneal limited (76775) |
$489.34 |
$889.70 |
4.5× |
| Us scrotum (76870) |
$564.69 |
$1,026.70 |
5.2× |
| Us soft tissue head/neck (76536) |
$562.73 |
$1,023.15 |
5.2× |
| Us spinal canal (76800) |
$493.25 |
$896.81 |
4.5× |
| Us transrectal (76872) |
$1,076.53 |
$1,957.33 |
9.9× |
| Us unlstd proc (76999) |
$585.24 |
$1,064.08 |
6.4× |
| Vascular flow imaging (78445) |
$936.25 |
$1,702.28 |
2.2× |
| Venous thrombosis imaging - nm extremity veins thrombosis right (78457) |
$915.87 |
$1,665.22 |
1.6× |
| Vertebral fracture assessment via dxa (77086) |
$155.77 |
$283.22 |
1.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$346.86 |
$630.66 |
3.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$455.65 |
$828.46 |
5.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$693.22 |
$1,260.40 |
3.8× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$549.77 |
$999.58 |
6.0× |
| X-ray exam hips bi 3-4 views (73522) |
$765.12 |
$1,391.12 |
7.0× |
| X-ray exam of finger(s) (73140) |
$357.27 |
$649.59 |
3.9× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$561.10 |
$1,020.18 |
3.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$281.36 |
$511.57 |
3.1× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$462.54 |
$840.99 |
5.1× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$564.78 |
$1,026.87 |
6.2× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$427.94 |
$778.08 |
3.9× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$494.44 |
$898.98 |
5.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$469.12 |
$852.94 |
5.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$452.03 |
$821.88 |
5.0× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$500.74 |
$910.44 |
5.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$612.89 |
$1,114.35 |
5.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$267.75 |
$486.82 |
2.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$532.64 |
$968.44 |
4.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$523.55 |
$951.90 |
4.8× |
| X-Ray Mastoids 3+ Vw - Xr Mastoids 3+ Views (70130) |
$620.46 |
$1,128.10 |
5.7× |
| X-ray perineogram (74775) |
$380.87 |
$692.49 |
1.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$480.08 |
$872.88 |
5.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$493.11 |
$896.56 |
4.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$652.89 |
$1,187.08 |
6.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$285.82 |
$519.67 |
2.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$553.66 |
$1,006.66 |
6.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$519.70 |
$944.90 |
5.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$428.10 |
$778.37 |
4.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$557.72 |
$1,014.03 |
5.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$519.15 |
$943.91 |
4.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$486.07 |
$883.76 |
5.3× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$333.25 |
$605.91 |
3.7× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$455 |
$827.28 |
5.0× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$510.66 |
$928.47 |
5.6× |
| Xr abdomen 1 view (74018) |
$440.78 |
$801.41 |
4.9× |
| Xr abdomen 2 views (74019) |
$587.93 |
$1,068.96 |
5.4× |
| Xr abdomen 3 views (74021) |
$723.39 |
$1,315.26 |
6.6× |
| Xr arthrogram ankle (73615) |
$1,555.08 |
$2,827.42 |
4.3× |
| Xr arthrogram elbow (73085) |
$631.28 |
$1,147.79 |
1.7× |
| Xr arthrogram hip (73525) |
$1,499.63 |
$2,726.60 |
4.1× |
| Xr bone density appendicular (77081) |
$873.87 |
$1,588.86 |
9.6× |
| Xr bone density axial (77080) |
$903.63 |
$1,642.96 |
8.3× |
| Xr bone length study (77073) |
$970.35 |
$1,764.28 |
8.9× |
| Xr bone survey infant (77076) |
$464.44 |
$844.44 |
4.3× |
| Xr bone survey limited (77074) |
$524.86 |
$954.29 |
4.8× |
| Xr chest 1 view (71045) |
$347.61 |
$632.02 |
3.8× |
| Xr chest 2 views (71046) |
$489.48 |
$889.96 |
5.4× |
| Xr chest 3 views (71047) |
$524.08 |
$952.88 |
5.8× |
| Xr cystogram 3+ views (74430) |
$1,340.77 |
$2,437.76 |
3.7× |
| Xr eye foreign body (70030) |
$209.60 |
$381.09 |
2.3× |
| Xr facial bones 3 views (70150) |
$653.56 |
$1,188.29 |
6.0× |
| Xr joint survey 1 view (77077) |
$295.80 |
$537.81 |
2.7× |
| Xr lower extremity 2 views infant (73592) |
$272.25 |
$495 |
3.0× |
| Xr lumbar spine 4 views w/ flex ext (72120) |
$436.23 |
$793.15 |
4.0× |
| Xr mandible 4 views (70110) |
$570.85 |
$1,037.91 |
5.2× |
| Xr myelogram c-spine (72240) |
$1,680.04 |
$3,054.62 |
2.1× |
| Xr nasal bones (70160) |
$415.07 |
$754.68 |
4.6× |
| Xr pelvis 3 views (72190) |
$616.53 |
$1,120.97 |
5.6× |
| Xr sella turcica (70240) |
$414.84 |
$754.26 |
4.6× |
| Xr sialogram (70390) |
$536.81 |
$976.02 |
2.2× |
| Xr spine 1 view (72020) |
$632.98 |
$1,150.87 |
7.0× |
| Xr sternum 2 views (71120) |
$529.93 |
$963.51 |
5.8× |
| Xr stress view joint (77071) |
$233.57 |
$424.68 |
2.6× |
| Xr surgical specimen (76098) |
$762.72 |
$1,386.76 |
1.3× |
| Xr upper extremity 2 views infant (73092) |
$185.06 |
$336.48 |
1.7× |
| Xray elbow 2 views (73070) |
$476.98 |
$867.23 |
5.2× |
| Xray forearm 2 views (73090) |
$562.06 |
$1,021.92 |
6.2× |
| Xray internal auditory meati compl (70134) |
$762.72 |
$1,386.76 |
1.3× |
| Xray knee 1 or 2 views rt (73560) |
$458.04 |
$832.80 |
5.0× |
| Xray neck soft tissue (70360) |
$231.18 |
$420.32 |
2.5× |
| Xray optic foramina (70190) |
$277.76 |
$505.02 |
3.1× |
| Xray orbits complete min 4 views (70200) |
$519.51 |
$944.57 |
4.8× |
| Xray pelvis 1 or 2 views (72170) |
$510.66 |
$928.47 |
4.7× |
| Xray ribs bilateral 3 views (71110) |
$459.94 |
$836.25 |
4.2× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$395.62 |
$719.31 |
3.6× |
| Xray scapula complete (73010) |
$547.06 |
$994.65 |
5.0× |
| Xray shoulder 1 view (73020) |
$263.84 |
$479.70 |
2.9× |
| Xray sinuses paranasal <3 views (70210) |
$244.63 |
$444.78 |
2.7× |
| Xray spine thoracic 2 views (72070) |
$632.15 |
$1,149.36 |
5.8× |
| Xray spine thoracic 3 views (72072) |
$315.65 |
$573.90 |
2.9× |
| Xray tibia-fibula 2 views bil (73590) |
$571.66 |
$1,039.38 |
6.3× |
| Xray tmj open - closed unilat (70328) |
$395.56 |
$719.20 |
4.4× |
| Xray tmj's bilateral open-clsc (70330) |
$349.91 |
$636.20 |
3.9× |