| 3-Dimensional radiotherapy plan including dose-volume histograms (77295) |
$3,297.80 |
$5,996 |
2.3× |
| Acute gi blood loss imaging (78278) |
$1,261.15 |
$2,293 |
3.0× |
| Angio adrenal bilat select (75733) |
$6,264.50 |
$11,390 |
1.9× |
| Angio adrenal unilat select (75731) |
$5,369.65 |
$9,763 |
1.6× |
| Angio extremity unilateral (75710) |
$4,617.25 |
$8,395 |
1.4× |
| Angio pulmonary unilateral (75741) |
$6,156.70 |
$11,194 |
1.9× |
| Angiogram extremity bilateral (75716) |
$9,234.50 |
$16,790 |
2.8× |
| Angiogram pelvic (75736) |
$6,194.65 |
$11,263 |
1.1× |
| Angiography internal mammary rs&i (75756) |
$6,849.42 |
$12,453.50 |
2.1× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$12,312.85 |
$22,387 |
3.7× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$4,645.85 |
$8,447 |
0.8× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$1,571.35 |
$2,857 |
0.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$6,316.75 |
$11,485 |
1.9× |
| Ankle 2 views (73600) |
$244.75 |
$445 |
2.7× |
| Aortography thoracic w/o serialography rs&i (75600) |
$4,710.75 |
$8,565 |
1.4× |
| Arthrography knee lt (73580) |
$993.85 |
$1,807 |
2.7× |
| Arthrography wrist lt (73115) |
$589.05 |
$1,071 |
1.6× |
| Barium enema (74270) |
$367.95 |
$669 |
2.0× |
| Basic dosimetry (77300) |
$354.75 |
$645 |
2.5× |
| Bilat selctv renal venogram (75833) |
$6,156.70 |
$11,194 |
1.9× |
| Bone age studies (77072) |
$282.70 |
$514 |
2.6× |
| Bone imaging limited area (78300) |
$942.70 |
$1,714 |
2.3× |
| Bone marrow imaging whole body (78104) |
$942.70 |
$1,714 |
2.3× |
| Bone survey complete (77075) |
$353.10 |
$642 |
3.2× |
| Bowel imaging (78290) |
$1,261.15 |
$2,293 |
3.0× |
| Brachytx isodose pln cplx w/dosimetry cal (77318) |
$844.25 |
$1,535 |
2.2× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$1,104.95 |
$2,009 |
1.9× |
| Brain image w/flow 4 + views (78606) |
$1,357.40 |
$2,468 |
2.4× |
| Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) |
$783.75 |
$1,425 |
1.9× |
| Card MRI w/stress img & dye (75563) |
$3,333 |
$6,060 |
4.1× |
| Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or… (78483) |
$1,104.95 |
$2,009 |
1.9× |
| Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or… (78481) |
$1,104.95 |
$2,009 |
1.9× |
| Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and… (78473) |
$942.70 |
$1,714 |
2.3× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$1,645.05 |
$2,991 |
4.5× |
| Cardiac shunt detection (78428) |
$942.70 |
$1,714 |
2.3× |
| Cerebrospinal fluid leakage (78650) |
$2,339.15 |
$4,253 |
1.7× |
| Cholecystography, oral contrast Other Diagnostic Radiology FS (74290) |
$390.50 |
$710 |
2.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$353.10 |
$642 |
1.9× |
| Cisternogram (78630) |
$1,104.95 |
$2,009 |
1.9× |
| Clavicle complete (73000) |
$204.05 |
$371 |
2.2× |
| Computed tomographic (CT) colonography, screening, including image postprocessing UNSCHEDULED (74263) |
$1,849.10 |
$3,362 |
7.4× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,201.75 |
$2,185 |
6.6× |
| Continuing medical physics consltj pr wk (77336) |
$367.95 |
$669 |
2.6× |
| Contrast exam abdominl aorta (75625) |
$6,156.70 |
$11,194 |
1.9× |
| Contrast exam thoracic aorta (75605) |
$6,194.65 |
$11,263 |
1.1× |
| Csf shunt evaluation (78645) |
$1,261.15 |
$2,293 |
2.2× |
| CT - st neck w&wo contr (70492) |
$1,324.40 |
$2,408 |
7.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,408 |
$2,560 |
3.9× |
| CT abdomen and pelvis without contrast (74176) |
$1,260.05 |
$2,291 |
5.1× |
| CT abdomen w wo contrast (74170) |
$1,291.68 |
$2,348.50 |
7.1× |
| CT abdomen w/contrast (74160) |
$1,201.75 |
$2,185 |
6.6× |
| CT abdomen w/o contrast (74150) |
$1,085.15 |
$1,973 |
9.9× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$1,408 |
$2,560 |
3.9× |
| CT angio abdom w/o & w/dye (74175) |
$1,201.75 |
$2,185 |
6.6× |
| CT angio abdominal arteries (75635) |
$1,201.75 |
$2,185 |
6.6× |
| CT angio hrt w/3d image (75574) |
$1,201.75 |
$2,185 |
3.3× |
| CT angiograph pelv w/o&w/dye (72191) |
$952.05 |
$1,731 |
5.2× |
| CT cervical spine w/contrast (72126) |
$1,198.45 |
$2,179 |
3.3× |
| CT cervical spine w/o contrast (72125) |
$1,141.25 |
$2,075 |
10.5× |
| CT chest w/contrast (71260) |
$1,261.70 |
$2,294 |
6.9× |
| CT colonography diag w cont (74262) |
$952.05 |
$1,731 |
5.2× |
| CT colonography w/o cntrst (74261) |
$952.05 |
$1,731 |
8.7× |
| CT extremity upper w & w/o contrast (73202) |
$952.05 |
$1,731 |
5.2× |
| CT head/brain with contrast (70460) |
$1,201.75 |
$2,185 |
6.6× |
| CT head/brain without and with contrast (70470) |
$1,450.62 |
$2,637.50 |
7.9× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,201.75 |
$2,185 |
3.3× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$952.05 |
$1,731 |
10.5× |
| CT hrt w/3d image congen (75573) |
$952.05 |
$1,731 |
2.6× |
| CT limited/localized follow up study (76380) |
$182.05 |
$331 |
2.0× |
| CT lower ext w/wo contrast (73702) |
$952.05 |
$1,731 |
5.2× |
| CT lower extremity w contrast (73701) |
$1,201.75 |
$2,185 |
6.6× |
| CT lower extremity w/o contrast unilateral (73700) |
$1,201.75 |
$2,185 |
11.0× |
| CT lumbar spine w/contrast (72132) |
$1,375.55 |
$2,501 |
3.8× |
| CT lumbar spine w/o contrast (72131) |
$1,285.35 |
$2,337 |
11.8× |
| CT lumbar spine w/o then w/ con (72133) |
$1,444.30 |
$2,626 |
7.9× |
| CT maxillofacial area w/o contrast (70486) |
$1,201.75 |
$2,185 |
11.0× |
| CT maxillofacial w/contrast (70487) |
$1,261.70 |
$2,294 |
6.9× |
| CT maxillofacial w/o then w/ con (70488) |
$1,324.40 |
$2,408 |
7.2× |
| CT orbit sella ear w/o con (70480) |
$1,201.75 |
$2,185 |
11.0× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$952.05 |
$1,731 |
5.2× |
| CT pelvis w & w/o contrast (72194) |
$1,138.22 |
$2,069.50 |
6.2× |
| CT pelvis w/o contrast (72192) |
$1,201.75 |
$2,185 |
11.0× |
| CT soft tissue neck w/contrast (70491) |
$1,261.70 |
$2,294 |
6.9× |
| CT soft tissue neck w/o contrast (70490) |
$1,201.75 |
$2,185 |
11.0× |
| CT spine cervical w/wo contrast (72127) |
$1,258.95 |
$2,289 |
6.9× |
| CT thoracic spine w/contrast (72129) |
$1,285.35 |
$2,337 |
7.0× |
| CT thoracic spine w/o contrast (72128) |
$1,201.75 |
$2,185 |
11.0× |
| CT thoracic spine w/o then w/ con (72130) |
$1,349.70 |
$2,454 |
7.4× |
| CT thorax lung cancer scr c- (71271) |
$1,201.75 |
$2,185 |
11.0× |
| CT thorax w/o contrast (71250) |
$1,201.75 |
$2,185 |
11.0× |
| CT thorax w/o then w/ contrast (71270) |
$1,381.60 |
$2,512 |
7.5× |
| CT upper extremity w/dye (73201) |
$1,201.75 |
$2,185 |
3.3× |
| CT upper extremity w/o contrast rt (73200) |
$1,201.75 |
$2,185 |
11.0× |
| CTA chest w/wo contrast (71275) |
$1,201.75 |
$2,185 |
6.6× |
| CTA head w contrast (70496) |
$1,699.50 |
$3,090 |
9.3× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$686.40 |
$1,248 |
1.9× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$1,201.75 |
$2,185 |
6.6× |
| Cta Neck (70498) |
$1,201.75 |
$2,185 |
6.6× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$952.05 |
$1,731 |
5.2× |
| Dilation ureters/urethra rs&i (74485) |
$3,917.65 |
$7,123 |
1.8× |
| Discography, cervical or thoracic, radiological supervision and interpretation Other Diagnostic Radiology FS (72285) |
$3,841.75 |
$6,985 |
1.9× |
| Diskography lumbar (72295) |
$7,943.65 |
$14,443 |
3.9× |
| Doppler echo fetal spectral display complete (76827) |
$376.20 |
$684 |
3.4× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$376.20 |
$684 |
3.4× |
| Doppler fetal mid cerebral artery (76821) |
$245.30 |
$446 |
2.2× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$1,006.50 |
$1,830 |
4.0× |
| Esophageal motility (78258) |
$1,261.15 |
$2,293 |
3.0× |
| Esophogram (74220) |
$367.95 |
$669 |
2.0× |
| Fetal biophysical profile non-stress testing (76818) |
$363.55 |
$661 |
3.3× |
| Fetal biophysical profile w/o nst (76819) |
$376.20 |
$684 |
3.4× |
| Fetal echo complete (76825) |
$1,054.35 |
$1,917 |
1.8× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$671.55 |
$1,221 |
2.7× |
| Functional MRI brain by phys/psych (70555) |
$1,323.85 |
$2,407 |
5.3× |
| Functional MRI brain by tech (70554) |
$1,323.85 |
$2,407 |
5.3× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit Age Under 21 (78265) |
$849.20 |
$1,544 |
2.0× |
| Gastric emptying study (78264) |
$1,497.65 |
$2,723 |
3.6× |
| Gastroesophageal reflux study (78262) |
$1,261.15 |
$2,293 |
3.0× |
| Gated heart planar single (78472) |
$1,261.15 |
$2,293 |
3.0× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,492.70 |
$2,714 |
2.1× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$2,406.25 |
$4,375 |
3.3× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$1,925 |
$3,500 |
2.6× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$6,156.70 |
$11,194 |
1.9× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Other… (75889) |
$4,617.25 |
$8,395 |
1.4× |
| Hepatobil syst image w/drug (78227) |
$1,530.65 |
$2,783 |
2.7× |
| Hepatobiliary system imaging (78226) |
$1,493.25 |
$2,715 |
3.6× |
| Humerus min 2 views (73060) |
$204.05 |
$371 |
2.2× |
| Hysterosalpingography (74740) |
$405.35 |
$737 |
1.6× |
| Imrt planning (77301) |
$3,379.20 |
$6,144 |
2.3× |
| Infusion of radioelement (77750) |
$623.15 |
$1,133 |
1.5× |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
$849.20 |
$1,544 |
2.0× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$1,925 |
$3,500 |
2.6× |
| Intracavitary radiation source applic intermed (77762) |
$1,259.50 |
$2,290 |
2.2× |
| Intracavitary radiation source applic simple (77761) |
$1,259.50 |
$2,290 |
2.2× |
| Intraoperative radiation treatment delivery, x-ray, single treatment session 2nd-5th Sessions (77424) |
$19,817.60 |
$36,032 |
2.6× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$844.25 |
$1,535 |
2.2× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$430.10 |
$782 |
1.1× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$1,056 |
$1,920 |
2.7× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$600.05 |
$1,091 |
1.5× |
| Ivp (74400) |
$390.50 |
$710 |
2.1× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$1,261.15 |
$2,293 |
2.2× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,240.80 |
$2,256 |
2.2× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,415.70 |
$2,574 |
2.5× |
| Kidney w vascular flow (78701) |
$849.20 |
$1,544 |
2.0× |
| Labeled red cell sequestration, differential organ/tissue (eg, splenic and/or hepatic) Age Under 21 (78140) |
$1,261.15 |
$2,293 |
3.0× |
| Liver & spleen; static only (78215) |
$741.40 |
$1,348 |
1.8× |
| Liver & spleen; w vasc flow (78216) |
$741.40 |
$1,348 |
1.8× |
| Liver imaging w/vascular flow (78202) |
$2,578.95 |
$4,689 |
4.5× |
| Lung perf&ventilat diferentl (78598) |
$1,647.25 |
$2,995 |
2.9× |
| Lung perfusion differential (78597) |
$1,338.15 |
$2,433 |
3.2× |
| Lung ventilat&perfus imaging (78582) |
$1,530.65 |
$2,783 |
2.7× |
| Lung ventilation imaging (78579) |
$849.20 |
$1,544 |
2.0× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75803) |
$1,571.35 |
$2,857 |
1.0× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75801) |
$533.50 |
$970 |
0.8× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75807) |
$6,130.30 |
$11,146 |
1.9× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$6,264.50 |
$11,390 |
1.9× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$1,658.25 |
$3,015 |
4.6× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$1,658.25 |
$3,015 |
4.6× |
| Mammary ductogram multiple ducts (77054) |
$437.25 |
$795 |
1.8× |
| Mammary ductogram single (77053) |
$437.25 |
$795 |
1.8× |
| Mlc device(s) for imrt (77338) |
$986.70 |
$1,794 |
2.5× |
| Mr safety determination physician/other qhp (76016) |
$179.67 |
$326.67 |
2.0× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$121.20 |
$220.37 |
2.0× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$49.97 |
$90.86 |
1.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$187.30 |
$340.55 |
1.9× |
| Mr safety med physics xm customization plng&mntr (76017) |
$554.44 |
$1,008.08 |
2.2× |
| MRA head w & w/o contrast (70546) |
$1,590.60 |
$2,892 |
4.4× |
| MRA head w/contrast (70545) |
$1,485.55 |
$2,701 |
4.1× |
| MRA head w/o contrast (70544) |
$1,368.95 |
$2,489 |
5.5× |
| MRA neck w/contrast (70548) |
$1,368.95 |
$2,489 |
3.8× |
| MRA neck w/o contrast (70547) |
$1,323.85 |
$2,407 |
5.3× |
| MRA neck w/wo contrast (70549) |
$1,658.25 |
$3,015 |
4.6× |
| MRI abdomen w/contrast (74182) |
$1,366.20 |
$2,484 |
3.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,658.25 |
$3,015 |
4.6× |
| MRI abdomen w/o contrast (74181) |
$1,584 |
$2,880 |
6.4× |
| MRI any jnt lwr ext with con lt (73722) |
$1,584 |
$2,880 |
1.9× |
| MRI bone marrow (77084) |
$519.20 |
$944 |
2.1× |
| MRI breast without contrast bilateral (77047) |
$1,323.85 |
$2,407 |
5.3× |
| MRI breast without contrast material unilateral (77046) |
$519.20 |
$944 |
2.1× |
| MRI cardiac w/o contrast (75557) |
$1,323.85 |
$2,407 |
5.3× |
| MRI cervical spine w/o contrast (72141) |
$1,606.55 |
$2,921 |
6.4× |
| MRI cervical spine with contrast (72142) |
$1,366.20 |
$2,484 |
3.8× |
| MRI chest w & w/o contrast (71552) |
$1,366.20 |
$2,484 |
3.8× |
| MRI chest w/contrast (71551) |
$1,327.15 |
$2,413 |
1.6× |
| MRI chest w/o contrast (71550) |
$1,323.85 |
$2,407 |
5.3× |
| MRI elastography (76391) |
$1,323.85 |
$2,407 |
5.3× |
| MRI fetal sngl/1st gestation (74712) |
$1,323.85 |
$2,407 |
5.3× |
| MRI joint upper ext w/contrast (73222) |
$1,610.95 |
$2,929 |
2.0× |
| MRI joint upr extr w/o&w/dye (73223) |
$1,658.25 |
$3,015 |
4.6× |
| MRI joint upr extrem w/o dye (73221) |
$1,507 |
$2,740 |
6.0× |
| Mri Lower Extremity W/O Dye (73718) |
$1,513.05 |
$2,751 |
6.1× |
| MRI lumbar spine with contrast (72149) |
$1,366.20 |
$2,484 |
3.8× |
| MRI lumbar w/wo contrast (72158) |
$1,658.25 |
$3,015 |
4.6× |
| MRI lwr ext w/o jnts with con rt (73719) |
$1,323.85 |
$2,407 |
3.6× |
| MRI orbit/face/neck w/contrast (70542) |
$1,366.20 |
$2,484 |
3.8× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$1,658.25 |
$3,015 |
4.6× |
| MRI orbit/face/neck w/o contrast (70540) |
$1,323.85 |
$2,407 |
5.3× |
| MRI pelvis w/ contrast (72196) |
$1,366.20 |
$2,484 |
3.8× |
| MRI pelvis w/o contrast (72195) |
$1,330.45 |
$2,419 |
5.3× |
| MRI pelvis w/wo contrast (72197) |
$1,658.25 |
$3,015 |
4.6× |
| MRI spectroscopy (76390) |
$1,323.85 |
$2,407 |
14.6× |
| MRI spine cervical wo/w contrast (72156) |
$1,658.25 |
$3,015 |
4.6× |
| MRI spine thoracic w/contrast (72147) |
$1,366.20 |
$2,484 |
3.8× |
| MRI thoracic spine w wo contrast (72157) |
$1,658.25 |
$3,015 |
4.6× |
| MRI thoracic spine w/o contrast (72146) |
$1,606.55 |
$2,921 |
6.4× |
| MRI tmj (70336) |
$1,323.85 |
$2,407 |
5.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,451.45 |
$2,639 |
5.8× |
| Mri Upper Extremity W/Dye (73219) |
$1,323.85 |
$2,407 |
3.6× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$1,658.25 |
$3,015 |
4.6× |
| Myelography 2 or more regions (72270) |
$1,892 |
$3,440 |
2.3× |
| Myelography lumbosacral (72265) |
$1,892 |
$3,440 |
2.3× |
| Myocardial perfusion planar 1 study rest/stress (78453) |
$3,239.50 |
$5,890 |
2.4× |
| Myocardial perfusion planar multiple studies (78454) |
$3,239.50 |
$5,890 |
2.4× |
| Myocardial spect single study at rest or stress (78451) |
$3,239.50 |
$5,890 |
2.4× |
| Myocrd img PET metab eval single study (78459) |
$3,135 |
$5,700 |
2.3× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$3,135 |
$5,700 |
2.1× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$3,135 |
$5,700 |
2.1× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$3,802.70 |
$6,914 |
1.7× |
| Myocrd img PET prfuj w/metab 2rtracer cncrnt CT (78433) |
$3,295.60 |
$5,992 |
1.4× |
| Myocrd img PET prfuj w/metab dual radiotracer (78432) |
$3,135 |
$5,700 |
2.0× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$2,201.10 |
$4,002 |
2.5× |
| Nm adrenal imaging (78075) |
$3,239.50 |
$5,890 |
2.4× |
| Nm bone 3 phase (78315) |
$1,530.65 |
$2,783 |
3.7× |
| Nm bone imaging whole body (78306) |
$1,414.05 |
$2,571 |
3.4× |
| Nm bone marrow scan multiple (78103) |
$849.20 |
$1,544 |
2.0× |
| Nm bone multi (78305) |
$849.20 |
$1,544 |
2.0× |
| Nm heart perfusion spect stress rest (78452) |
$3,239.50 |
$5,890 |
2.4× |
| Nm kidney function (78725) |
$1,261.15 |
$2,293 |
3.0× |
| Nm liver image static only (78201) |
$1,104.95 |
$2,009 |
1.9× |
| Nm lymph system (78195) |
$1,530.65 |
$2,783 |
2.7× |
| Nm thyroid imaging only (78013) |
$783.75 |
$1,425 |
1.9× |
| Nose to rectum for fb child (76010) |
$443.30 |
$806 |
4.9× |
| Nuclear medicine study of heart pumping function by labeling red blood cells with measurement of internal blood volume… (78494) |
$849.20 |
$1,544 |
2.0× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$1,261.15 |
$2,293 |
3.0× |
| Nuclear rx IV admin (79101) |
$605 |
$1,100 |
2.5× |
| Ob us < 14 wks single fetus (76801) |
$245.30 |
$446 |
2.2× |
| Ob us nuchal meas 1 gest (76813) |
$245.30 |
$446 |
2.2× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$239.25 |
$435 |
2.2× |
| Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter Age Under… (76510) |
$257.95 |
$469 |
1.9× |
| Oral radiopharm rx (79005) |
$1,261.15 |
$2,293 |
5.2× |
| Orthopantogram (70355) |
$163.35 |
$297 |
1.8× |
| Parathyrd planar w/spect&CT (78072) |
$1,261.15 |
$2,293 |
2.2× |
| Parathyroid imaging (78070) |
$1,261.15 |
$2,293 |
3.0× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$942.70 |
$1,714 |
2.3× |
| Peritoneal-venous shunt patency test (78291) |
$1,261.15 |
$2,293 |
3.0× |
| Peritoneogram rs&i (74190) |
$991.10 |
$1,802 |
1.7× |
| PET brain metabolic eval (78608) |
$4,334 |
$7,880 |
2.9× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$4,117.30 |
$7,486 |
2.8× |
| PET imaging CT for attenuation limited area (78814) |
$3,407.80 |
$6,196 |
2.3× |
| PET imaging for CT attenuation whole body (78816) |
$4,334 |
$7,880 |
2.9× |
| PET imaging limited area chest head/neck (78811) |
$3,135 |
$5,700 |
2.3× |
| PET imaging whole body (78813) |
$3,915.45 |
$7,119 |
2.6× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Age Under 21 (78812) |
$3,915.45 |
$7,119 |
2.6× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,999.80 |
$3,636 |
0.6× |
| Pulmonary perfusion imaging particulate (78580) |
$1,297.45 |
$2,359 |
3.1× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$1,829.85 |
$3,327 |
1.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$658.35 |
$1,197 |
1.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$134.75 |
$245 |
1.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$309.65 |
$563 |
2.8× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$513.15 |
$933 |
4.7× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$513.15 |
$933 |
4.7× |
| Radex hip unilateral with pelvis 1 view (73501) |
$168.30 |
$306 |
1.9× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$226.60 |
$412 |
2.5× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$248.05 |
$451 |
2.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$309.65 |
$563 |
2.8× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$641.30 |
$1,166 |
5.9× |
| Radex spine cervical 2 or 3 views (72040) |
$367.95 |
$669 |
4.0× |
| Radex spine cervical 4 or 5 views (72050) |
$353.10 |
$642 |
3.2× |
| Radex spine cervical 6 or more views (72052) |
$353.10 |
$642 |
3.2× |
| Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) |
$204.05 |
$371 |
2.2× |
| Radiation delivery stereotactic cranial linear (77372) |
$18,521.25 |
$33,675 |
2.4× |
| Radiation tx delivery lvl 1 (77402) |
$375.65 |
$683 |
3.5× |
| Radiation tx delivery lvl 2 (77407) |
$367.95 |
$669 |
0.9× |
| Radiation tx delivery lvl 3 (77412) |
$646.25 |
$1,175 |
1.1× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$282.70 |
$514 |
2.6× |
| Radiologic exam esophagus double contrast study (74221) |
$294.25 |
$535 |
1.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$367.95 |
$669 |
2.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$320.65 |
$583 |
1.8× |
| Radiologic Examination Femur 1 View - Xr Femur 1 Vw Right (73551) |
$134.75 |
$245 |
1.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$168.30 |
$306 |
1.9× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$557.15 |
$1,013 |
5.1× |
| Radiologic examination, salivary gland for calculus Other Diagnostic Radiology FS (70380) |
$177.65 |
$323 |
2.0× |
| Radiologic examination, spine; thoracic, minimum of 4 views Other Diagnostic Radiology FS (72074) |
$282.70 |
$514 |
2.6× |
| Radiologic examination, teeth; single view Other Diagnostic Radiology FS (70300) |
$177.65 |
$323 |
2.0× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Other Diagnostic… (70370) |
$168.30 |
$306 |
1.9× |
| Radiopharmaceutical dacryocystography Age Under 21 (78660) |
$681.45 |
$1,239 |
1.6× |
| Radiopharmaceutical therapy, by intra-articular administration Age Under 21 (79440) |
$621.50 |
$1,130 |
2.6× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion UNSCHEDULED (79403) |
$588.50 |
$1,070 |
2.4× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$517 |
$940 |
1.3× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$566.50 |
$1,030 |
1.4× |
| Renal cyst study (74470) |
$1,058.20 |
$1,924 |
1.9× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$783.75 |
$1,425 |
1.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$849.20 |
$1,544 |
2.0× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$3,239.50 |
$5,890 |
5.7× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,967.90 |
$3,578 |
3.5× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,813.25 |
$5,115 |
5.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,647.25 |
$2,995 |
1.2× |
| Rp loclzj tum spect CT 2area/sep acquisj img (78832) |
$1,647.25 |
$2,995 |
1.1× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,647.25 |
$2,995 |
1.2× |
| Rp therapy intra-arterial particulate admn (79445) |
$506.55 |
$921 |
2.1× |
| Saline infused sonohysterogram (76831) |
$457.60 |
$832 |
1.8× |
| Salivary gland funct study (78232) |
$732.60 |
$1,332 |
1.8× |
| Screening digital breast tomosynthesis; bilateral (77063) |
$136.40 |
$248 |
5.8× |
| Selective spinal angiogram (75705) |
$3,873.65 |
$7,043 |
0.7× |
| Shoulder arthrogram (73040) |
$993.85 |
$1,807 |
2.7× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$248.05 |
$451 |
2.3× |
| Simulation complex (77290) |
$986.70 |
$1,794 |
2.5× |
| Simulation intermediate (77285) |
$789.25 |
$1,435 |
2.0× |
| Simulation simple (77280) |
$515.90 |
$938 |
3.7× |
| Small bowel series (74250) |
$282.70 |
$514 |
1.5× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$789.25 |
$1,435 |
2.0× |
| Special dosimetry (77331) |
$294.25 |
$535 |
2.1× |
| Special physics consult (77370) |
$489.50 |
$890 |
3.5× |
| Special treatment procedure (77470) |
$1,259.50 |
$2,290 |
2.2× |
| Speech evaluation complex (70371) |
$303.05 |
$551 |
1.2× |
| Spleen imaging only (78185) |
$783.75 |
$1,425 |
1.9× |
| Splenoportography (75810) |
$5,419.15 |
$9,853 |
1.6× |
| Stereotactic body radiation delivery (77373) |
$5,145.80 |
$9,356 |
2.8× |
| Superior sagittal sinus venogram (75870) |
$6,506.50 |
$11,830 |
2.0× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Other Diagnostic Radiology FS (70332) |
$504.35 |
$917 |
2.0× |
| Testicular imaging w/flow (78761) |
$849.20 |
$1,544 |
2.0× |
| Therapeutic enema barium or air (74283) |
$513.15 |
$933 |
2.8× |
| Thyroid met imaging body (78018) |
$1,552.65 |
$2,823 |
2.7× |
| Thyroid uptake single/multiple quant measurement (78012) |
$888.25 |
$1,615 |
2.1× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,144.55 |
$2,081 |
2.7× |
| Treatment device intermediate (77333) |
$402.05 |
$731 |
2.9× |
| Treatment devices complex (77334) |
$828.30 |
$1,506 |
2.1× |
| Treatment devices simple (77332) |
$231.55 |
$421 |
1.6× |
| Ultrasound breast limited (76642) |
$332.75 |
$605 |
3.7× |
| Ultrasound, abdomen limited (76705) |
$455.95 |
$829 |
4.2× |
| Ultrasound, elastography; first target lesion (76982) |
$266.75 |
$485 |
2.4× |
| Umbilical-artery Doppler (OB) (76820) |
$245.30 |
$446 |
2.2× |
| Unlisted diagnostic radiographic procedure (76499) |
$177.65 |
$323 |
2.0× |
| Unlisted fluoroscopic procedure (76496) |
$134.75 |
$245 |
1.5× |
| Unlisted gastrointestinal procedure, diagnostic nuclear medicine UNSCHEDULED (78299) |
$849.20 |
$1,544 |
2.0× |
| Unlisted magnetic resonance procedure (76498) |
$153.45 |
$279 |
1.7× |
| Unlisted procedure, clinical brachytherapy (77799) |
$264 |
$480 |
2.5× |
| Ureteral reflux study (78740) |
$849.20 |
$1,544 |
2.0× |
| Urethrocystography retrograde rs&i (74450) |
$574.20 |
$1,044 |
2.3× |
| Urethrocystography voiding (74455) |
$699.60 |
$1,272 |
2.8× |
| Urography antegrade (74425) |
$1,144.55 |
$2,081 |
3.1× |
| Urography retrograde w/wo kub (74420) |
$1,086.25 |
$1,975 |
3.0× |
| Us abdominal aorta real time screen study aaa (76706) |
$290.40 |
$528 |
2.7× |
| Us breast uni real time with image complete (76641) |
$450.45 |
$819 |
4.1× |
| Us chest (76604) |
$323.95 |
$589 |
3.0× |
| Us compl joint r-t w/image documentation (76881) |
$566.50 |
$1,030 |
5.2× |
| Us elastography parenchyma (76981) |
$266.75 |
$485 |
2.4× |
| Us encephalogram (76506) |
$266.75 |
$485 |
2.4× |
| Us gi endoscopic (76975) |
$524.15 |
$953 |
2.1× |
| Us guided compression repair (76936) |
$606.10 |
$1,102 |
2.7× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$278.85 |
$507 |
3.1× |
| Us kidney transplanted (76776) |
$466.95 |
$849 |
4.3× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$290.95 |
$529 |
2.7× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$239.25 |
$435 |
2.2× |
| Us ob detailed single fetus (76811) |
$398.20 |
$724 |
1.6× |
| Us ob followup per fetus (76816) |
$239.25 |
$435 |
2.2× |
| Us ob limited 1 or more fetuses (76815) |
$376.20 |
$684 |
3.4× |
| Us obstetric transvaginal (76817) |
$466.95 |
$849 |
4.3× |
| Us pelvic limited or f/u non-ob (76857) |
$239.25 |
$435 |
2.2× |
| Us pelvis complete (76856) |
$566.50 |
$1,030 |
5.2× |
| Us retroperitoneal complete (76770) |
$546.70 |
$994 |
5.0× |
| Us retroperitoneal limited (76775) |
$455.95 |
$829 |
4.2× |
| Us scrotum (76870) |
$566.50 |
$1,030 |
5.2× |
| Us soft tissue head/neck (76536) |
$566.50 |
$1,030 |
5.2× |
| Us spinal canal (76800) |
$292.05 |
$531 |
2.7× |
| Us transrectal (76872) |
$301.95 |
$549 |
2.8× |
| Us unlstd proc (76999) |
$184.80 |
$336 |
2.0× |
| Vein X-ray liver w/hemodynam (75885) |
$6,156.70 |
$11,194 |
1.9× |
| Venogram extremity bilateral (75822) |
$2,670.25 |
$4,855 |
1.6× |
| Venogram ivc w serialography (75825) |
$4,074.95 |
$7,409 |
1.2× |
| Venogram svc w serialography (75827) |
$1,513.05 |
$2,751 |
0.9× |
| Venography adrenal unilateral selective rs&i (75840) |
$6,156.70 |
$11,194 |
1.9× |
| Venography ext unilateral (75820) |
$1,669.25 |
$3,035 |
1.0× |
| Venography renal unilateral selective rs&i (75831) |
$6,156.70 |
$11,194 |
1.9× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,258.75 |
$5,925 |
1.0× |
| Venous sampling by catheter (75893) |
$6,194.65 |
$11,263 |
1.1× |
| Venous thrombosis imaging - nm extremity veins thrombosis right (78457) |
$1,261.15 |
$2,293 |
2.2× |
| Vertebral fracture assessment via dxa (77086) |
$177.65 |
$323 |
2.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$163.35 |
$297 |
1.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$303.05 |
$551 |
3.3× |
| X-ray aorta leg arteries (75630) |
$6,215 |
$11,300 |
1.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$513.15 |
$933 |
2.8× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$204.05 |
$371 |
2.2× |
| X-ray exam hips bi 3-4 views (73522) |
$309.65 |
$563 |
2.8× |
| X-ray exam of finger(s) (73140) |
$171.05 |
$311 |
1.9× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$488.40 |
$888 |
2.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$134.75 |
$245 |
1.5× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$218.90 |
$398 |
2.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$229.90 |
$418 |
2.5× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$329.45 |
$599 |
3.0× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$345.95 |
$629 |
3.8× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$189.75 |
$345 |
2.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$221.65 |
$403 |
2.4× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$262.35 |
$477 |
2.9× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$315.15 |
$573 |
2.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$331.10 |
$602 |
3.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$353.10 |
$642 |
3.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$389.40 |
$708 |
3.6× |
| X-Ray Mastoids 3+ Vw - Xr Mastoids 3+ Views (70130) |
$282.70 |
$514 |
2.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$204.05 |
$371 |
2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$341 |
$620 |
3.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$353.10 |
$642 |
3.2× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$309.65 |
$563 |
2.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$204.05 |
$371 |
2.2× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$204.05 |
$371 |
2.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$171.60 |
$312 |
1.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$370.70 |
$674 |
3.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$353.10 |
$642 |
3.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$163.35 |
$297 |
1.8× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$189.75 |
$345 |
2.1× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$189.75 |
$345 |
2.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$204.05 |
$371 |
2.2× |
| Xr abdomen 1 view (74018) |
$204.05 |
$371 |
2.2× |
| Xr abdomen 2 views (74019) |
$265.65 |
$483 |
2.4× |
| Xr abdomen 3 views (74021) |
$440.55 |
$801 |
4.0× |
| Xr arthrogram ankle (73615) |
$999.90 |
$1,818 |
2.7× |
| Xr arthrogram elbow (73085) |
$993.85 |
$1,807 |
2.7× |
| Xr arthrogram hip (73525) |
$993.85 |
$1,807 |
2.7× |
| Xr bone density appendicular (77081) |
$163.35 |
$297 |
1.8× |
| Xr bone density axial (77080) |
$353.10 |
$642 |
3.2× |
| Xr bone length study (77073) |
$166.10 |
$302 |
1.5× |
| Xr bone survey infant (77076) |
$282.70 |
$514 |
2.6× |
| Xr bone survey limited (77074) |
$282.70 |
$514 |
2.6× |
| Xr chest 1 view (71045) |
$163.35 |
$297 |
1.8× |
| Xr chest 2 views (71046) |
$198 |
$360 |
2.2× |
| Xr chest 3 views (71047) |
$242 |
$440 |
2.7× |
| Xr cystogram 3+ views (74430) |
$619.85 |
$1,127 |
1.7× |
| Xr eye foreign body (70030) |
$163.35 |
$297 |
1.8× |
| Xr facial bones 3 views (70150) |
$282.70 |
$514 |
2.6× |
| Xr joint survey 1 view (77077) |
$242 |
$440 |
2.2× |
| Xr lower extremity 2 views infant (73592) |
$163.35 |
$297 |
1.8× |
| Xr lumbar spine 4 views w/ flex ext (72120) |
$408.65 |
$743 |
3.7× |
| Xr mandible 4 views (70110) |
$282.70 |
$514 |
2.6× |
| Xr nasal bones (70160) |
$163.35 |
$297 |
1.8× |
| Xr pelvis 3 views (72190) |
$353.10 |
$642 |
3.2× |
| Xr sella turcica (70240) |
$177.65 |
$323 |
2.0× |
| Xr sialogram (70390) |
$472.45 |
$859 |
1.9× |
| Xr spine 1 view (72020) |
$204.05 |
$371 |
2.2× |
| Xr sternum 2 views (71120) |
$163.35 |
$297 |
1.8× |
| Xr stress view joint (77071) |
$134.75 |
$245 |
1.5× |
| Xr surgical specimen (76098) |
$707.30 |
$1,286 |
1.2× |
| Xr upper extremity 2 views infant (73092) |
$282.70 |
$514 |
2.6× |
| Xray elbow 2 views (73070) |
$204.05 |
$371 |
2.2× |
| Xray forearm 2 views (73090) |
$188.65 |
$343 |
2.1× |
| Xray internal auditory meati compl (70134) |
$1,058.20 |
$1,924 |
1.9× |
| Xray knee 1 or 2 views rt (73560) |
$204.05 |
$371 |
2.2× |
| Xray neck soft tissue (70360) |
$204.05 |
$371 |
2.2× |
| Xray optic foramina (70190) |
$163.35 |
$297 |
1.8× |
| Xray orbits complete min 4 views (70200) |
$353.10 |
$642 |
3.2× |
| Xray pelvis 1 or 2 views (72170) |
$353.10 |
$642 |
3.2× |
| Xray ribs bilateral 3 views (71110) |
$353.10 |
$642 |
3.2× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$341 |
$620 |
3.1× |
| Xray scapula complete (73010) |
$207.35 |
$377 |
1.9× |
| Xray shoulder 1 view (73020) |
$161.70 |
$294 |
1.8× |
| Xray sinuses paranasal <3 views (70210) |
$163.35 |
$297 |
1.8× |
| Xray spine thoracic 2 views (72070) |
$294.25 |
$535 |
2.7× |
| Xray spine thoracic 3 views (72072) |
$265.65 |
$483 |
2.4× |
| Xray tibia-fibula 2 views bil (73590) |
$204.05 |
$371 |
2.2× |
| Xray tmj open - closed unilat (70328) |
$163.35 |
$297 |
1.8× |
| Xray tmj's bilateral open-clsc (70330) |
$163.35 |
$297 |
1.8× |