Imaging prices at UMass Memorial Health–Milford Regional Medical Center

Milford, MA · every code in this section with a posted price and a Medicare benchmark.

294 codes. Prices are the hospital's own posted facility charges.

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $487 $487 3.9×
Acute gi blood loss imaging (78278) $1,215 $1,215 2.5×
Acute venous thrombosis imaging, peptide Non-Facility (78456) $3,456 $3,456 2.2×
Angio Adrenal Bilat Select (75733) $10,800 $10,800 2.9×
Angiography extremity bilateral rs&i (75716) $10,800 $10,800 2.9×
Angiography extremity unilateral rs&i (75710) $10,800 $10,800 2.9×
Angiography pelvic slctv/supraslctv rs&i (75736) $10,985 $10,985 1.6×
Angiography pulmonary bilateral slctv rs&i (75743) $10,800 $10,800 2.9×
Angiography pulmonary unilateral slctv rs&i (75741) $10,800 $10,800 2.9×
Angiography visceral slctv/supraslctv rs&i (75726) $16,912 $16,912 2.5×
Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) $3,101 $3,101 0.8×
Angrph pulmonary nonslctv cath/ven njx rs&i (75746) $10,800 $10,800 2.9×
Ankle 2 views (73600) $487 $487 4.7×
Aortogram thoracic (75605) $10,985 $10,985 1.6×
Aortography abdl bi iliofem low extrem cath rs&i (75630) $10,800 $10,800 2.9×
Aortography abdominal serialography rs&i (75625) $10,800 $10,800 2.9×
Artery X-Rays Adrenal Gland (75731) $10,800 $10,800 2.9×
Arthrogram ankle (73615) $1,274 $1,274 3.0×
Arthrogram elbow (73085) $1,274 $1,274 3.0×
Arthrogram hip (73525) $1,274 $1,274 3.0×
Arthrogram knee (73580) $1,274 $1,274 3.0×
Arthrogram shoulder (73040) $1,274 $1,274 3.0×
Arthrogram wrist (73115) $1,274 $1,274 3.0×
Bone &/Joint Imaging Multiple Areas (78305) $1,211 $1,211 2.5×
Bone &/joint imaging whole body (78306) $1,413 $1,413 2.9×
Bone age studies (77072) $319 $319 2.5×
Bone Imaging 3 Phase (78315) $1,580 $1,580 3.3×
Bone survey complete (77075) $343 $343 2.7×
Bowel imaging (78290) $1,215 $1,215 2.5×
Brain Imaging Min 4 Static Views W Vascular Flow (78606) $2,000 $2,000 3.1×
Brain Imaging Pet Metabolic Evaluation (78608) $5,109 $5,109 3.0×
Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) $1,495 $1,495 3.1×
Cardiac shunt detection (78428) $1,439 $1,439 3.0×
Cervical spine 2 or 3 views (72040) $476 $476 4.6×
Chest 1 view (71045) $476 $476 4.6×
Chest xray 3 views (71047) $498 $498 4.8×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $469 $469 2.2×
Clavicle complete (73000) $505 $505 4.8×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $1,954 $1,954 15.6×
CT abdomen and pelvis without and with contrast (74178) $2,872 $2,872 6.9×
CT abdomen and pelvis without contrast (74176) $2,709 $2,709 9.5×
CT abdomen w contrast (74160) $1,927 $1,927 9.2×
CT abdomen w wo contrast (74170) $2,073 $2,073 9.9×
CT abdomen w/o contrast (74150) $1,927 $1,927 15.4×
CT angio lwr extr w/o&w/dye (73706) $1,927 $1,927 9.2×
CT angiography upper extremity lt (73206) $1,927 $1,927 9.2×
CT c-spine w/contrast (72126) $1,954 $1,954 4.7×
CT c-spine w/o contrast (72125) $1,927 $1,927 15.4×
CT cervical spine w&w/o contrast (72127) $2,236 $2,236 10.6×
CT chest w contrast (71260) $2,008 $2,008 9.6×
CT chest w/wo contrast (71270) $2,236 $2,236 10.6×
CT head/brain with contrast (70460) $1,954 $1,954 9.3×
CT head/brain without and with contrast (70470) $2,008 $2,008 9.6×
CT iac w contrast (70481) $1,954 $1,954 9.3×
CT lower ext w/o (73700) $1,927 $1,927 15.4×
CT lower extremity w wo contrast (73702) $2,008 $2,008 9.6×
CT lower extremity w/contrast material (73701) $1,954 $1,954 9.3×
CT lumbar spine w & w/o contrast (72133) $2,236 $2,236 10.6×
CT lumbar spine w/contrast (72132) $1,954 $1,954 4.7×
CT lumbar spine w/o contrast (72131) $1,927 $1,927 15.4×
CT maxillofacial w contrast (70487) $1,954 $1,954 9.3×
CT maxillofacial w/wo contrast (70488) $2,008 $2,008 9.6×
CT maxillofacial wo contrast (70486) $1,927 $1,927 15.4×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $2,008 $2,008 9.6×
CT orbits w/o contrast (70480) $1,927 $1,927 15.4×
CT pelvis w/o contrast (72192) $1,927 $1,927 15.4×
CT scan of arm combo (73202) $2,008 $2,008 9.6×
CT soft tissue neck w contrast (70491) $1,954 $1,954 9.3×
CT soft tissue neck w/o & w/contrast material (70492) $1,841 $1,841 8.8×
CT soft tissue neck w/o contrast (70490) $1,927 $1,927 15.4×
CT thoracic spine w/contrast (72129) $1,954 $1,954 9.3×
CT thoracic spine w/o contrast (72128) $1,927 $1,927 15.4×
CT thoracic spine w/wo contrast (72130) $2,236 $2,236 10.6×
CT thorax w/o contrast (71250) $1,954 $1,954 15.6×
CT upper ext wo (73200) $1,927 $1,927 15.4×
CT upper extremity with contrast (73201) $1,954 $1,954 4.7×
Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) $1,464 $1,464 7.0×
Cta Abdomen (74175) $1,927 $1,927 9.2×
CTA abdomen pelvis (74174) $2,379 $2,379 5.7×
CTA chest (71275) $1,954 $1,954 9.3×
Cta Head (70496) $1,927 $1,927 9.2×
Cta Neck (70498) $1,927 $1,927 9.2×
Cta Pelvis (72191) $1,927 $1,927 9.2×
Cystography minimum 3 views rs&i (74430) $969 $969 2.3×
Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) $1,194 $1,194 4.2×
Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) $4,784 $4,784 1.9×
Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) $340 $340 2.7×
Doppler Echo Fetal Spectral Display Complete (76827) $378 $378 3.0×
Dxa bone density study 1/> sites axial skel (77080) $584 $584 4.7×
Dxa bone density study 1/>sites appendiclr skel (77081) $259 $259 2.5×
Echo exam of eye (76529) $648 $648 6.2×
Esophagus (74220) $445 $445 2.1×
Facial bones min 3 views (70150) $476 $476 3.8×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $608 $608 4.9×
Fluoroscopy up to 1 hr (76000) $590 $590 2.1×
Foot 2 views (73620) $487 $487 4.7×
Forearm 2 views (73090) $505 $505 4.8×
Hand 2 views (73120) $487 $487 3.9×
Heart Infarct Image (78466) $3,456 $3,456 7.2×
Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) $9,655 $9,655 2.6×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $1,525 $1,525 2.3×
Hepatobiliary syst imaging including gallbladder (78226) $1,184 $1,184 2.5×
Hysterosalpingogram (74740) $1,194 $1,194 4.2×
Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) $293 $293 2.3×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $1,629 $1,629 2.5×
Kidney img morphology vascular flow 1 w/rx (78708) $1,564 $1,564 2.4×
Kidney Img Morphology Vascular Flow Multiple (78709) $1,744 $1,744 2.7×
Knee 3 views (73562) $498 $498 4.8×
Liver & spleen imaging static only (78215) $1,399 $1,399 2.9×
Lung perf&ventilat diferentl (78598) $1,617 $1,617 2.5×
Lung perfusion differential (78597) $1,149 $1,149 2.4×
Lung ventilation imaging (78579) $1,757 $1,757 3.7×
Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) $4,920 $4,920 1.3×
Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) $3,366 $3,366 1.8×
Lymphoscintigraphy (78195) $1,299 $1,299 2.0×
Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) $2,848 $2,848 3.0×
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) $2,629 $2,629 6.3×
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) $2,784 $2,784 6.7×
Mammary ductogram or galactogram multiple (77054) $1,620 $1,620 5.7×
Mammary ductogram or galactogram single (77053) $1,194 $1,194 4.2×
MRA head w & w/o contrast (70546) $3,351 $3,351 8.0×
MRA head w/o contrast (70544) $2,385 $2,385 8.3×
MRA head with contrast (70545) $1,605 $1,605 3.8×
MRA neck w contrast (70548) $1,605 $1,605 3.8×
Mra Neck W/O &W/Contrast Material (70549) $4,169.50 $4,169.50 10.0×
MRA neck w/o contrast (70547) $2,412 $2,412 8.4×
MRI abdomen w contrast (74182) $2,607 $2,607 6.2×
MRI abdomen w/o & w/contrast material (74183) $4,734 $4,734 11.3×
MRI abdomen w/o contrast (74181) $2,703 $2,703 9.5×
MRI any jt lower extrem w/contrast material (73722) $2,848 $2,848 3.0×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $4,807 $4,807 11.5×
MRI breast w/o contrast bilateral (77047) $2,498 $2,498 8.7×
MRI breast wo contrast unilateral (77046) $1,998 $1,998 7.0×
MRI c-spine with contrast (72142) $3,249 $3,249 7.8×
MRI cervical spine w/o contrast (72141) $2,703 $2,703 9.5×
MRI chest w/o & w/contrast material (71552) $3,413 $3,413 8.2×
MRI chest w/o contrast (71550) $2,730 $2,730 9.5×
MRI chest with contrast (71551) $2,902 $2,902 3.1×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $2,629 $2,629 6.3×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $2,784 $2,784 6.7×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $2,385 $2,385 8.3×
MRI orbit face &/neck w/o contrast (70540) $2,703 $2,703 9.5×
MRI orbit face neck w contrast (70542) $2,629 $2,629 6.3×
MRI orbit/face/neck w&w/o cont (70543) $4,807 $4,807 11.5×
MRI pelvis w/contrast (72196) $2,730 $2,730 6.5×
MRI pelvis w/o & w/contrast material (72197) $4,815 $4,815 11.5×
MRI pelvis w/o contrast (72195) $2,385 $2,385 8.3×
MRI spinal canal cervical w/o & w/contr matrl (72156) $3,303 $3,303 7.9×
MRI spinal canal lumbar w/contrast material (72149) $3,249 $3,249 7.8×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $3,303 $3,303 7.9×
MRI spinal canal thoracic w/contrast matrl (72147) $3,249 $3,249 7.8×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $3,303 $3,303 7.9×
MRI temporomandibular joint (70336) $2,754 $2,754 9.6×
MRI thoracic spine w/o contrast (72146) $2,988 $2,988 10.4×
MRI up ext w/o contrast (73218) $2,385 $2,385 8.3×
MRI upper ext joint w/o contrast (73221) $2,703 $2,703 9.5×
MRI, joint upper extrem combo (73223) $4,807 $4,807 11.5×
Myocardial Perfusion Planar 1 Study Rest/Stress (78453) $4,498 $4,498 2.9×
Myocardial Perfusion Planar Multiple Studies (78454) $5,508 $5,508 3.5×
Myocardial Spect Multiple Studies (78452) $4,496 $4,496 2.9×
Myocardial spect single study at rest or stress (78451) $4,498 $4,498 2.9×
Neck soft tissue (70360) $476 $476 4.6×
Nm cisternogram (78630) $2,000 $2,000 3.1×
Nm csf leak detection (78650) $3,399 $3,399 2.2×
Nm gastric emptying study (78264) $1,215 $1,215 2.5×
Ob us nuchal meas 1 gest (76813) $1,047 $1,047 8.4×
Parathyroid Planar Imaging (78070) $1,077 $1,077 2.2×
Pelvis 1 or 2 views (72170) $487 $487 3.9×
PET image w/CT, skull-thigh (78815) $6,275 $6,275 3.7×
PET imaging for CT attenuation whole body (78816) $7,857 $7,857 4.6×
Prq transhepatc portograpy w/o hemodyn evl intrp (75887) $3,511 $3,511 0.9×
Pulmonary Perfusion Imaging Particulate (78580) $1,148 $1,148 2.4×
Pulmonary Ventilation & Perfusion Imaging (78582) $1,616 $1,616 2.5×
Radex abscess/fistula/sinus tract rs&i (76080) $1,194 $1,194 1.8×
Radex Ankle Compl Minimum 3 Views (73610) $505 $505 4.8×
Radex Calcaneus Minimum 2 Views (73650) $503 $503 4.8×
Radex Elbw Compl Minimum 3 Views (73080) $505 $505 4.8×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $476 $476 4.6×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $487 $487 3.9×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) $473 $473 3.8×
Radex fingr minimum 2 views (73140) $498 $498 4.8×
Radex Foot Compl Minimum 3 Views (73630) $505 $505 4.8×
Radex Hand Minimum 3 Views (73130) $505 $505 4.8×
Radex Hip Unilateral With Pelvis 1 View (73501) $476 $476 4.6×
Radex Hips Bilateral With Pelvis 2 Views (73521) $487 $487 3.9×
Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) $729 $729 5.8×
Radex Humerus Minimum 2 Views (73060) $505 $505 4.8×
Radex Kne 1/2 Views (73560) $487 $487 4.7×
Radex Kne Compl 4/More Views (73564) $530 $530 4.2×
Radex Mndbl Compl Minimum 4 Views (70110) $476 $476 3.8×
Radex Nasal Bones Complete Minimum 3 Views (70160) $476 $476 4.6×
Radex Pelvis Compl Minimum 3 Views (72190) $498 $498 4.0×
Radex Sho Compl Minimum 2 Views (73030) $505 $505 4.8×
Radex Sinuses Paransl < 3 Views (70210) $487 $487 4.7×
Radex Spine Lumbosacral Only Bending 2/3 Views (72120) $476 $476 3.8×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $487 $487 4.7×
Radex Toe Minimum 2 Views (73660) $498 $498 4.8×
Radex upper extremity infant minimum 2 views (73092) $487 $487 3.9×
Radex Wrst Compl Minimum 3 Views (73110) $509 $509 4.9×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $476 $476 4.6×
Radiologic exam chest 2 views (71046) $487 $487 4.7×
Radiologic exam colon single contrast study (74270) $570 $570 2.7×
Radiologic exam upr gi trc double contrast study (74246) $1,031 $1,031 4.9×
Radiologic exam upr gi trc single contrast study (74240) $570 $570 2.7×
Radiologic examination tibia & fibula 2 views (73590) $505 $505 4.8×
Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) $512 $512 4.1×
Radiological examination surgical specimen (76098) $1,194 $1,194 1.8×
Rp loclzj tum plnr whole body single day imaging (78802) $2,748 $2,748 4.2×
Rp loclzj tum spect 1 area single day imaging (78803) $3,633 $3,633 5.6×
Saline Infus Sonohysterography W/Color Doppler (76831) $756 $756 2.6×
Scapula (73010) $505 $505 4.0×
Screening Digital Breast Tomosynthesis Bi (77063) $123 $123 5.3×
Sella turcica (70240) $758 $758 7.3×
Sialogram (70390) $1,194 $1,194 4.2×
Small bowel series (74250) $469 $469 2.2×
Spine thoracic 3 views (72072) $487 $487 3.9×
Splenoportograpy rs&i (75810) $10,800 $10,800 2.9×
Testicular Imaging With Vascular Flow (78761) $3,348 $3,348 7.0×
Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Non-Facility (78015) $1,437 $1,437 3.0×
Thyroid imaging w/blood flow (78013) $942 $942 2.0×
Thyroid uptake measurement (78012) $852 $852 1.8×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $1,077 $1,077 2.2×
Ultrasound breast complete (76641) $730 $730 5.8×
Ultrasound Exam Aaa Screen (76706) $395 $395 3.2×
Ultrasound, abdomen limited (76705) $692 $692 5.5×
Umbilical-artery Doppler (OB) (76820) $368 $368 2.9×
Unlisted Diagnostic Radiographic Procedure (76499) $545 $545 5.2×
Unlisted miscellaneous px dx nuclear medicine (78999) $810 $810 1.7×
Unlisted ultrasound procedure (76999) $259 $259 2.5×
Urethrocystogram voiding (74455) $969 $969 3.4×
Urethrocystography retrograde rs&i (74450) $969 $969 3.4×
Us breast unilateral limited (76642) $365 $365 3.5×
Us chest (76604) $692 $692 5.5×
Us compl joint r-t w/image documentation (76881) $508 $508 4.1×
Us encephalogram (76506) $508 $508 4.1×
Us hips infant static (76886) $432 $432 4.1×
Us infant hips w manipulation (76885) $662 $662 6.3×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $692 $692 5.5×
Us ob detailed single fetus (76811) $1,047 $1,047 3.7×
Us ob limited (76815) $785 $785 6.3×
Us ob transvaginal (76817) $508 $508 4.1×
Us pelvic non ob complete (76856) $1,074 $1,074 8.6×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $692 $692 5.5×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $1,047 $1,047 8.4×
Us pg uter r-t img f-up tabdl appr pr fetus (76816) $785 $785 6.3×
Us retroperitoneal complete (76770) $540 $540 4.3×
Us retroperitoneal limited (76775) $810 $810 6.5×
Us scrotum and contents (76870) $745 $745 5.9×
Us soft tissue head/neck (76536) $692 $692 5.5×
Us spinal canal and contents (76800) $340 $340 2.7×
Us transrectal (76872) $508 $508 4.1×
Us transrectal prostate volume (76873) $718 $718 5.7×
Us, eye b-scan (76512) $592 $592 4.7×
Venogram extremity bilateral (75822) $4,225 $4,225 2.2×
Venogram Extremity Unilateral (75820) $3,402 $3,402 1.8×
Venography caval inferior serialography rs&i (75825) $7,083 $7,083 1.9×
Venography caval superior serialography rs&i (75827) $3,366 $3,366 1.8×
Venography Renal Bilateral (75833) $9,655 $9,655 2.6×
Wrist 2 views (73100) $356.50 $356.50 3.4×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $540 $540 4.3×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $476 $476 4.6×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $723 $723 3.4×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $487 $487 4.7×
X-Ray Exam Hip Uni 2-3 Views (73502) $487 $487 4.7×
X-ray exam of femur 2/> (73552) $505 $505 4.8×
X-ray eye for foreign body (70030) $476 $476 4.6×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $487 $487 4.7×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $487 $487 4.7×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $487 $487 4.7×
X-ray leg, infant (73592) $487 $487 4.7×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $487 $487 3.9×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $818 $818 6.5×
X-ray nose-rectum child f.b. (76010) $235 $235 2.3×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $476 $476 3.8×
X-ray retrograde pyelogram (74420) $1,103 $1,103 2.6×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $482 $482 4.6×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $476 $476 3.8×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $613 $613 4.9×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $476 $476 3.8×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $476 $476 4.6×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $487 $487 4.7×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $543 $543 4.3×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $487 $487 3.9×
X-Ray Small Bowel Enteroclysis (74251) $572 $572 2.7×
X-Ray Spine One View - Xr Spine (72020) $476 $476 4.6×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $563 $563 5.4×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $476 $476 4.6×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $476 $476 3.8×
Xr bone length studies (77073) $469 $469 3.7×
Xr c-spine 4 or 5 views (72050) $509 $509 4.1×
Xr c-spine 6 or more views (72052) $818 $818 6.5×
Xr chest 4+ views (71048) $509 $509 4.1×
Xr myelogram posterior fossa (70010) $2,241 $2,241 5.4×
Xr urogram antegrade (74425) $1,013 $1,013 2.4×