Imaging prices at Kaiser Permanente Central Hospital

Seattle, WA · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedurePosted cashPosted gross× Medicare
3-D radiotherapy plan dose-volume histograms (77295) $7,120 $8,900 4.4×
Abdomen 1 View (74018) $304 $380 3.0×
Abdomen 2 views (74019) $368 $460 3.0×
Acute Gastrointestinal Blood Loss Imaging (78278) $1,382.40 $1,728 3.0×
Acute venous thrombosis imaging, peptide Non-Facility (78456) $4,560 $5,700 3.0×
Adrenal Cortex & Medulla Img (78075) $4,483.20 $5,604 3.0×
Angio internal mammary (75756) $10,880 $13,600 3.0×
Angio pulmonary bilat (75743) $10,880 $13,600 3.0×
Angiography Adrenal Bilateral Slctv Rs&I (75733) $10,880 $13,600 3.0×
Angiography extremity bilateral rs&i (75716) $10,880 $13,600 3.0×
Angiography extremity unilateral rs&i (75710) $10,880 $13,600 3.0×
Angiography pulmonary unilateral slctv rs&i (75741) $10,880 $13,600 3.0×
Angrph pulmonary nonslctv cath/ven njx rs&i (75746) $10,880 $13,600 3.0×
Ankle 2 views (73600) $304 $380 3.0×
Aortography thoracic serialography rs&i (75605) $18,640 $23,300 2.9×
Aortography thoracic w/o serialography rs&i (75600) $10,880 $13,600 3.0×
Artery X-Rays Abdomen (75726) $18,640 $23,300 2.9×
Artery X-Rays Adrenal Gland (75731) $10,880 $13,600 3.0×
Artery X-Rays Pelvis (75736) $18,640 $23,300 2.9×
Artery X-Rays Spine (75705) $18,640 $23,300 2.9×
Arthrogram ankle (73615) $1,280 $1,600 3.2×
Arthrogram hip (73525) $1,280 $1,600 3.2×
Arthrogram Wrist (73115) $1,280 $1,600 3.2×
Basic radiation dosimetry calculation (77300) $560 $700 3.6×
Bone age studies (77072) $368 $460 3.0×
Bone Imaging 3 Phase (78315) $1,382.40 $1,728 3.0×
Bone Imaging Limited Area (78300) $1,382.40 $1,728 3.0×
Bone Imaging Multiple Areas (78305) $1,382.40 $1,728 3.0×
Bone Imaging Whole Body (78306) $1,382.40 $1,728 3.0×
Bone marrow imaging limited area (78102) $1,382.40 $1,728 3.0×
Bone marrow imaging; multiple areas (78103) $1,382.40 $1,728 3.0×
Bone marrow imaging; whole body (78104) $1,382.40 $1,728 3.0×
Bone survey infant (77076) $368 $460 3.0×
Brachytx isodose complex (77318) $1,440 $1,800 3.3×
Brachytx isodose intermed (77317) $1,280 $1,600 2.9×
Brachytx Isodose Plan Simple (77316) $1,280 $1,600 2.9×
Brain Flow Imaging Only (78610) $1,848 $2,310 2.9×
Brain Image W/Flow < 4 Views (78601) $1,382.40 $1,728 3.0×
Brain imaging < 4 static views (78600) $1,382.40 $1,728 3.0×
Brain Imaging Min 4 Static Views W Vascular Flow (78606) $1,848 $2,310 2.9×
Brain Imaging Minimum 4 Static Views (78605) $1,848 $2,310 2.9×
Brain Imaging Pet Metabolic Evaluation (78608) $5,011.20 $6,264 3.0×
Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) $1,382.40 $1,728 3.0×
Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) $1,848 $2,310 2.9×
Cardiac Shunt Detection (78428) $1,382.40 $1,728 3.0×
Cat Scan Follow-Up Study (76380) $1,200 $1,500 11.9×
Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) $1,848 $2,310 2.9×
Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) $1,848 $2,310 2.9×
Cerebrospinal Fluid Scan (78630) $1,848 $2,310 2.9×
Chest 1 view (71045) $304 $380 3.0×
Chest 2 views (71046) $304 $380 3.0×
Chest 3 views (71047) $304 $380 3.0×
Chest 4 or more views (71048) $368 $460 3.0×
Cholecystography Oral Contrast (74290) $616 $770 3.0×
Cineradiograpy/vidradiograpy xcpt where spec (76120) $368 $460 3.0×
Cisternography Positive Contrast Rs&I (70015) $2,720 $3,400 3.0×
Clavicle complete (73000) $304 $380 3.0×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $400 $500 3.3×
Continuing medical physics consltj pr wk (77336) $960 $1,200 6.2×
Contrast Exam Abdominl Aorta (75625) $10,880 $13,600 3.0×
Contrast X-Ray Bladder (74430) $1,280 $1,600 3.2×
Contrast X-Ray Of Elbow (73085) $1,280 $1,600 3.2×
Contrast X-Ray Of Knee Joint (73580) $1,280 $1,600 3.2×
Contrast Xray Throat/Cerv Esopha (74210) $616 $770 3.0×
Corpora cavernosography (74445) $368 $460 3.0×
CT abdomen and pelvis without and with contrast (74178) $4,000 $5,000 9.9×
CT abdomen and pelvis without contrast (74176) $3,200 $4,000 11.5×
CT abdomen w contrast (74160) $1,520 $1,900 7.5×
CT abdomen w wo contrast (74170) $1,920 $2,400 9.4×
CT abdomen w/o contrast (74150) $1,120 $1,400 9.2×
CT Angio Abdomen and Pelvis (74174) $3,600 $4,500 8.9×
CT Angio Chest (71275) $2,720 $3,400 13.4×
CT Angio Head (70496) $2,560 $3,200 12.6×
CT angio hrt w/3d image (75574) $1,280 $1,600 3.2×
Ct Angio Lwr Extr W/O&W/Dye (73706) $1,920 $2,400 9.4×
CT Angio Neck (70498) $2,560 $3,200 12.6×
Ct Angio Upr Extrm W/O&W/Dye (73206) $1,200 $1,500 5.9×
CT bone density (77078) $560 $700 5.5×
CT cervical spine w/ contrast (72126) $1,600 $2,000 3.9×
CT cervical spine w/o contrast (72125) $1,840 $2,300 15.2×
CT cervical spine w/wo cont (72127) $960 $1,200 4.7×
CT chest w contrast (71260) $2,000 $2,500 9.8×
CT chest w/wo contrast (71270) $2,400 $3,000 11.8×
CT head/brain with contrast (70460) $1,760 $2,200 8.6×
CT head/brain without and with contrast (70470) $1,920 $2,400 9.4×
CT heart contrast eval cardiac structure&morph (75572) $1,200 $1,500 3.0×
CT heart no contrast quant eval coronry calcium (75571) $344 $430 3.4×
CT hrt w/3d image congen (75573) $1,280 $1,600 3.2×
CT iac w contrast (70481) $1,600 $2,000 7.9×
CT l-spine w&w/o contrast (72133) $2,240 $2,800 11.0×
CT lower ext w/o (73700) $1,440 $1,800 11.9×
CT lower extremity w/contrast material (73701) $1,920 $2,400 9.4×
CT lumbar spine w contrast (72132) $1,920 $2,400 4.7×
CT lumbar spine w/o contrast (72131) $1,600 $2,000 13.2×
CT maxillofacial w contrast (70487) $1,760 $2,200 8.6×
CT maxillofacial wo contrast (70486) $1,440 $1,800 11.9×
CT neck tissue combo (70492) $2,080 $2,600 10.2×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $2,000 $2,500 9.8×
CT orbits w/o contrast (70480) $1,200 $1,500 9.9×
CT pelvis w&w/o contrast (72194) $2,240 $2,800 11.0×
CT pelvis w/o contrast (72192) $1,600 $2,000 13.2×
CT scan of leg combo (73702) $960 $1,200 4.7×
CT scans face/jaw combo (70488) $2,080 $2,600 10.2×
CT soft tissue neck w contrast (70491)
range across 2 matching MRF lines		 $960–$1,920 $1,200–$2,400 varies
CT soft tissue neck w/o contrast (70490) $1,680 $2,100 13.8×
CT thoracic spine w contrast (72129) $1,920 $2,400 9.4×
CT thoracic spine w/o contrast (72128) $1,600 $2,000 13.2×
CT thoracic spine w/wo cont (72130) $2,240 $2,800 11.0×
CT thorax w/o contrast (71250) $1,600 $2,000 13.2×
CT upper ext wo (73200) $1,440 $1,800 11.9×
CT upper extremity w/o & w/contrast material (73202) $2,080 $2,600 10.2×
CT upper extremity with contrast (73201) $1,760 $2,200 4.3×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $3,200 $4,000 15.7×
Cta Abdomen (74175) $2,800 $3,500 13.7×
CTA pelvis (72191) $1,200 $1,500 5.9×
Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) $880 $1,100 3.2×
Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without… (78414) $1,848 $2,310 2.9×
Dilation ureters/urethra rs&i (74485) $7,040 $8,800 2.9×
Discography Cerv/Thor Spine (72285) $6,720 $8,400 3.0×
Diskography lumbar (72295) $6,720 $8,400 3.0×
Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) $364.80 $456 3.0×
Doppler Echo Fetal Spectral Display Complete (76827) $364.80 $456 3.0×
Doppler Fetal Mid Cerebral Artery (76821) $364.80 $456 3.0×
Dxa Bone Density Axial (77080) $368 $460 3.0×
Dxa bone density study (77085) $368 $460 3.0×
Dxa bone density study 1/>sites appendiclr skel (77081) $304 $380 3.0×
Echo exam of fetal heart (76825) $1,881.60 $2,352 3.0×
Echo exam uterus (76831) $830.40 $1,038 3.0×
Echo Guide For Artery Repair (76936) $1,070.40 $1,338 4.3×
Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) $830.40 $1,038 3.0×
Esophageal Motility Study (78258) $1,382.40 $1,728 3.0×
Esophagram (74220) $616 $770 3.0×
Fetal Biophys Profile W/Nst (76818) $319.20 $399 2.6×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $364.80 $456 3.0×
Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) $1,200 $1,500 4.3×
Fluoroscopy up to 1 hr (76000) $880 $1,100 3.2×
Follow-Up Angiography (75898) $10,880 $13,600 3.0×
Foot 2 views (73620) $304 $380 3.0×
Forearm 2 views (73090) $304 $380 3.0×
Gastric emptying imaging study (78264) $1,382.40 $1,728 3.0×
Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) $1,440 $1,800 3.1×
Gastric Mucosa Imaging (78261) $1,382.40 $1,728 3.0×
Gastroesophageal Reflux Exam (78262) $1,382.40 $1,728 3.0×
Gastrointestinal Protein Loss (78282) $1,382.40 $1,728 3.0×
Gated Heart Planar Single (78472) $1,382.40 $1,728 3.0×
Gated Heart, Multiple (78473) $1,382.40 $1,728 3.0×
GI Endoscopic US S&I (76975) $830.40 $1,038 3.0×
Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) $1,920 $2,400 3.0×
Hand 2 views (73120) $368 $460 3.0×
Hdr Rdncl Ntrstl/Icav Brchtx (77772) $2,385.60 $2,982 2.9×
Hdr Rdncl Ntrstl/Icav Brchtx (77771) $2,385.60 $2,982 2.9×
Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) $2,385.60 $2,982 2.9×
Heart first pass single,planar (78481) $1,848 $2,310 2.9×
Heart Image (Pet) Multiple (78492) $5,011.20 $6,264 3.0×
Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889)
range across 2 matching MRF lines		 $5,440–$10,880 $6,800–$13,600 varies
Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) $10,880 $13,600 3.0×
Hepatobil Syst Image W/Drug (78227) $1,848 $2,310 2.9×
Hepatobiliary System Imaging (78226) $1,382.40 $1,728 3.0×
Ht Musc Image Planar Mult (78454) $4,483.20 $5,604 3.0×
Ht Muscle Image Spect Sing (78451) $4,483.20 $5,604 3.0×
Hyperthermia external generated superficial (77600) $2,160 $2,700 4.8×
Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) $2,800 $3,500 4.4×
Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators Non-Facility (77615) $4,480 $5,600 7.0×
Hyperthermia generated by intracavitary probe(s) Non-Facility (77620) $2,560 $3,200 4.0×
Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) $3,840 $4,800 4.7×
Hysterosalpingogram (74740) $880 $1,100 3.2×
Infant hip ultrasound with hip movement (dynamic) (76885) $422.40 $528 4.2×
Infant hip ultrasound, limited static exam (76886) $337.60 $422 3.3×
Infusion Ivp (74410) $616 $770 3.0×
Interstitial radiation source applic complex (77778) $2,385.60 $2,982 2.9×
Intracavitary Radiation Source Applic Complex (77763) $2,400 $3,000 3.0×
Intracavitary Radiation Source Applic Intermed (77762) $2,000 $2,500 3.1×
Intracavitary radiation source applic simple (77761) $2,000 $2,500 3.1×
Joint Survey Single View (77077) $368 $460 3.0×
K Flow/Funct Image Multiple (78709) $1,848 $2,310 2.9×
K Flow/Funct Image W/Drug (78708) $1,848 $2,310 2.9×
K Flow/Funct Image W/O Drug (78707) $1,848 $2,310 2.9×
Kidney Funcj Study Non-Img Radioisotopic Study (78725) $1,382.40 $1,728 3.0×
Kidney Imaging Morphol (78700) $1,382.40 $1,728 3.0×
Kidney Imaging Morphoogy W/Vascular Flow (78701) $1,382.40 $1,728 3.0×
Knee 3 Views (73562) $304 $380 3.0×
Labeled RBC Sequestration Differntl Organ/Tissue (78140) $1,382.40 $1,728 3.0×
Leveen/Shunt Patency Exam (78291) $1,382.40 $1,728 3.0×
Liver & Spleen Imaging Static Only (78215) $1,382.40 $1,728 3.0×
Liver & Spleen Imaging W/Vascular Flow (78216) $1,382.40 $1,728 3.0×
Liver imaging static only (78201) $1,848 $2,310 2.9×
Liver imaging w/vascular flow (78202) $1,848 $2,310 2.9×
Lung Perf&Ventilat Diferentl (78598) $1,848 $2,310 2.9×
Lung perfusion differential (78597) $1,382.40 $1,728 3.0×
Lung Ventilat&Perfus Imaging (78582) $1,848 $2,310 2.9×
Lung Ventilation Imaging (78579) $1,382.40 $1,728 3.0×
Lymph System Imaging (78195) $1,848 $2,310 2.9×
Lymphangiography Extremity Only Bilateral Rs&I (75803) $5,360 $6,700 2.9×
Lymphangiography extremity only unilateral rs&i (75801) $2,160 $2,700 3.0×
Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) $10,880 $13,600 3.0×
Lymphangiography, pelvic/abdominal, unilateral (75805) $10,880 $13,600 3.0×
Magnetic Image Jaw Joint (70336) $1,280 $1,600 4.6×
Magnetic Resonance Elastography (76391) $830.40 $1,038 3.0×
Mammary ductogram or galactogram multiple (77054) $880 $1,100 3.2×
Mammary ductogram or galactogram single (77053) $880 $1,100 3.2×
Meckels Divert Exam (78290) $1,382.40 $1,728 3.0×
Mlc imrt design & construction per imrt plan (77338) $4,640 $5,800 10.7×
Mra Head W/O & W/Contrast Material (70546) $2,320 $2,900 5.7×
MRA head w/o contrast (70544) $1,680 $2,100 6.1×
MRA head with contrast (70545) $2,000 $2,500 4.9×
MRA neck w contrast (70548) $2,000 $2,500 4.9×
Mra Neck W/O &W/Contrast Material (70549) $2,400 $3,000 5.9×
MRA neck w/o contrast (70547) $1,600 $2,000 5.8×
MRI abdomen w contrast (74182) $2,720 $3,400 6.7×
MRI abdomen w/o contrast (74181) $2,160 $2,700 7.8×
MRI any jt lower extrem w/contrast material (73722)
range across 2 matching MRF lines		 $2,712–$2,800 $3,390–$3,500 varies
MRI any jt lower extrem w/o & w/contrast matrl (73723) $2,800 $3,500 6.9×
MRI any jt upper extremity w/contrast matrl (73222)
range across 2 matching MRF lines		 $2,712–$2,800 $3,390–$3,500 varies
MRI bone marrow blood supply (77084) $2,000 $2,500 7.2×
MRI brain functional w/o physician admnistration (70554) $1,840 $2,300 6.6×
MRI Breast W/O Contrast Bilateral (77047) $1,920 $2,400 6.9×
MRI Breast Without Contrast Material Unilateral (77046) $1,280 $1,600 4.6×
MRI cervical spine w contrast (72142) $1,920 $2,400 4.7×
MRI cervical spine w/o cont (72141) $1,760 $2,200 6.4×
MRI chest w/o contrast (71550) $2,560 $3,200 9.2×
MRI chest with contrast (71551) $2,400 $3,000 2.6×
MRI chest wo w contrast (71552) $2,800 $3,500 6.9×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $2,400 $3,000 5.9×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $3,200 $4,000 7.9×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,600 $2,000 5.8×
MRI lumbar spine w contrast (72149)
range across 3 matching MRF lines		 $1,120–$2,240 $1,400–$2,800 varies
Mri Neck Spine W/O & W/Dye (72156) $2,800 $3,500 6.9×
MRI orbit face &/neck w/o contrast (70540) $1,200 $1,500 4.3×
MRI orbit face neck w contrast (70542) $1,600 $2,000 3.9×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $2,000 $2,500 4.9×
MRI pelvis w contrast (72196) $1,600 $2,000 3.9×
MRI pelvis w/o & w contrast (72197) $2,800 $3,500 6.9×
MRI pelvis w/o contrast (72195) $2,000 $2,500 7.2×
MRI spectroscopy (76390) $1,600 $2,000 15.8×
MRI thoracic spine w/o contrast (72146) $2,080 $2,600 7.5×
MRI upper extremity oth than jt w/contr matrl (73219) $1,840 $2,300 4.5×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,600 $2,000 5.8×
Mri Uppr Extremity W/O&W/Dye (73220) $4,400 $5,500 10.9×
MRI, abdomen, combo (74183) $3,280 $4,100 8.1×
MRI, dorsal spine combo (72157) $3,120 $3,900 7.7×
MRI, dorsal spine contrast (72147) $2,240 $2,800 5.5×
MRI, joint upper extrem (73221) $1,920 $2,400 6.9×
MRI, joint upper extrem combo (73223) $2,400 $3,000 5.9×
MRI, lumbar spine combo (72158) $3,440 $4,300 8.5×
Myelogram cervical (72240) $2,720 $3,400 3.0×
Myelogram Lumbar (72265) $2,720 $3,400 3.0×
Myelography thoracic (72255) $2,720 $3,400 3.0×
Myelograpy 2/more regions rs&i (72270) $2,720 $3,400 3.0×
Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) $1,382.40 $1,728 3.0×
Myocardial Imaging Pet Metabolic Evaluation (78459) $4,483.20 $5,604 3.0×
Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) $1,848 $2,310 2.9×
Myocardial Perfusion Planar 1 Study Rest/Stress (78453) $4,483.20 $5,604 3.0×
Myocardial Spect Multiple Studies (78452) $4,483.20 $5,604 3.0×
Neck soft tissue (70360) $304 $380 3.0×
Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) $880 $1,100 2.0×
Nm csf leak detection (78650) $4,483.20 $5,604 3.0×
Nm myocard infarct spect (78469) $1,848 $2,310 2.9×
Nm red cell survival study (78130) $1,382.40 $1,728 3.0×
Nm whole blood volume (78122) $1,848 $2,310 2.9×
Nonvascular Shunt X-Ray (75809) $368 $460 3.0×
Ntsty modul radthx pln dose-vol histos (77301) $9,120 $11,400 5.7×
Nuclear Rx Oral Admin (79005) $768 $960 2.8×
Oph bmtry us echograpy a-scan io lens pwr cal (76519) $554.40 $693 4.6×
Oph us dx ant sgm us immersion b-scan/hr biom (76513) $1,693.60 $2,117 14.0×
Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) $441.60 $552 2.9×
Ophthalmic Biometry US Echograpy a-Scan (76516) $364.80 $456 3.0×
Ophthalmic Ultrasonic Foreign Body Localization (76529) $258.40 $323 2.6×
Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) $560 $700 4.6×
Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) $96.80 $121 2.9×
Ophthalmic us dx quantitative a-scan only (76511) $364.80 $456 3.0×
Optic foramina (70190) $304 $380 3.0×
Panoramic X-ray of jaws (70355) $304 $380 3.0×
Parathyroid imaging w/tomographic spect & CT (78072) $1,848 $2,310 2.9×
Parathyroid Planar Imaging (78070) $1,382.40 $1,728 3.0×
Parathyroid planar imaging w/wo subtraction (78071) $1,382.40 $1,728 3.0×
Pelvis 1 or 2 views (72170) $368 $460 3.0×
Perineogram (74775) $880 $1,100 3.2×
Peritoneogram Rs&I (74190) $1,920 $2,400 3.0×
Pet Image Skull-Thigh (78812) $6,400 $8,000 3.9×
Pet Image W/Ct Lmtd (78814) $4,480 $5,600 2.7×
PET image w/CT, full body (78816) $7,200 $9,000 4.3×
PET imaging CT attenuation skull base mid-thigh (78815) $6,400 $8,000 3.9×
Pet Imaging Limited Area Chest Head/Neck (78811) $4,480 $5,600 3.0×
Pet Myocardial Sngl Study (78491) $5,011.20 $6,264 3.0×
PET whole body (78813) $7,200 $9,000 4.3×
Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) $4,483.20 $5,604 3.0×
Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) $4,483.20 $5,604 3.0×
Platelet survival study Non-Facility (78191) $1,382.40 $1,728 3.0×
Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) $10,880 $13,600 3.0×
Pulmonary Perfusion Imaging Particulate (78580) $1,382.40 $1,728 3.0×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $368 $460 3.0×
Radex abscess/fistula/sinus tract rs&i (76080) $1,920 $2,400 3.0×
Radex Ankle Complete Minimum 3 Views (73610) $304 $380 3.0×
Radex Calcaneus Minimum 2 Views (73650) $304 $380 3.0×
Radex elbow complete minimum 3 views (73080) $304 $380 3.0×
Radex Facial Bones Complete Minimum 3 Views (70150) $368 $460 3.0×
Radex fingr minimum 2 views (73140) $304 $380 3.0×
Radex foot complete minimum 3 views (73630) $304 $380 3.0×
Radex Hand Minimum 3 Views (73130) $304 $380 3.0×
Radex lower extremity infant minimum 2 views (73592) $304 $380 3.0×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $368 $460 3.0×
Radex Nasal Bones Complete Minimum 3 Views (70160) $304 $380 3.0×
Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) $304 $380 3.0×
Radex Ribs Unilateral 2 Views (71100) $304 $380 3.0×
Radex shoulder complete minimum 2 views (73030)
range across 2 matching MRF lines		 $180–$304 $225–$380 varies
Radex Sinuses Paransl < 3 Views (70210) $304 $380 3.0×
Radex sm int w/mlt srl imges via enteroclss tube (74251) $632 $790 3.1×
Radex Spine 1 View Specify Level (72020) $304 $380 3.0×
Radex Sternum Minimum 2 Views (71120) $304 $380 3.0×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $304 $380 3.0×
Radex Toe Minimum 2 Views (73660) $304 $380 3.0×
Radex upper extremity infant minimum 2 views (73092) $368 $460 3.0×
Radex Wrist Complete Minimum 3 Views (73110) $304 $380 3.0×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $368 $460 3.0×
Radiation Delivery Stereotactic Cranial Linear (77372) $26,240 $32,800 3.1×
Radiation treatment delivery level 1 (77402) $424 $530 3.6×
Radiation treatment delivery level 2 (77407) $960 $1,200 2.1×
Radiation treatment delivery level 3 (77412) $960 $1,200 1.5×
Radiolog exam mandible compl minimum 4 views (70110) $368 $460 3.0×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $368 $460 3.0×
Radiologic exam colon double contrast study (74280) $616 $770 3.0×
Radiologic exam colon single contrast study (74270) $616 $770 3.0×
Radiologic Exam Esophagus Double Contrast Study (74221) $616 $770 3.0×
Radiologic exam knee complete 4/more views (73564) $368 $460 3.0×
Radiologic exam pelvis compl minimum 3 views (72190) $368 $460 3.0×
Radiologic Exam Small Int Single Contrast Study (74250) $616 $770 3.0×
Radiologic exam swallow function contrast study (74230)
range across 2 matching MRF lines		 $308–$616 $385–$770 varies
Radiologic exam teeth complete full mouth (70320) $880 $1,100 3.2×
Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) $880 $1,100 3.2×
Radiologic exam upr gi trc double contrast study (74246) $616 $770 3.0×
Radiologic examination femur 1 view (73551) $304 $380 3.0×
Radiologic examination femur minimum 2 views (73552) $304 $380 3.0×
Radiologic examination knee 1/2 views (73560) $304 $380 3.0×
Radiologic Examination Osseous Survey Limited (77074) $368 $460 3.0×
Radiologic Examination Salivary Gland Calculus (70380) $304 $380 3.0×
Radiologic examination tibia & fibula 2 views (73590) $304 $380 3.0×
Radiologic examination, internal auditory meati, complete Non-Facility (70134) $1,920 $2,400 3.0×
Radiologic examination, teeth; single view Non-Facility (70300) $304 $380 3.0×
Radiopharm Dacryocystography (78660) $1,382.40 $1,728 3.0×
Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) $768 $960 2.8×
Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) $768 $960 2.8×
Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) $768 $960 2.8×
Red Cell Volume Determination Spx 1 Sampling (78120) $1,382.40 $1,728 3.0×
Red Cell Volume Determination Spx Mult Samplings (78121) $1,848 $2,310 2.9×
Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) $1,001.28 $1,251.60 2.2×
Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) $902.40 $1,128 2.0×
Renal Cyst Study (74470) $1,920 $2,400 3.0×
Ribs bilateral 3 views (71110) $368 $460 3.0×
Rp loclzj tum plnr 1 area single day imaging (78800) $1,382.40 $1,728 3.0×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $1,382.40 $1,728 3.0×
Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) $4,483.20 $5,604 7.1×
Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) $4,483.20 $5,604 7.1×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $4,483.20 $5,604 7.1×
Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) $768 $960 2.8×
Rp Therapy Intravenous Administration (79101) $768 $960 2.8×
Salivary Gland Function Study (78232) $1,382.40 $1,728 3.0×
Salivary Gland Imaging (78230) $1,382.40 $1,728 3.0×
Salivary Gland Imaging Serial Images (78231) $1,382.40 $1,728 3.0×
Scapula (73010) $368 $460 3.0×
Screening Digital Breast Tomosynthesis Bi (77063)
range across 2 matching MRF lines		 $80–$120 $100–$150 varies
Sella turcica (70240) $304 $380 3.0×
Shoulder 1 view (73020) $304 $380 3.0×
Shoulder Arthrography (73040) $1,280 $1,600 3.2×
Sialogram (70390) $880 $1,100 3.2×
Skull less than 4 views (70250) $368 $460 3.0×
Special dosimetry (77331) $560 $700 3.6×
Special teletherapy port plan (77321) $1,440 $1,800 3.3×
Special treatment procedure (77470) $2,480 $3,100 3.9×
Speech evaluation, complex (70371) $880 $1,100 3.2×
Spleen Imaging (78185) $1,382.40 $1,728 3.0×
Stereotactic Body Radiation Delivery (77373) $8,080 $10,100 3.9×
Sternoclavicular joints (71130) $304 $380 3.0×
Superior sagittal sinus venogram (75870) $10,880 $13,600 3.0×
Surface Applic Low Dose Rate Radionuclide Source (77789) $320 $400 2.7×
Telethx isodose pln cplx w/basic dosimetry (77307) $1,200 $1,500 2.8×
Telethx isodose pln smpl w/dosimetry calculation (77306) $1,280 $1,600 2.9×
Temporomandble Jt Arthrography Rs&I (70332) $880 $1,100 3.2×
Testicular Imaging W/Flow (78761) $1,382.40 $1,728 3.0×
Ther Rad Simulaj-Aided Field Setting Complex (77290) $1,920 $2,400 4.4×
Ther Rad Simulaj-Aided Field Setting Intermed (77285) $1,760 $2,200 4.0×
Ther rad simulaj-aided field setting simple (77280) $1,040 $1,300 6.7×
Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) $616 $770 3.0×
Thoracic spine 2 views (72070) $368 $460 3.0×
Thoracic spine 3 views (72072) $368 $460 3.0×
Thoracolumbar 2 views (72080) $304 $380 3.0×
Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) $1,382.40 $1,728 3.0×
Thyroid Carcinoma Metastases Img Lmtd Area (78015) $1,382.40 $1,728 3.0×
Thyroid Imaging With Vascular Flow (78013) $1,382.40 $1,728 3.0×
Thyroid Met Imaging Body (78018) $1,848 $2,310 2.9×
Thyroid Uptake Measurement (78012) $1,382.40 $1,728 3.0×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $1,382.40 $1,728 3.0×
Tx Devices Design & Construction Complex (77334) $1,440 $1,800 3.3×
Tx devices design & construction intermediate (77333) $1,200 $1,500 7.7×
Tx devices design & construction simple (77332) $800 $1,000 5.1×
Ultrasound Breast Limited (76642) $382.40 $478 3.8×
Ultrasound elastography first target lesion (76982) $364.80 $456 3.0×
Ultrasound Elastography Parenchyma (76981) $528 $660 4.3×
Ultrasound trgt dynamic microbubble 1st lesion (76978) $1,022.40 $1,278 2.5×
Ultrasound, abdomen limited (76705) $576 $720 4.7×
Umbilical-artery Doppler (OB) (76820) $364.80 $456 3.0×
Unlisted magnetic resonance procedure (76498) $1,200 $1,500 11.9×
Upper gi w/o kub (74240) $616 $770 3.0×
Ureteral Reflux Study (78740) $1,382.40 $1,728 3.0×
Urethrocystogram voiding (74455) $880 $1,100 3.2×
Urethrocystography retrograde (74450) $880 $1,100 3.2×
Us bone density measurement (76977) $364.80 $456 3.0×
Us breast unilateral complete (76641) $654.40 $818 5.4×
Us chest (76604) $412.80 $516 3.4×
Us complete joint (76881) $498.40 $623 4.1×
Us exam, pelvic, limited (76857) $478.40 $598 3.9×
Us head (76506) $393.60 $492 3.2×
Us kidney transplant (76776) $702.40 $878 5.8×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $334.40 $418 2.8×
Us ob detailed single fetus (76811) $830.40 $1,038 3.0×
Us ob limited 1 or more fetuses (76815) $364.80 $456 3.0×
Us ob transvaginal (76817) $364.80 $456 3.0×
Us pelvic non ob complete (76856) $616.80 $771 5.1×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $328.80 $411 2.7×
Us preg uterus real time f/u trnsabdl per fetus (76816) $324 $405 2.7×
Us retroperitoneal complete (76770) $725.60 $907 6.0×
Us retroperitoneal limited (76775) $422.40 $528 3.5×
Us scrotum and contents (76870) $614.40 $768 5.1×
Us spinal canal and contents (76800) $510.40 $638 4.2×
Us thyroid (76536) $558.40 $698 4.6×
Us transrectal (76872) $368.80 $461 3.0×
Vascular Flow Imaging (78445) $1,382.40 $1,728 3.0×
Vasogram (74440) $880 $1,100 3.2×
Vein X-Ray Chest (75827) $5,360 $6,700 2.9×
Vein X-Ray Liver W/O Hemodyn (75887) $10,880 $13,600 3.0×
Vein X-Ray Skull Epidural (75872) $2,160 $2,700 3.0×
Vein X-Ray Spleen/Liver (75810) $10,880 $13,600 3.0×
Venogram Sinus/Jugular (75860) $10,880 $13,600 3.0×
Venography Adrenal Unilateral (75840) $10,880 $13,600 3.0×
Venography caval inferior serialography rs&i (75825) $10,880 $13,600 3.0×
Venography extremity bilateral rs&i (75822) $5,360 $6,700 2.9×
Venography extremity unilateral rs&i (75820) $5,360 $6,700 2.9×
Venography Orbital Rs&I (75880) $2,160 $2,700 3.0×
Venography Renal Bilateral (75833) $10,880 $13,600 3.0×
Venography Renal Unilateral (75831) $10,880 $13,600 3.0×
Venous sampling by catheter (75893) $18,640 $23,300 2.9×
Venous thrombosis imaging (78457) $1,848 $2,310 2.9×
Venous Thrombosis Imaging Venogram Bilateral (78458) $1,382.40 $1,728 3.0×
Vertebral fracture assessment via dxa (77086) $304 $380 3.0×
Wrist 2 views (73100) $304 $380 3.0×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $304 $380 3.0×
X-ray antegrade pyelogram tube (74425) $1,280 $1,600 3.2×
X-Ray Aorta Leg Arteries (75630) $10,880 $13,600 3.0×
X-Ray Bend Only L-S Spine (72120) $368 $460 3.0×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $304 $380 3.0×
X-Ray Exam Breast Specimen (76098) $1,920 $2,400 3.0×
X-Ray Exam Entire Spi 1 Vw (72081) $304 $380 3.0×
X-Ray Exam Entire Spi 2/3 Vw (72082) $368 $460 3.0×
X-Ray Exam Entire Spi 4/5 Vw (72083) $368 $460 3.0×
X-Ray Exam Hip Uni 1 View (73501) $304 $380 3.0×
X-Ray Exam Hip Uni 2-3 Views (73502) $304 $380 3.0×
X-Ray Exam Hip Uni 4/> Views (73503) $368 $460 3.0×
X-Ray Exam Hips Bi 2 Views (73521)
range across 2 matching MRF lines		 $184–$368 $230–$460 varies
X-Ray Exam Hips Bi 3-4 Views (73522) $368 $460 3.0×
X-Ray Exam Hips Bi 5/> Views (73523) $368 $460 3.0×
X-Ray Exam L-S Spine Bending (72114) $368 $460 3.0×
X-Ray Exam Neck Spine 2-3 Vw (72040) $304 $380 3.0×
X-Ray Exam Neck Spine 6/>Vws (72052) $368 $460 3.0×
X-Ray Exam Unilat Ribs/Chest (71101) $368 $460 3.0×
X-ray eye for foreign body (70030) $304 $380 3.0×
X-ray head for orthodontia (70350) $304 $380 3.0×
X-ray humerus (73060) $304 $380 3.0×
X-ray IV pyelogram (ivp) (74400) $616 $770 3.0×
X-ray IV pyelogram+tomography (74415) $616 $770 3.0×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $304 $380 3.0×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $304 $380 3.0×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $368 $460 3.0×
X-ray nose-rectum child f.b. (76010) $304 $380 3.0×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $368 $460 3.0×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $368 $460 3.0×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $368 $460 3.0×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $304 $380 3.0×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $304 $380 3.0×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $368 $460 3.0×
X-ray thoracic spine 4 vw (72074) $368 $460 3.0×
X-Ray Tmj Unilat (70328) $304 $380 3.0×
X-Ray Urinary Tract Exam With Contrast Material (74420) $1,280 $1,600 3.2×
X-Rays Bone Length Studies (77073) $368 $460 3.0×
X-Rays Bone Survey Complete (77075) $368 $460 3.0×
Xr c-spine 4 or 5 views (72050) $368 $460 3.0×
Xr facial bones less than 3 views (70140) $304 $380 3.0×
XR Mastoids < 3 Views Bilateral (70120) $368 $460 3.0×
Xr myelogram posterior fossa (70010) $1,433.60 $1,792 3.5×
Xr orbits complete 4 views (70200) $368 $460 3.0×
Xr Tomogram Single Plane (76100) $368 $460 3.0×

A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.