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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ProcedureCash priceGross charge× Medicare
3-D radiotherapy plan dose-volume histograms (77295) $7,120 $8,900 4.4×
Abdomen 2 views (74019) $368 $460 3.0×
Acute gi 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×
Angio Adrenal Bilat Select (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 internal mammary rs&i (75756) $10,880 $13,600 3.0×
Angiography pelvic slctv/supraslctv rs&i (75736) $18,640 $23,300 2.9×
Angiography pulmonary bilateral slctv rs&i (75743) $10,880 $13,600 3.0×
Angiography pulmonary unilateral slctv rs&i (75741) $10,880 $13,600 3.0×
Angiography Spinal Selective Rs&I (75705) $18,640 $23,300 2.9×
Angiography visceral slctv/supraslctv rs&i (75726) $18,640 $23,300 2.9×
Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) $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×
Aortogram thoracic (75605) $18,640 $23,300 2.9×
Aortography abdl bi iliofem low extrem cath rs&i (75630) $10,880 $13,600 3.0×
Aortography abdominal serialography rs&i (75625) $10,880 $13,600 3.0×
Aortography Thoracic W/O Serialography Rs&I (75600) $10,880 $13,600 3.0×
Artery X-Rays Adrenal Gland (75731) $10,880 $13,600 3.0×
Arthrogram ankle (73615) $1,280 $1,600 3.2×
Arthrogram elbow (73085) $1,280 $1,600 3.2×
Arthrogram hip (73525) $1,280 $1,600 3.2×
Arthrogram knee (73580) $1,280 $1,600 3.2×
Arthrogram shoulder (73040) $1,280 $1,600 3.2×
Arthrogram wrist (73115) $1,280 $1,600 3.2×
Basic dosimetry (77300) $560 $700 3.6×
Bone &/Joint Imaging Limited Area (78300) $1,382.40 $1,728 3.0×
Bone &/Joint Imaging Multiple Areas (78305) $1,382.40 $1,728 3.0×
Bone &/joint imaging whole body (78306) $1,382.40 $1,728 3.0×
Bone age studies (77072) $368 $460 3.0×
Bone Imaging 3 Phase (78315) $1,382.40 $1,728 3.0×
Bone Marrow Imaging Limited Area (78102) $1,382.40 $1,728 3.0×
Bone survey complete (77075) $368 $460 3.0×
Bone survey infant (77076) $368 $460 3.0×
Bowel imaging (78290) $1,382.40 $1,728 3.0×
Brachytx isodose complex (77318) $1,440 $1,800 3.3×
Brachytx isodose intermed (77317) $1,280 $1,600 2.9×
Brachytx isodose pln smpl w/dosimetry cal (77316) $1,280 $1,600 2.9×
Brain imaging < 4 static views (78600) $1,382.40 $1,728 3.0×
Brain Imaging < 4 Static Views W Vascular Flow (78601) $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 Pet Metabolic Evaluation (78608) $5,011.20 $6,264 3.0×
Brain Imaging Vascular Flow Only (78610) $1,848 $2,310 2.9×
Brain imaging, minimum 4 static views; Non-Facility (78605) $1,848 $2,310 2.9×
Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) $1,382.40 $1,728 3.0×
Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) $1,382.40 $1,728 3.0×
Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or… (78483) $1,848 $2,310 2.9×
Cardiac shunt detection (78428) $1,382.40 $1,728 3.0×
Cephalogram, orthodontic Non-Facility (70350) $304 $380 3.0×
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×
Cervical spine 2 or 3 views (72040) $304 $380 3.0×
Chest 1 view (71045) $304 $380 3.0×
Chest xray 3 views (71047) $304 $380 3.0×
Cholecystography, oral contrast Non-Facility (74290) $616 $770 3.0×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $462 $577.50 2.3×
Cineradiography/videoradiography (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×
Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Non-Facility (77078) $560 $700 5.5×
Continuing medical physics consltj pr wk (77336) $960 $1,200 6.2×
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 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 angiography upper extremity lt (73206) $1,200 $1,500 5.9×
CT c-spine w/contrast (72126) $1,600 $2,000 3.9×
CT c-spine w/o contrast (72125) $1,840 $2,300 15.2×
CT cervical spine w&w/o contrast (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 w/o contrast quant eval coronary 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 limited/localized follow up study (76380) $1,200 $1,500 11.9×
CT lower ext w/o (73700) $1,440 $1,800 11.9×
CT lower extremity w wo contrast (73702) $960 $1,200 4.7×
CT lower extremity w/contrast material (73701) $1,920 $2,400 9.4×
CT lumbar spine w & w/o contrast (72133) $2,240 $2,800 11.0×
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 w/wo contrast (70488) $2,080 $2,600 10.2×
CT maxillofacial wo contrast (70486) $1,440 $1,800 11.9×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $2,000 $2,500 9.8×
CT orbits w/o contrast (70480) $1,200 $1,500 9.9×
CT pelvis w/o contrast (72192) $1,600 $2,000 13.2×
CT pelvis w/wo contrast (72194) $2,240 $2,800 11.0×
CT scan of arm combo (73202) $2,080 $2,600 10.2×
CT soft tissue neck w contrast (70491) $1,440 $1,800 7.1×
CT soft tissue neck w/o & w/contrast material (70492) $2,080 $2,600 10.2×
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 contrast (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 with contrast (73201) $1,760 $2,200 4.3×
Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) $3,200 $4,000 15.7×
Cta Abdomen (74175) $2,800 $3,500 13.7×
CTA abdomen pelvis (74174) $3,600 $4,500 8.9×
CTA chest (71275) $2,720 $3,400 13.4×
Cta Head (70496) $2,560 $3,200 12.6×
Cta Neck (70498) $2,560 $3,200 12.6×
Cta Pelvis (72191) $1,200 $1,500 5.9×
Cystography minimum 3 views rs&i (74430) $1,280 $1,600 3.2×
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 of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) $7,040 $8,800 2.9×
Diskogram cervical (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 study 1/> sites axial skel (77080) $368 $460 3.0×
Dxa bone density study 1/>sites appendiclr skel (77081) $304 $380 3.0×
Dxa bone density study axial skeleton (77085) $368 $460 3.0×
Echo exam of eye (76529) $258.40 $323 2.6×
Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) $830.40 $1,038 3.0×
Esophageal motility (78258) $1,382.40 $1,728 3.0×
Esophagus (74220) $616 $770 3.0×
Facial bones min 3 views (70150) $368 $460 3.0×
Fetal biophysical profile non-stress testing (76818) $319.20 $399 2.6×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $364.80 $456 3.0×
Fetal Echo (76825) $1,881.60 $2,352 3.0×
Fluoroscopy up to 1 hr (76000) $880 $1,100 3.2×
Foot 2 views (73620) $304 $380 3.0×
Forearm 2 views (73090) $304 $380 3.0×
Functional MRI brain by tech (70554) $1,840 $2,300 6.6×
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×
Gastrointestinal endoscopic ultrasound, supervision and interpretation Non-Facility (76975) $830.40 $1,038 3.0×
Gastrointestinal protein loss Facility (78282) $1,382.40 $1,728 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/intrcav brachytx 1 channel (77770) $2,385.60 $2,982 2.9×
Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) $2,385.60 $2,982 2.9×
Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) $2,385.60 $2,982 2.9×
Heart first pass single,planar (78481) $1,848 $2,310 2.9×
Heart Infarct Image (78466) $1,382.40 $1,728 3.0×
Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) $8,160 $10,200 2.2×
Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) $10,880 $13,600 3.0×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $1,848 $2,310 2.9×
Hepatobiliary syst imaging including gallbladder (78226) $1,382.40 $1,728 3.0×
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×
Hyperthermia, externally generated; superficial (ie, heating to a depth of 4 cm or less) Non-Facility (77600) $2,160 $2,700 4.8×
Hysterosalpingogram (74740) $880 $1,100 3.2×
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 - Xr Joint Anteroposterior 2+ Joints (77077) $368 $460 3.0×
Kidney function study, non-imaging radioisotopic study Non-Facility (78725) $1,382.40 $1,728 3.0×
Kidney imaging morphology (78700) $1,382.40 $1,728 3.0×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $1,848 $2,310 2.9×
Kidney img morphology vascular flow 1 w/rx (78708) $1,848 $2,310 2.9×
Kidney Img Morphology Vascular Flow Multiple (78709) $1,848 $2,310 2.9×
Knee 3 views (73562) $304 $380 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 ventilation imaging (78579) $1,382.40 $1,728 3.0×
Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) $10,880 $13,600 3.0×
Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) $10,880 $13,600 3.0×
Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) $5,360 $6,700 2.9×
Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) $2,160 $2,700 3.0×
Lymphoscintigraphy (78195) $1,848 $2,310 2.9×
Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) $2,756 $3,445 3.0×
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) $1,840 $2,300 4.5×
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) $4,400 $5,500 10.9×
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×
Mlc imrt design & construction per imrt plan (77338) $4,640 $5,800 10.7×
MRA head w & w/o contrast (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 & w/contrast material (74183) $3,280 $4,100 8.1×
MRI abdomen w/o contrast (74181) $2,160 $2,700 7.8×
MRI any jt lower extrem w/contrast material (73722) $2,756 $3,445 3.0×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $2,800 $3,500 6.9×
MRI bone marrow blood supply (77084) $2,000 $2,500 7.2×
MRI breast w/o contrast bilateral (77047) $1,920 $2,400 6.9×
MRI breast wo contrast unilateral (77046) $1,280 $1,600 4.6×
MRI c-spine with contrast (72142) $1,920 $2,400 4.7×
MRI cervical spine w/o contrast (72141) $1,760 $2,200 6.4×
MRI chest w/o & w/contrast material (71552) $2,800 $3,500 6.9×
MRI chest w/o contrast (71550) $2,560 $3,200 9.2×
MRI chest with contrast (71551) $2,400 $3,000 2.6×
MRI fetal sngl/1st gestation (74712) $1,200 $1,500 4.3×
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 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 orbit/face/neck w&w/o cont (70543) $2,000 $2,500 4.9×
MRI pelvis w/contrast (72196) $1,600 $2,000 3.9×
MRI pelvis w/o & w/contrast material (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 spinal canal cervical w/o & w/contr matrl (72156) $2,800 $3,500 6.9×
MRI spinal canal lumbar w/contrast material (72149) $2,240 $2,800 5.5×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $3,440 $4,300 8.5×
MRI spinal canal thoracic w/contrast matrl (72147) $2,240 $2,800 5.5×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $3,120 $3,900 7.7×
MRI temporomandibular joint (70336) $1,280 $1,600 4.6×
MRI thoracic spine w/o contrast (72146) $2,080 $2,600 7.5×
MRI up ext w/o contrast (73218) $1,600 $2,000 5.8×
MRI upper ext joint w/o contrast (73221) $1,920 $2,400 6.9×
MRI, joint upper extrem combo (73223) $2,400 $3,000 5.9×
Myelogram Cervical (72240) $2,720 $3,400 3.0×
Myelogram Lumbar (72265) $2,720 $3,400 3.0×
Myelogram thoracic (72255) $2,720 $3,400 3.0×
Myelography 2 or more regions (72270) $2,720 $3,400 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 imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) $5,011.20 $6,264 3.0×
Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) $5,011.20 $6,264 3.0×
Myocardial infarct spect (78469) $1,848 $2,310 2.9×
Myocardial Perfusion Planar 1 Study Rest/Stress (78453) $4,483.20 $5,604 3.0×
Myocardial Perfusion Planar Multiple Studies (78454) $4,483.20 $5,604 3.0×
Myocardial Spect Multiple Studies (78452) $4,483.20 $5,604 3.0×
Myocardial spect single study at rest or stress (78451) $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 adrenal scan (78075) $4,483.20 $5,604 3.0×
Nm bone marrow multi (78103) $1,382.40 $1,728 3.0×
Nm bone marrow wb (78104) $1,382.40 $1,728 3.0×
Nm cardiac blood pool multiple (78473) $1,382.40 $1,728 3.0×
Nm cisternogram (78630) $1,848 $2,310 2.9×
Nm csf leak detection (78650) $4,483.20 $5,604 3.0×
Nm gastric emptying study (78264) $1,382.40 $1,728 3.0×
Nm gastroesophageal reflux study (78262) $1,382.40 $1,728 3.0×
Nm kidney scan w/flow (78701) $1,382.40 $1,728 3.0×
Nm peritoneal-venous shunt patency (78291) $1,382.40 $1,728 3.0×
Nm red cell sequestration (78140) $1,382.40 $1,728 3.0×
Noncardiac Vascular Flow Imaging (78445) $1,382.40 $1,728 3.0×
Nonvascular shunt X-ray (75809) $368 $460 3.0×
Ntsty modul radthx pln dose-vol histos (77301) $9,120 $11,400 5.7×
Nuclear medicine study to assess blood clot in vein of both sides (78458) $1,382.40 $1,728 3.0×
Nuclear Rx Oral Admin (79005) $768 $960 2.8×
Ophthalmic biometry by ultrasound echography, A-scan; Non-Facility (76516) $364.80 $456 3.0×
Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Non-Facility (76519) $554.40 $693 4.6×
Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution… (76513) $1,693.60 $2,117 14.0×
Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter… (76510) $441.60 $552 2.9×
Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) $96.80 $121 2.9×
Ophthalmic ultrasound, diagnostic; quantitative A-scan only Non-Facility (76511) $364.80 $456 3.0×
Orthopantogram (70355) $304 $380 3.0×
Osseous survey limited (77074) $368 $460 3.0×
Parathyrd planar w/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 after injection (74190) $1,920 $2,400 3.0×
PET image w/CT, skull-thigh (78815) $6,400 $8,000 3.9×
PET imaging CT for attenuation limited area (78814) $4,480 $5,600 2.7×
PET imaging for CT attenuation whole body (78816) $7,200 $9,000 4.3×
Pet Imaging Limited Area Chest Head/Neck (78811) $4,480 $5,600 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×
Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) $6,400 $8,000 3.9×
Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) $10,880 $13,600 3.0×
Prq transhepatc portograpy w/o hemodyn evl intrp (75887) $10,880 $13,600 3.0×
Pulmonary Perfusion Imaging Particulate (78580) $1,382.40 $1,728 3.0×
Pulmonary Ventilation & Perfusion Imaging (78582) $1,848 $2,310 2.9×
Radex abscess/fistula/sinus tract rs&i (76080) $1,920 $2,400 3.0×
Radex Ankle Compl Minimum 3 Views (73610) $304 $380 3.0×
Radex Calcaneus Minimum 2 Views (73650) $304 $380 3.0×
Radex Elbw Compl Minimum 3 Views (73080) $304 $380 3.0×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $304 $380 3.0×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $368 $460 3.0×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) $368 $460 3.0×
Radex fingr minimum 2 views (73140) $304 $380 3.0×
Radex Foot Compl Minimum 3 Views (73630) $304 $380 3.0×
Radex Hand Minimum 3 Views (73130) $304 $380 3.0×
Radex Hip Unilateral With Pelvis 1 View (73501) $304 $380 3.0×
Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) $368 $460 3.0×
Radex Hips Bilateral With Pelvis 2 Views (73521) $276 $345 2.3×
Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) $368 $460 3.0×
Radex Humerus Minimum 2 Views (73060) $304 $380 3.0×
Radex Kne 1/2 Views (73560) $304 $380 3.0×
Radex Kne Compl 4/More Views (73564) $368 $460 3.0×
Radex Mndbl Compl Minimum 4 Views (70110) $368 $460 3.0×
Radex Nasal Bones Complete Minimum 3 Views (70160) $304 $380 3.0×
Radex Pelvis Compl Minimum 3 Views (72190) $368 $460 3.0×
Radex Sho Compl Minimum 2 Views (73030) $242 $302.50 2.4×
Radex Sinuses Paransl < 3 Views (70210) $304 $380 3.0×
Radex Spine Lumbosacral Only Bending 2/3 Views (72120) $368 $460 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 Wrst Compl 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×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $304 $380 3.0×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $368 $460 3.0×
Radiologic exam chest 2 views (71046) $304 $380 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 upr gi trc double contrast study (74246) $616 $770 3.0×
Radiologic exam upr gi trc single contrast study (74240) $616 $770 3.0×
Radiologic examination femur 1 view (73551) $304 $380 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, mastoids; complete, minimum of 3 views per side Non-Facility (70130) $368 $460 3.0×
Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) $368 $460 3.0×
Radiologic examination, teeth; complete, full mouth Non-Facility (70320) $880 $1,100 3.2×
Radiologic examination, teeth; partial examination, less than full mouth Non-Facility (70310) $880 $1,100 3.2×
Radiologic examination, teeth; single view Non-Facility (70300) $304 $380 3.0×
Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) $304 $380 3.0×
Radiological examination surgical specimen (76098) $1,920 $2,400 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×
Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) $768 $960 2.8×
Red cell survival study Non-Facility (78130) $1,382.40 $1,728 3.0×
Red cell volume determination (separate procedure); multiple samplings Non-Facility (78121) $1,848 $2,310 2.9×
Red cell volume determination (separate procedure); single sampling Non-Facility (78120) $1,382.40 $1,728 3.0×
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 Therapy Intravenous Administration (79101) $768 $960 2.8×
Sacroiliac Joints < 3 Views (72200) $368 $460 3.0×
Saline Infus Sonohysterography W/Color Doppler (76831) $830.40 $1,038 3.0×
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; with serial images Non-Facility (78231) $1,382.40 $1,728 3.0×
Scapula (73010) $368 $460 3.0×
Screening Digital Breast Tomosynthesis Bi (77063) $100 $125 4.3×
Sella turcica (70240) $304 $380 3.0×
Shoulder 1 view (73020) $304 $380 3.0×
Sialogram (70390) $880 $1,100 3.2×
Simulation intermediate (77285) $1,760 $2,200 4.0×
Small bowel series (74250) $616 $770 3.0×
Spec telethx port pln parts hemibdy tot bdy (77321) $1,440 $1,800 3.3×
Special dosimetry (77331) $560 $700 3.6×
Special treatment procedure (77470) $2,480 $3,100 3.9×
Speech evaluation complex (70371) $880 $1,100 3.2×
Spine thoracic 3 views (72072) $368 $460 3.0×
Spleen imaging only (78185) $1,382.40 $1,728 3.0×
Splenoportograpy rs&i (75810) $10,880 $13,600 3.0×
Stereotactic Body Radiation Delivery (77373) $8,080 $10,100 3.9×
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×
Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) $880 $1,100 3.2×
Testicular Imaging With Vascular 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 simple (77280) $1,040 $1,300 6.7×
Thoracolumbar 2 views (72080) $304 $380 3.0×
Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Non-Facility (78015) $1,382.40 $1,728 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 whole body (78018) $1,848 $2,310 2.9×
Thyroid imaging w/blood flow (78013) $1,382.40 $1,728 3.0×
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×
Tmj unilateral (70328) $304 $380 3.0×
Tomogram (76100) $368 $460 3.0×
Treatment device complex (77334) $1,440 $1,800 3.3×
Treatment device intermediate (77333) $1,200 $1,500 7.7×
Treatment devices simple (77332) $800 $1,000 5.1×
Ultrasound bone density measurement and interpretation, peripheral site(s), any method Non-Facility (76977) $364.80 $456 3.0×
Ultrasound breast complete (76641) $654.40 $818 5.4×
Ultrasound elastography first target lesion (76982) $364.80 $456 3.0×
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×
Ureteral reflux study (78740) $1,382.40 $1,728 3.0×
Urethrocystogram voiding (74455) $880 $1,100 3.2×
Urethrocystography retrograde rs&i (74450) $880 $1,100 3.2×
Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) $616 $770 3.0×
Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) $616 $770 3.0×
Us breast unilateral limited (76642) $382.40 $478 3.8×
Us chest (76604) $412.80 $516 3.4×
Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) $1,070.40 $1,338 4.3×
Us compl joint r-t w/image documentation (76881) $498.40 $623 4.1×
Us elastography parenchyma (76981) $528 $660 4.3×
Us encephalogram (76506) $393.60 $492 3.2×
Us hips infant static (76886) $337.60 $422 3.3×
Us infant hips w manipulation (76885) $422.40 $528 4.2×
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 (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 pelvic nonobstetric image dcmtn limited/f/u (76857) $478.40 $598 3.9×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $328.80 $411 2.7×
Us pg uter r-t img f-up tabdl appr pr 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 soft tissue head/neck (76536) $558.40 $698 4.6×
Us spinal canal and contents (76800) $510.40 $638 4.2×
Us transrectal (76872) $368.80 $461 3.0×
Us, eye b-scan (76512) $560 $700 4.6×
Us,transplanted kidney, real time/ doppler (76776) $702.40 $878 5.8×
Vasogram (74440) $880 $1,100 3.2×
Venogram adrenal unilat (75840) $10,880 $13,600 3.0×
Venogram extremity bilateral (75822) $5,360 $6,700 2.9×
Venogram Extremity Unilateral (75820) $5,360 $6,700 2.9×
Venography caval inferior serialography rs&i (75825) $10,880 $13,600 3.0×
Venography caval superior serialography rs&i (75827) $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 selective rs&i (75831) $10,880 $13,600 3.0×
Venography venous sinus/jugular cath rs&i (75860) $10,880 $13,600 3.0×
Venography, epidural, radiological supervision and interpretation Non-Facility (75872) $2,160 $2,700 3.0×
Venous sampling by catheter (75893) $18,640 $23,300 2.9×
Venous thrombosis imaging, venogram; unilateral Non-Facility (78457) $1,848 $2,310 2.9×
Vertebral fracture assessment via dxa (77086) $304 $380 3.0×
Whole blood volume determination, including separate measurement of plasma volume and red cell volume… (78122) $1,848 $2,310 2.9×
Wrist 2 views (73100) $304 $380 3.0×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $368 $460 3.0×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $304 $380 3.0×
X-ray b.e. reductn intuss (74283) $616 $770 3.0×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $616 $770 3.0×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $304 $380 3.0×
X-Ray Exam Hip Uni 2-3 Views (73502) $304 $380 3.0×
X-Ray Exam Hips Bi 3-4 Views (73522) $368 $460 3.0×
X-ray exam of femur 2/> (73552) $304 $380 3.0×
X-ray eye for foreign body (70030) $304 $380 3.0×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $304 $380 3.0×
X-ray IV pyelogram (ivp) (74400) $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 leg, infant (73592) $304 $380 3.0×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $368 $460 3.0×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $368 $460 3.0×
X-ray nose-rectum child f.b. (76010) $304 $380 3.0×
X-ray optic foramen (70190) $304 $380 3.0×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $368 $460 3.0×
X-ray retrograde pyelogram (74420) $1,280 $1,600 3.2×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $304 $380 3.0×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $368 $460 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 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 Skull <4 Vw - Xr Skull 1-3 Views (70250) $368 $460 3.0×
X-Ray Small Bowel Enteroclysis (74251) $632 $790 3.1×
X-Ray Spine One View - Xr Spine (72020) $304 $380 3.0×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $304 $380 3.0×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $304 $380 3.0×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $368 $460 3.0×
X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) $368 $460 3.0×
Xr bone length studies (77073) $368 $460 3.0×
Xr c-spine 4 or 5 views (72050) $368 $460 3.0×
Xr c-spine 6 or more views (72052) $368 $460 3.0×
Xr chest 4+ views (71048) $368 $460 3.0×
Xr myelogram posterior fossa (70010) $1,433.60 $1,792 3.5×
Xr urogram antegrade (74425) $1,280 $1,600 3.2×