Imaging prices at MedStar Georgetown University Hospital

Washington, DC · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
3-Dimensional radiotherapy plan including dose-volume histograms (77295) $4,580.08 $7,046.28 3.1×
Acute gi blood loss imaging (78278) $1,899.89 $2,922.90 4.5×
Angio adrenal bilat select (75733) $8,032.15 $12,357.15 2.4×
Angio adrenal unilat select (75731) $6,364.88 $9,792.12 1.9×
Angio extremity unilateral (75710) $6,589.65 $10,137.93 2.0×
Angio pulmonary unilateral (75741) $8,299.56 $12,768.56 2.5×
Angiogram extremity bilateral (75716) $6,537.23 $10,057.27 1.9×
Angiogram pelvic (75736) $8,473.96 $13,036.86 1.4×
Angiography internal mammary rs&i (75756) $9,370.28 $14,415.81 2.8×
Angiography pulmonary bilateral slctv rs&i (75743) $8,712.50 $13,403.84 2.6×
Angiography visceral slctv/supraslctv rs&i (75726) $8,473.96 $13,036.86 1.4×
Angrph cath f-up std tcat other than thrombylsis (75898) $5,267.08 $8,103.20 1.6×
Angrph pulmonary nonslctv cath/ven njx rs&i (75746) $9,370.28 $14,415.81 2.8×
Ankle 2 views (73600) $342.19 $526.45 3.7×
Arthrography knee lt (73580) $1,595.94 $2,455.29 4.3×
Arthrography wrist lt (73115) $1,879.87 $2,892.10 5.1×
Barium enema (74270) $790.11 $1,215.55 4.2×
Basic dosimetry (77300) $835.71 $1,285.71 5.8×
Bilat selctv renal venogram (75833) $7,126.77 $10,964.26 2.1×
Bone age studies (77072) $248.92 $382.95 2.2×
Bone imaging limited area (78300) $1,570.71 $2,416.48 3.7×
Bone marrow imaging whole body (78104) $1,315.30 $2,023.54 3.1×
Bone survey complete (77075) $459.13 $706.35 4.1×
Bowel imaging (78290) $1,889.08 $2,906.28 4.4×
Brachytx isodose pln cplx w/dosimetry cal (77318) $2,321.53 $3,571.58 5.8×
Brain flow imaging only - nm brain flow only brain death (78610) $1,653.76 $2,544.24 2.9×
Brain image w/flow 4 + views (78606) $2,377.93 $3,658.36 4.1×
Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) $1,283.34 $1,974.37 3.0×
Card MRI w/stress img & dye (75563) $1,809.11 $2,783.24 2.2×
Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or… (78481) $1,564.69 $2,407.21 2.7×
Cardiac MRI w/stress img (75559) $1,244.24 $1,914.21 2.1×
Cardiac MRI w/wo contrast & further seq (75561) $2,350.43 $3,616.04 6.3×
Cardiac shunt detection (78428) $1,564.69 $2,407.21 3.7×
Cerebrospinal fluid leakage (78650) $2,975.46 $4,577.63 2.2×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $772.81 $1,188.94 4.1×
Cisternogram (78630) $2,441.46 $3,756.09 4.2×
Cisternography, positive contrast, radiological supervision and interpretation Other Diagnostic Radiology FS (70015) $1,644.58 $2,530.13 2.0×
Clavicle complete (73000) $438.28 $674.28 4.7×
Computed tomographic (CT) colonography, screening, including image postprocessing UNSCHEDULED (74263) $1,332.74 $2,050.37 5.2×
Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Age Under 21 (77078) $848.66 $1,305.63 9.2×
Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) $2,186.28 $3,363.50 11.7×
Continuing medical physics consltj pr wk (77336) $592.62 $911.72 4.1×
Contrast exam abdominl aorta (75625) $5,114.60 $7,868.61 1.5×
Contrast exam thoracic aorta (75605) $8,588.61 $13,213.24 1.4×
Corpora cavernosography (74445) $632 $972.30 5.7×
Csf shunt evaluation (78645) $1,878.28 $2,889.66 3.2×
CT - st neck w&wo contr (70492) $2,310.83 $3,555.12 12.4×
CT abdomen and pelvis without and with contrast (74178) $5,331.51 $8,202.33 14.4×
CT abdomen and pelvis without contrast (74176) $2,768.81 $4,259.70 10.9×
CT abdomen w wo contrast (74170) $3,361.01 $5,170.78 18.0×
CT abdomen w/contrast (74160) $2,542.44 $3,911.44 13.6×
CT abdomen w/o contrast (74150) $1,804.53 $2,776.20 16.2×
CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) $4,175.89 $6,424.44 11.2×
CT angio abdom w/o & w/dye (74175) $2,736.62 $4,210.19 14.7×
CT angio abdominal arteries (75635) $2,606.10 $4,009.38 14.0×
CT angio hrt w/3d image (75574) $1,604.96 $2,469.17 4.3×
CT angiograph pelv w/o&w/dye (72191) $2,333.66 $3,590.25 12.5×
CT cere prfuj alys c+ w/o CT/CTA same anatomy (70473) $760.21 $1,169.55 4.1×
CT cervical spine w/contrast (72126) $2,319.64 $3,568.67 6.2×
CT cervical spine w/o contrast (72125) $1,711.90 $2,633.69 15.4×
CT chest w/contrast (71260) $2,606.10 $4,009.38 14.0×
CT colonography diag w cont (74262) $2,515.55 $3,870.07 13.5×
CT colonography w/o cntrst (74261) $1,913.45 $2,943.77 17.2×
CT extremity upper w & w/o contrast (73202) $2,120.07 $3,261.65 11.4×
CT head/brain with contrast (70460) $2,186.28 $3,363.50 11.7×
CT head/brain without and with contrast (70470) $2,621.44 $4,032.98 14.0×
CT heart contrast eval cardiac structure&morph (75572) $1,768.77 $2,721.18 4.8×
CT heart w/o contrast quant eval coronary calcium (75571) $438.29 $674.29 4.7×
CT hrt w/3d image congen (75573) $1,604.96 $2,469.17 4.3×
CT limited/localized follow up study (76380) $1,200.71 $1,847.25 13.0×
CT lower ext w/wo contrast (73702) $2,793.71 $4,298.01 15.0×
CT lower extremity w contrast (73701) $1,782.16 $2,741.79 9.5×
CT lower extremity w/o contrast unilateral (73700) $1,435.92 $2,209.10 12.9×
CT lumbar spine w/contrast (72132) $2,391.10 $3,678.62 6.4×
CT lumbar spine w/o contrast (72131) $1,787.55 $2,750.07 16.1×
CT lumbar spine w/o then w/ con (72133) $2,409.74 $3,707.29 12.9×
CT maxillofacial area w/o contrast (70486) $1,698.74 $2,613.44 15.3×
CT maxillofacial w/contrast (70487) $2,054.45 $3,160.69 11.0×
CT maxillofacial w/o then w/ con (70488) $2,551.72 $3,925.73 13.7×
CT orbit sella ear w/o con (70480) $1,767.06 $2,718.56 15.9×
CT orbit/ear/fossa w/o then w/ con (70482) $2,258 $3,473.85 12.1×
CT pelvis w & w/o contrast (72194) $2,430.92 $3,739.87 13.0×
CT pelvis w/o contrast (72192) $1,565.04 $2,407.76 14.1×
CT soft tissue neck w/contrast (70491) $1,869.63 $2,876.35 10.0×
CT soft tissue neck w/o contrast (70490) $1,593.87 $2,452.10 14.3×
CT spine cervical w/wo contrast (72127) $2,355.28 $3,623.51 12.6×
CT thoracic spine w/contrast (72129) $1,883.79 $2,898.14 10.1×
CT thoracic spine w/o contrast (72128) $1,645.09 $2,530.91 14.8×
CT thoracic spine w/o then w/ con (72130) $2,491.95 $3,833.77 13.3×
CT thorax lung cancer scr c- (71271) $1,525.91 $2,347.55 13.7×
CT thorax w/o contrast (71250) $2,060.95 $3,170.69 18.5×
CT thorax w/o then w/ contrast (71270) $3,173.68 $4,882.58 17.0×
CT upper extremity w/dye (73201) $2,053.53 $3,159.28 5.5×
CT upper extremity w/o contrast rt (73200) $1,882.94 $2,896.83 16.9×
CTA chest w/wo contrast (71275) $2,736.62 $4,210.19 14.7×
CTA head w contrast (70496) $2,483.72 $3,821.10 13.3×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $4,967.43 $7,642.20 13.4×
CTA lower extremity w/wo contrast unilateral (73706) $3,623.80 $5,575.08 19.4×
Cta Neck (70498) $2,483.72 $3,821.10 13.3×
CTA upper extremity w/wo contrast unilateral (73206) $1,753.93 $2,698.35 9.4×
Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Other Diagnostic Radiology FS (70170) $548.20 $843.39 2.2×
Dilation ureters/urethra rs&i (74485) $4,136.11 $6,363.25 1.9×
Discography, cervical or thoracic, radiological supervision and interpretation Other Diagnostic Radiology FS (72285) $6,859.20 $10,552.61 3.3×
Diskography lumbar (72295) $7,961.01 $12,247.70 3.8×
Doppler echo fetal spectral display complete (76827) $434.58 $668.58 3.9×
Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) $434.58 $668.58 3.9×
Doppler fetal mid cerebral artery (76821) $296.14 $455.60 2.7×
Dxa bone density study axial skeleton (77085) $217.85 $335.16 2.0×
Esophageal motility (78258) $1,217.62 $1,873.26 2.9×
Esophogram (74220) $479.63 $737.89 2.6×
Fetal biophysical profile non-stress testing (76818) $566.65 $871.77 5.1×
Fetal biophysical profile w/o nst (76819) $566.65 $871.77 5.1×
Fetal echo complete (76825) $2,910.51 $4,477.70 5.0×
Fluoroscopy up to 1 hour physician/qhp time (76000) $777.01 $1,195.40 3.1×
Full mouth X-ray of teeth (70320) $510.13 $784.81 2.0×
Functional MRI brain by phys/psych (70555) $1,813.01 $2,789.24 7.1×
Functional MRI brain by tech (70554) $1,813.01 $2,789.24 7.1×
Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) $2,253.36 $3,466.71 3.9×
Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit Age Under 21 (78265) $1,698.31 $2,612.78 4.0×
Gastric emptying study (78264) $1,627.21 $2,503.40 3.8×
Gastric mucosa imaging (78261) $1,283.34 $1,974.37 3.0×
Gastroesophageal reflux study (78262) $2,339.10 $3,598.61 5.5×
Gated heart planar single (78472) $1,784.87 $2,745.96 4.2×
Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) $3,406.34 $5,240.53 4.6×
Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) $3,406.34 $5,240.53 4.6×
Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) $3,406.34 $5,240.53 4.6×
Heart infarct image (78466) $1,283.34 $1,974.37 3.0×
Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) $5,114.60 $7,868.61 1.5×
Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Other… (75889) $5,114.60 $7,868.61 1.5×
Hepatobil syst image w/drug (78227) $2,560.46 $3,939.17 4.4×
Hepatobiliary system imaging (78226) $1,865.33 $2,869.74 4.4×
Humerus min 2 views (73060) $306.16 $471.02 3.3×
Hysterosalpingography (74740) $1,284.48 $1,976.12 5.1×
Imrt planning (77301) $9,437.23 $14,518.82 6.4×
Infusion of radioelement (77750) $814.88 $1,253.66 2.0×
Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) $1,283.34 $1,974.37 3.0×
Intraoperative radiation treatment delivery, electrons, single treatment session 2nd-5th Sessions (77425) $28,365.10 $43,638.62 3.6×
Intraoperative radiation treatment delivery, x-ray, single treatment session 2nd-5th Sessions (77424) $28,365.10 $43,638.62 3.6×
Isodose brachytherapy intermed 5 to 10 sources (77317) $1,949.45 $2,999.16 4.9×
Isodose brachytherapy plan simple 1 to 4 source (77316) $1,715.06 $2,638.56 4.3×
Isodose teletherapy plan complex multi tx w/cal (77307) $4,850.63 $7,462.50 12.2×
Isodose teletherapy plan simple 1 or 2 port w/cal (77306) $4,479.35 $6,891.31 11.2×
Ivp w tomography (74415) $596.21 $917.25 3.2×
Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) $1,914.69 $2,945.67 3.3×
Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) $1,821.72 $2,802.64 3.2×
Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) $1,938.46 $2,982.25 3.4×
Kidney w vascular flow (78701) $1,746.71 $2,687.25 4.1×
Labeled red cell sequestration, differential organ/tissue (eg, splenic and/or hepatic) Age Under 21 (78140) $2,004.28 $3,083.51 4.7×
Liver & spleen; static only (78215) $1,707.24 $2,626.52 4.0×
Liver & spleen; w vasc flow (78216) $1,863.35 $2,866.69 4.4×
Liver imaging w/vascular flow (78202) $4,463.18 $6,866.43 7.7×
Lung perf&ventilat diferentl (78598) $2,459.87 $3,784.42 4.3×
Lung perfusion differential (78597) $1,055.69 $1,624.14 2.5×
Lung ventilat&perfus imaging (78582) $1,787.64 $2,750.22 3.1×
Lung ventilation imaging (78579) $1,027.65 $1,581 2.4×
Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75803) $2,799.32 $4,306.65 1.7×
Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75801) $1,200.50 $1,846.92 1.8×
Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75807) $6,925.87 $10,655.18 2.1×
Lymphangiography, pelvic/abdominal, unilateral (75805) $5,405.60 $8,316.30 1.6×
Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) $2,786.93 $4,287.58 7.5×
Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) $2,309.64 $3,553.29 6.2×
Mammary ductogram multiple ducts (77054) $615.32 $946.65 2.4×
Mammary ductogram single (77053) $615.32 $946.65 2.4×
Mlc device(s) for imrt (77338) $1,751.18 $2,694.13 4.4×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $118.10 $181.69 3.8×
MRA head w & w/o contrast (70546) $2,667.95 $4,104.54 7.2×
MRA head w/contrast (70545) $2,425.98 $3,732.28 6.5×
MRA head w/o contrast (70544) $1,564.10 $2,406.30 6.2×
MRA neck w/contrast (70548) $1,991 $3,063.07 5.4×
MRA neck w/o contrast (70547) $1,564.10 $2,406.30 6.2×
MRA neck w/wo contrast (70549) $2,667.95 $4,104.54 7.2×
MRI abdomen w/contrast (74182) $2,850.08 $4,384.74 7.7×
MRI abdomen w/o & w/contrast material (74183) $3,845 $5,915.39 10.4×
MRI abdomen w/o contrast (74181) $2,218.66 $3,413.33 8.7×
MRI any jnt lwr ext with con lt (73722) $2,116.87 $3,256.72 2.5×
MRI breast without contrast bilateral (77047) $1,722.67 $2,650.26 6.8×
MRI breast without contrast material unilateral (77046) $1,722.67 $2,650.26 6.8×
MRI cardiac w/o contrast (75557) $1,203.53 $1,851.58 4.7×
MRI cervical spine w/o contrast (72141) $1,768.73 $2,721.13 7.0×
MRI cervical spine with contrast (72142) $2,434.13 $3,744.81 6.6×
MRI chest w & w/o contrast (71552) $3,463.79 $5,328.90 9.3×
MRI chest w/contrast (71551) $2,710.42 $4,169.87 3.2×
MRI chest w/o contrast (71550) $2,096.63 $3,225.59 8.3×
MRI elastography (76391) $1,722.67 $2,650.26 6.8×
MRI fetal sngl/1st gestation (74712) $1,072.51 $1,650.01 4.2×
MRI joint upper ext w/contrast (73222) $1,953.58 $3,005.50 2.3×
MRI joint upr extr w/o&w/dye (73223) $2,481.04 $3,816.99 6.7×
MRI joint upr extrem w/o dye (73221) $1,841.65 $2,833.30 7.2×
Mri Lower Extremity W/O Dye (73718) $1,970.52 $3,031.57 7.8×
MRI lumbar spine with contrast (72149) $2,213.85 $3,405.93 6.0×
MRI lumbar w/wo contrast (72158) $3,052.11 $4,695.56 8.2×
MRI lwr ext w/o jnts with con rt (73719) $2,100.16 $3,231.02 5.7×
MRI orbit/face/neck w/contrast (70542) $2,496.44 $3,840.68 6.7×
MRI orbit/face/neck w/o & w/contrast (70543) $2,915.68 $4,485.66 7.8×
MRI orbit/face/neck w/o contrast (70540) $2,400.68 $3,693.36 9.4×
MRI pelvis w/ contrast (72196) $2,483.62 $3,820.96 6.7×
MRI pelvis w/o contrast (72195) $1,782.33 $2,742.04 7.0×
MRI pelvis w/wo contrast (72197) $3,288.73 $5,059.59 8.9×
MRI spectroscopy (76390) $2,253.81 $3,467.40 24.3×
MRI spine cervical wo/w contrast (72156) $2,994.20 $4,606.46 8.1×
MRI spine thoracic w/contrast (72147) $2,208.38 $3,397.50 5.9×
MRI thoracic spine w wo contrast (72157) $2,965.49 $4,562.29 8.0×
MRI thoracic spine w/o contrast (72146) $1,776.94 $2,733.76 7.0×
MRI tmj (70336) $2,119.72 $3,261.10 8.3×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,970.64 $3,031.75 7.8×
Mri Upper Extremity W/Dye (73219) $2,710.42 $4,169.87 7.3×
MRI upr ext w/o jnts w/o-w/con rt (73220) $2,253.91 $3,467.56 6.1×
Myelogram thoracic (72255) $2,179.54 $3,353.14 2.6×
Myelography 2 or more regions (72270) $3,168.95 $4,875.30 3.8×
Myelography lumbosacral (72265) $2,179.54 $3,353.14 2.6×
Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) $5,838.18 $8,981.82 3.8×
Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) $5,838.18 $8,981.82 3.8×
Myocardial perfusion planar 1 study rest/stress (78453) $4,110.68 $6,324.13 3.0×
Myocardial perfusion planar multiple studies (78454) $5,561.50 $8,556.15 4.0×
Myocardial spect single study at rest or stress (78451) $3,924.20 $6,037.23 2.8×
Myocrd img PET metab eval single study (78459) $6,662.05 $10,249.31 4.8×
Myocrd img PET metab eval single study cncrnt CT (78429) $5,239.36 $8,060.55 3.4×
Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) $5,239.36 $8,060.55 3.4×
Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) $8,171.29 $12,571.22 3.5×
Myocrd img PET prfuj w/metab 2rtracer cncrnt CT (78433) $9,986.72 $15,364.19 4.3×
Myocrd img PET prfuj w/metab dual radiotracer (78432) $9,986.72 $15,364.19 6.2×
N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) $4,253.77 $6,544.26 4.7×
Nm adrenal imaging (78075) $5,009.63 $7,707.12 3.6×
Nm bone 3 phase (78315) $1,876.13 $2,886.35 4.4×
Nm bone imaging whole body (78306) $1,570.71 $2,416.48 3.7×
Nm bone marrow scan limited (78102) $1,192.06 $1,833.94 2.8×
Nm bone marrow scan multiple (78103) $1,192.06 $1,833.94 2.8×
Nm bone multi (78305) $1,570.71 $2,416.48 3.7×
Nm heart perfusion spect stress rest (78452) $5,561.50 $8,556.15 4.0×
Nm kidney function (78725) $855.56 $1,316.24 2.0×
Nm kidney imaging morphology (78700) $1,647.69 $2,534.91 3.9×
Nm liver image static only (78201) $4,463.18 $6,866.43 7.7×
Nm lymph system (78195) $1,886.92 $2,902.95 3.3×
Nm myocard infarct spect (78469) $2,975.46 $4,577.63 5.1×
Nm thyroid ca mets limited (78015) $1,121.43 $1,725.27 2.6×
Nm thyroid imaging only (78013) $1,242.98 $1,912.27 2.9×
Nose to rectum for fb child (76010) $580.26 $892.70 6.3×
Nuclear medicine study of brain, 4 static views or more (78605) $1,102.51 $1,696.17 1.9×
Nuclear medicine study of brain, less than 4 static views (78600) $1,283.34 $1,974.37 3.0×
Nuclear medicine study of red blood cell survival (78130) $2,004.28 $3,083.51 4.7×
Nuclear medicine study of salivary gland with serial images (78231) $992.14 $1,526.37 2.3×
Nuclear medicine study to assess blood clot in vein of both sides (78458) $1,018.69 $1,567.21 2.4×
Nuclear rx IV admin (79101) $1,078.04 $1,658.53 4.3×
Ob us < 14 wks single fetus (76801) $541.48 $833.05 4.9×
Ob us nuchal meas 1 gest (76813) $272.32 $418.95 2.4×
Oral radiopharm rx (79005) $1,515.72 $2,331.87 6.1×
Parathyrd planar w/spect&CT (78072) $1,695.25 $2,608.08 2.9×
Parathyroid imaging (78070) $1,653.70 $2,544.15 3.9×
Parathyroid planar imaging w/wo subtraction (78071) $1,752.37 $2,695.96 4.1×
Peritoneal-venous shunt patency test (78291) $1,217.62 $1,873.26 2.9×
Peritoneogram rs&i (74190) $1,214.75 $1,868.84 2.1×
PET brain metabolic eval (78608) $5,838.18 $8,981.82 3.8×
PET imaging CT attenuation skull base mid-thigh (78815) $5,840.75 $8,985.77 3.8×
PET imaging CT for attenuation limited area (78814) $5,840.75 $8,985.77 3.8×
PET imaging for CT attenuation whole body (78816) $5,840.75 $8,985.77 3.8×
PET imaging limited area chest head/neck (78811) $1,678.60 $2,582.46 1.2×
PET imaging whole body (78813) $3,329.20 $5,121.85 2.2×
Plasma volume multiple (78111) $2,975.46 $4,577.63 2.2×
Platelet survival study (78191) $855.56 $1,316.24 2.0×
Proton treatment complex (77525) $5,038.72 $7,751.87 3.8×
Proton trmt intermediate (77523) $5,028.74 $7,736.52 3.8×
Proton trmt simple w/comp (77522) $5,018.77 $7,721.18 3.8×
Proton trmt simple w/o comp (77520) $2,504.39 $3,852.91 4.3×
Prq transhepatc portograpy w/o hemodyn evl intrp (75887) $5,698.65 $8,767.16 1.7×
Pulmonary perfusion imaging particulate (78580) $1,284.60 $1,976.31 3.0×
Quan&charac c atherosclerotc plaq asses sev c ds (75577) $4,253.77 $6,544.26 4.3×
Radex abscess/fistula/sinus tract rs&i (76080) $1,182.75 $1,819.61 2.0×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $183.99 $283.06 2.0×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $256.59 $394.75 2.3×
Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) $493.14 $758.68 4.4×
Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) $493.14 $758.68 4.4×
Radex hip unilateral with pelvis 1 view (73501) $181.27 $278.88 2.0×
Radex hip unilateral with pelvis 2-3 views (73502) $181.27 $278.88 2.0×
Radex hip unilateral with pelvis minimum 4 views (73503) $300.22 $461.87 2.7×
Radex hips bilateral with pelvis 2 views (73521) $300.22 $461.87 2.7×
Radex hips bilateral with pelvis minimum 5 views (73523) $572.34 $880.53 5.1×
Radex spine cervical 2 or 3 views (72040) $341.74 $525.75 3.7×
Radex spine cervical 4 or 5 views (72050) $732.12 $1,126.34 6.6×
Radex spine cervical 6 or more views (72052) $898.20 $1,381.84 8.1×
Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) $205.54 $316.21 2.2×
Radiation delivery stereotactic cranial linear (77372) $31,128.17 $47,889.49 4.0×
Radiation tx delivery lvl 1 (77402) $293.80 $452 2.7×
Radiation tx delivery lvl 2 (77407) $1,110.62 $1,708.65 2.7×
Radiation tx delivery lvl 3 (77412) $1,591.06 $2,447.78 2.7×
Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) $546.33 $840.50 4.9×
Radiologic exam esophagus double contrast study (74221) $435.26 $669.63 2.3×
Radiologic exam phrnx&/crv esoph contrast study (74210) $479.63 $737.89 2.6×
Radiologic exam upr gi trc double contrast study (74246) $721.49 $1,109.99 3.9×
Radiologic exam upr gi trc single contrast study (74240) $969.20 $1,491.08 5.2×
Radiologic Examination Femur 1 View - Xr Femur 1 Vw Right (73551) $181.27 $278.88 2.0×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $453.11 $697.10 4.9×
Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) $673.44 $1,036.06 6.0×
Radiologic examination, mastoids; less than 3 views per side Other Diagnostic Radiology FS (70120) $328.88 $505.98 3.0×
Radiologic examination, spine; thoracic, minimum of 4 views Other Diagnostic Radiology FS (72074) $248.92 $382.95 2.2×
Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Other Diagnostic… (70370) $408.82 $628.95 4.4×
Radiopharmaceutical dacryocystography Age Under 21 (78660) $934.30 $1,437.39 2.2×
Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion UNSCHEDULED (79403) $3,045.39 $4,685.22 12.3×
Red cell mass multiple (78121) $2,004.28 $3,083.51 3.5×
Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) $655.36 $1,008.24 1.6×
Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) $655.36 $1,008.24 1.6×
Renal cyst study (74470) $1,182.75 $1,819.61 2.0×
Rp loclzj tum plnr 1 area single day imaging (78800) $1,305.24 $2,008.06 3.1×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $2,824.75 $4,345.77 6.6×
Rp loclzj tum plnr whole body 2+ days imaging (78804) $4,316.37 $6,640.57 7.5×
Rp loclzj tum plnr whole body single day imaging (78802) $2,975.46 $4,577.63 5.1×
Rp loclzj tum spect 1 area single day imaging (78803) $4,931.76 $7,587.33 8.5×
Rp loclzj tum spect 2 area/sep acquisj img (78831) $4,618.65 $7,105.62 3.4×
Rp loclzj tum spect CT 2area/sep acquisj img (78832) $5,239.36 $8,060.55 3.4×
Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) $4,618.65 $7,105.62 3.4×
Rp therapy intra-arterial particulate admn (79445) $1,306.14 $2,009.44 5.3×
Saline infused sonohysterogram (76831) $1,034.70 $1,591.85 4.1×
Salivary gland funct study (78232) $1,164.27 $1,791.18 2.7×
Salivary gland imaging (78230) $1,283.34 $1,974.37 3.0×
Screening digital breast tomosynthesis; bilateral (77063) $145.39 $223.68 6.2×
Selective spinal angiogram (75705) $9,223.06 $14,189.32 1.6×
Shoulder arthrogram (73040) $1,136.17 $1,747.96 3.1×
Shuntogram indwelling nonvascular shunt rs&i (75809) $365.64 $562.53 3.3×
Simulation complex (77290) $2,663.60 $4,097.84 6.7×
Simulation intermediate (77285) $2,337.67 $3,596.42 5.9×
Simulation simple (77280) $410.87 $632.11 2.9×
Small bowel series (74250) $670.21 $1,031.09 3.6×
Spec telethx port pln parts hemibdy tot bdy (77321) $1,162.59 $1,788.60 2.9×
Special dosimetry (77331) $355.93 $547.58 2.5×
Special physics consult (77370) $966.86 $1,487.48 6.8×
Special treatment procedure (77470) $1,258.20 $1,935.69 2.1×
Spleen imaging only (78185) $1,192.06 $1,833.94 2.8×
Splenoportography (75810) $10,535.45 $16,208.38 3.1×
Stereotactic body radiation delivery (77373) $23,495.06 $36,146.25 12.3×
Superior sagittal sinus venogram (75870) $5,405.60 $8,316.30 1.6×
Surface application of low dose rate radionuclide source 2nd-5th Sessions (77789) $678.56 $1,043.94 6.2×
Temporomandibular joint arthrography, radiological supervision and interpretation Other Diagnostic Radiology FS (70332) $1,213.42 $1,866.80 4.8×
Testicular imaging w/flow (78761) $1,647.69 $2,534.91 3.9×
Therapeutic enema barium or air (74283) $587.89 $904.44 3.1×
Thyroid met imaging body (78018) $1,776.91 $2,733.71 3.1×
Thyroid uptake single/multiple quant measurement (78012) $855.56 $1,316.24 2.0×
Thyroid uptake w/blood flow sngle/mult quan meas (78014) $1,373.09 $2,112.45 3.2×
Treatment device intermediate (77333) $1,014.05 $1,560.08 7.1×
Treatment devices complex (77334) $1,781.08 $2,740.13 4.5×
Treatment devices simple (77332) $980.69 $1,508.76 6.9×
Ultrasound breast limited (76642) $914.78 $1,407.35 9.9×
Ultrasound, abdomen limited (76705) $623.20 $958.77 5.6×
Ultrasound, elastography; first target lesion (76982) $1,046.32 $1,609.73 9.4×
Umbilical-artery Doppler (OB) (76820) $296.14 $455.60 2.7×
Unlisted cardiovascular procedure, diagnostic nuclear medicine UNSCHEDULED (78499) $1,283.34 $1,974.37 3.0×
Unlisted CT procedure (76497) $2,281.63 $3,510.20 24.6×
Unlisted diagnostic radiographic procedure (76499) $161.03 $247.74 1.7×
Unlisted fluoroscopic procedure (76496) $216.37 $332.88 2.3×
Unlisted gastrointestinal procedure, diagnostic nuclear medicine UNSCHEDULED (78299) $1,307.48 $2,011.50 3.1×
Unlisted magnetic resonance procedure (76498) $2,299.89 $3,538.29 24.8×
Urea breath test, C-14 (isotopic); acquisition for analysis Other Outpatient (78267) $169.83 $261.28 15.4×
Ureteral reflux study (78740) $1,627.49 $2,503.83 3.8×
Urethrocystography retrograde rs&i (74450) $853.34 $1,312.83 3.4×
Urethrocystography voiding (74455) $853.34 $1,312.83 3.4×
Urography antegrade (74425) $1,007.64 $1,550.22 2.7×
Urography retrograde w/wo kub (74420) $917.40 $1,411.39 2.5×
Urography, infusion, drip technique and/or bolus technique; Other Diagnostic Radiology FS (74410) $578.82 $890.49 3.1×
Us abdominal aorta real time screen study aaa (76706) $644.56 $991.63 5.8×
Us breast uni real time with image complete (76641) $914.78 $1,407.35 8.2×
Us chest (76604) $533.90 $821.38 4.8×
Us compl joint r-t w/image documentation (76881) $610.75 $939.62 5.5×
Us elastography parenchyma (76981) $1,046.32 $1,609.73 9.4×
Us encephalogram (76506) $1,031.93 $1,587.58 9.3×
Us guided compression repair (76936) $526.45 $809.93 2.3×
Us inft hips r-t img dynamic req phys/qhp manj (76885) $772.08 $1,187.82 8.3×
Us inft hips r-t img lmtd static phys/qhp manj (76886) $485.76 $747.32 5.2×
Us kidney transplanted (76776) $839.10 $1,290.93 7.5×
Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) $358.31 $551.24 3.2×
Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) $284.86 $438.24 2.6×
Us ob detailed single fetus (76811) $1,064.80 $1,638.16 4.2×
Us ob followup per fetus (76816) $370.18 $569.50 3.3×
Us ob limited 1 or more fetuses (76815) $490.82 $755.10 4.4×
Us obstetric transvaginal (76817) $831.56 $1,279.32 7.5×
Us pelvic limited or f/u non-ob (76857) $332.61 $511.70 3.0×
Us pelvis complete (76856) $782.26 $1,203.47 7.0×
Us retroperitoneal complete (76770) $677.50 $1,042.31 6.1×
Us retroperitoneal limited (76775) $644.56 $991.63 5.8×
Us scrotum (76870) $395.47 $608.42 3.6×
Us soft tissue head/neck (76536) $623.16 $958.70 5.6×
Us spinal canal (76800) $507.34 $780.53 4.6×
Us transrectal (76872) $679.71 $1,045.70 6.1×
Us transrectal prostate volume (76873) $272.32 $418.95 2.4×
Us trgt dyn mbubb 1st les (76978) $704.51 $1,083.86 1.9×
Us unlstd proc (76999) $201.29 $309.68 2.2×
Vascular flow imaging (78445) $936.34 $1,440.53 2.2×
Vein X-ray liver w/hemodynam (75885) $5,559.67 $8,553.34 1.7×
Venogram epidural (75872) $7,113.27 $10,943.49 10.6×
Venogram extremity bilateral (75822) $2,697.30 $4,149.69 1.6×
Venogram ivc w serialography (75825) $5,114.60 $7,868.61 1.5×
Venogram svc w serialography (75827) $3,902.70 $6,004.15 2.3×
Venography adrenal unilateral selective rs&i (75840) $7,820.53 $12,031.59 2.3×
Venography ext unilateral (75820) $2,875.07 $4,423.19 1.7×
Venography renal unilateral selective rs&i (75831) $6,302.92 $9,696.80 1.9×
Venography venous sinus/jugular cath rs&i (75860) $6,518.45 $10,028.39 1.9×
Venography, orbital, radiological supervision and interpretation Other Diagnostic Radiology FS (75880) $6,925.87 $10,655.18 10.4×
Venous sampling by catheter (75893) $8,473.96 $13,036.86 1.4×
Venous thrombosis imaging - nm extremity veins thrombosis right (78457) $2,975.46 $4,577.63 5.1×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $299.78 $461.18 3.2×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $420.32 $646.65 4.5×
X-ray aorta leg arteries (75630) $5,114.60 $7,868.61 1.5×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $1,149.73 $1,768.81 6.2×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $756.13 $1,163.28 8.2×
X-ray exam hips bi 3-4 views (73522) $300.22 $461.87 2.7×
X-ray exam of finger(s) (73140) $487.77 $750.42 5.3×
X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) $701.72 $1,079.57 3.8×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $162.90 $250.61 1.8×
X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) $501.54 $771.60 5.4×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $565.35 $869.77 6.1×
X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) $389.79 $599.67 3.5×
X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) $467.43 $719.13 5.0×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $459.03 $706.20 5.0×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $243.56 $374.70 2.6×
X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) $807.56 $1,242.40 8.7×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $648.78 $998.12 5.8×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $294.44 $452.99 3.2×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $400.96 $616.86 3.6×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $624.12 $960.19 5.6×
X-Ray Mastoids 3+ Vw - Xr Mastoids 3+ Views (70130) $328.88 $505.98 3.0×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $189.98 $292.27 2.1×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $617.72 $950.34 5.5×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $435.10 $669.38 3.9×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $248.92 $382.95 2.2×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $205.54 $316.21 2.2×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $478.46 $736.10 5.2×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $302.30 $465.08 3.3×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $340.25 $523.46 3.1×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $438.60 $674.77 3.9×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $263.03 $404.66 2.8×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $359.89 $553.68 3.9×
X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) $451.35 $694.39 4.9×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $478.55 $736.23 5.2×
Xr abdomen 1 view (74018) $412.02 $633.87 4.4×
Xr abdomen 2 views (74019) $484.63 $745.58 4.4×
Xr abdomen 3 views (74021) $421.40 $648.31 3.8×
Xr arthrogram ankle (73615) $896.86 $1,379.78 2.4×
Xr arthrogram elbow (73085) $1,645.29 $2,531.21 4.4×
Xr arthrogram hip (73525) $1,144.55 $1,760.84 3.1×
Xr bone density appendicular (77081) $183.99 $283.06 2.0×
Xr bone density axial (77080) $248.92 $382.95 2.2×
Xr bone length study (77073) $459.71 $707.25 4.1×
Xr bone survey infant (77076) $392.63 $604.05 3.5×
Xr bone survey limited (77074) $433.69 $667.22 3.9×
Xr chest 1 view (71045) $442.83 $681.28 4.8×
Xr chest 2 views (71046) $442.83 $681.28 4.8×
Xr chest 3 views (71047) $509.33 $783.59 5.5×
Xr cystogram 3+ views (74430) $917.40 $1,411.39 2.5×
Xr eye foreign body (70030) $184.67 $284.11 2.0×
Xr facial bones 3 views (70150) $475.35 $731.30 4.3×
Xr joint survey 1 view (77077) $248.92 $382.95 2.2×
Xr lower extremity 2 views infant (73592) $209.50 $322.32 2.3×
Xr lumbar spine 4 views w/ flex ext (72120) $583 $896.92 5.2×
Xr mandible 4 views (70110) $451.39 $694.45 4.1×
Xr myelogram c-spine (72240) $2,447.32 $3,765.11 2.9×
Xr nasal bones (70160) $263.78 $405.81 2.8×
Xr pelvis 3 views (72190) $372.13 $572.50 3.3×
Xr sialogram (70390) $980.23 $1,508.04 3.9×
Xr spine 1 view (72020) $293.14 $450.98 3.2×
Xr sternum 2 views (71120) $200.11 $307.86 2.2×
Xr stress view joint (77071) $183.99 $283.06 2.0×
Xr surgical specimen (76098) $1,325.47 $2,039.18 2.3×
Xr upper extremity 2 views infant (73092) $291.48 $448.42 2.6×
Xray elbow 2 views (73070) $382.25 $588.08 4.1×
Xray forearm 2 views (73090) $473.29 $728.14 5.1×
Xray knee 1 or 2 views rt (73560) $287.90 $442.93 3.1×
Xray neck soft tissue (70360) $540.04 $830.83 5.8×
Xray optic foramina (70190) $204.43 $314.51 2.2×
Xray orbits complete min 4 views (70200) $488.72 $751.88 4.4×
Xray pelvis 1 or 2 views (72170) $335.60 $516.31 3.0×
Xray ribs bilateral 3 views (71110) $351.92 $541.41 3.2×
Xray ribs unilat w/ pa chest 3v rt (71101) $339.86 $522.86 3.1×
Xray scapula complete (73010) $527.78 $811.96 4.7×
Xray shoulder 1 view (73020) $426.92 $656.80 4.6×
Xray sinuses paranasal <3 views (70210) $209.79 $322.76 2.3×
Xray spine thoracic 2 views (72070) $248.92 $382.95 2.2×
Xray spine thoracic 3 views (72072) $248.92 $382.95 2.2×
Xray tibia-fibula 2 views bil (73590) $315.26 $485.02 3.4×
Xray tmj open - closed unilat (70328) $183.99 $283.06 2.0×
Xray tmj's bilateral open-clsc (70330) $227.30 $349.69 2.5×