| PROCEDURE |
|---|
| MRA, Angiography Carotid w/ or w/o Contrast |
| MRA, Angiography Carotid w/o Contrast |
| MRA, Angiography Chest w/ or w/o Contrast |
| MRA, Angiography Head w/ Contrast |
| MRA, Angiography Head w/ or w/o Contrast |
| MRA, Angiography Head w/o Contrast |
| MRA, Angiography Neck w/ Contrast |
| MRA, Angiography Pelvis w/ or w/o Contrast |
| MRA, Angiography Spinal Canal w/ or w/o Contrast |
| MRA, Angiography Upper Ext. w/ or w/o Contrast |
| MRA, Angiography, Abd/Renal w/ or w/o Contrast |
| MRA, Angiography, Lower Ext. w/ or w/o Contrast |
| MRI, Abdomen w/ Contrast |
| MRI, Abdomen w/ & w/o Contrast |
| MRI, Abdomen w/o Contrast |
| MRI, Brain w/ Contrast |
| MRI, Brain w/ & w/o Contrast |
| MRI, Brain w/o Contrast |
| MRI, Cervical Spine w/ Contrast |
| MRI, Cervical Spine w/ & w/o Contrast |
| MRI, Cervical Spine w/o Contrast |
| MRI, Chest w/ Contrast |
| MRI, Chest w/ & w/o Contrast |
| MRI, Chest w/o Contrast |
| MRI, Lower Ext. Joint w/ Contrast |
| MRI, Lower Ext. Joint w/ & w/o Contrast |
| MRI, Lower Ext. Joint w/o Contrast |
| MRI, Lower Ext. Non-Joint w/ Contrast |
| MRI, Lower Ext. Non-Joint w/ & w/o Contrast |
| MRI, Lower Ext. Non-Joint w/o Contrast |
| MRI, Lumbar Spine w/ Contrast |
| MRI, Lumbar Spine w/ & w/o Contrast |
| MRI, Lumbar Spine w/o Contrast |
| MRI, Orbit, Face or Neck w/ Contrast |
| MRI, Orbit, Face or Neck w/ & w/o Contrast |
| MRI, Orbit, Face or Neck w/o Contrast |
| MRI, Pelvis w/ Contrast |
| MRI, Pelvis w/ & w/o Contrast |
| MRI, Pelvis w/o Contrast |
| MRI, Thoracic Spine w/ Contrast |
| MRI, Thoracic Spine w/ & w/o Contrast |
| MRI, Thoracic Spine w/o Contrast |
| MRI, TMJ(s) |
| MRI, Upper Ext. Joint w/o Contrast |
| MRI, Upper Ext. Joint w/ Contrast |
| MRI, Upper Ext. Joint w/ & w/o Contrast |
| MRI, Upper Ext. Non-Joint w/ Contrast |
| MRI, Upper Ext. Non-Joint w/ & w/o Contrast |
| MRI, Upper Ext. Non-Joint w/o Contrast |
| PROCEDURE |
|---|
| CT, Abd & Pelvis w/ & w/o Contrast |
| CT, Abd & Pelvis w/o Contrast |
| CT, Abdomen w/ Contrast |
| CT, Abdomen w/ & w/o Contrast |
| CT, Abdomen w/o Contrast |
| CT, Angiography Abd/Pelvis w/ & w/o Contrast |
| CT, AngiographyAorta & Bilat Iliofemor run off w/ & w/o Contrast |
| CT, Angiography Chest w/ & w/o Contrast |
| CT, Angiography Head w/ & w/o Contrast |
| CT, Angiography Lower Ext. w/ & w/o Contrast |
| CT, Angiography Neck w/ & w/o Contrast |
| CT, Angiography Pelvis w/ & w/o Contrast |
| CT, Angiography, Abdomen w/ & w/o Contrast |
| CT, Angiography, Upper Ext. w/ & w/o Contrast |
| CT, Cervical Spine w/ Contrast |
| CT, Cervical Spine w/ & w/o Contrast |
| CT, Cervical Spine w/o Contrast |
| CT, Head or Brain w/ Contrast |
| CT, Head or Brain w/ & w/o Contrast |
| CT, Head or Brain w/o Contrast |
| CT, Lower Extremity w/ Contrast |
| CT, Lower Extremity w/ & w/o Contrast |
| CT, Lower Extremity w/o Contrast |
| CT, Lumbar Spine w/ Contrast |
| CT, Lumbar Spine w/ & w/o Contrast |
| CT, Lumbar Spine w/o Contrast |
| CT, Maxillofacial Area w/ Contrast |
| CT, Maxillofacial Area w/ & w/o Contrast |
| CT, Maxillofacial Area w/o Contrast |
| CT, Orbit, Sella, Post Fossa or Ear w/ Contrast |
| CT, Orbit, Sella, Post Fossa or Ear w/ & w/o Contrast |
| CT, Orbit, Sella, Post Fossa or Ear w/o Contrast |
| CT, Pelvis w/ Contrast |
| CT, Pelvis w/ & w/o Contrast |
| CT, Pelvis w/o Contrast |
| CT, Soft Tissue Neck w/ Contrast |
| CT, Soft Tissue Neck w/ & w/o Contrast |
| CT, Soft Tissue Neck w/o Contrast |
| CT, Thoracic Spine w/ Contrast |
| CT, Throacic Spine w/ & w/o Contrast |
| CT, Thoracic Spine w/o Contrast |
| CT, Thorax (Chest) w/ Contrast |
| CT, Thorax (Chest) w/ & w/o Contrast |
| CT, Thorax (Chest) w/o Contrast |
| CT, Upper Extremity w/ Contrast |
| CT, Upper Extremity w/ & w/o Contrast |
| CT, Upper Extremity w/o Contrast |
| PROCEDURE |
|---|
| X-ray, Abdomen, 1 view |
| X-ray, Abdomen, 2 views |
| X-ray, Abdomen, 3 or more views |
| X-ray, Abscess, Fistula or Sinus Tract |
| X-ray, AC Joints, Bilateral w/ or w/o Weights |
| X-ray, Ankle 2 Views |
| X-ray, Ankle, Minimum 3 Views |
| X-ray, Bone Age Study |
| X0ray, Calcaneus (Heel), Minimum 2 Views |
| X-ray, Cervical Spine, 2 or 3 Views |
| X-ray, Cervical Spine, Minimum 4 Views |
| X-ray, Cervical Spine, 7 Views Complete |
| X-ray, Chest, 1 View - Frontal |
| X-ray, Chest, 2 Views PA & Lateral |
| X-ray, Chest, 3 Views PA & Lateral |
| X-ray, Chest, 4 or More Views |
| X-ray, Clavicle, Complete |
| X-ray, Elbow, 2 Views |
| X-ray, Elbow, Minimum 3 Views |
| X-ray, Entire GI Tract, Foreign Body, 1 View |
| X-ray, Facial Bones, 3 or More Views |
| X-ray, Facial Bones, Less than 3 Views |
| X-ray, Finger(s), Minimum 2 Views |
| X-ray, Foot, 2 Views |
| X-ray, Foot, Minimum 3 Views |
| X-ray, Forearm, 2 Views |
| X-ray, Hand, 2 Views |
| X-ray, Hand, Minimum 3 Views |
| X-ray, Humerus, Minimum 2 Views |
| X-ray, Knee, 1 or 2 Views |
| X-ray, Knee, 3 Views |
| X-ray, Knee, Bilateral Standing |
| X-ray, Knee, Minimum 4 Views |
| X-ray, Lower Ext, Infant Under 1 Year, Minimum 2 Views |
| X-ray, Lumbosacral, 2 or 3 Views |
| X-ray, Lumbosacral, Bend Only, 2 or 3 Views |
| X-ray, Lumbosacral, Compl w/ Bend, Minimum 6 Views |
| X-ray, Lumbosacral, Minimum 4 Views |
| X-ray, Mandible (Jaw), 4 or More Views |
| X-ray, Mandible (Jaw), Less than 4 Views |
| X-ray, Mastoids, 3 or More Views per Side |
| X-ray, Mastoids, Less than 3 Views per Side |
| X-ray, Nasal Bones, Minimum 3 Views |
| X-ray, Neck Soft Tissue |
| X-ray, Optic Foramina, Bilateral |
| X-ray, Orbits Bilateral, Minimum 4 Views |
| X-ray, Osseous Survey, Complete |
| X-ray, Osseous Survey, Infant |
| X-ray, Osseous Survey, Limited |
| X-ray, Pelvis, 1 or 2 Views |
| X-ray, Pelvis, Minimum 3 Views |
| X-ray, Ribs, 2 Views, Unilateral |
| X-ray, Ribs, 2 Views, Unilateral plus PA Chest |
| X-ray, Ribs, 3 Views, Unilateral |
| X-ray, Ribs, 3 Views, Unilateral plus PA Chest |
| X-ray, Sacrum & Coccyx, Minimum 2 Views |
| X-ray, SC Joint(s), Minimum 3 Views |
| X-ray, Scapula, Complete |
| X-ray, Sella Turcica (Pituitary) |
| X-ray, Shoulder, 1 View |
| X-ray, Shoulder, Minimum 2 Views |
| X-ray, SI Joints, 3 or More Views |
| X-ray, SI Joints, Less than 3 Views |
| X-ray, Sinuses, 3 or More Views |
| X-ray, Sinuses, Less than 3 Views |
| X-ray, Skull, 4 or More Views |
| X-ray, Skull, Less than 4 Views |
| X-ray, Spine, 1 View, Specify Level |
| X-ray, Sternum, Minimum 2 Views |
| X-ray, Thoracic Spine, 2 Views |
| X-ray, Thoracic Spine, 3 Views |
| X-ray, Thoracic Spine, Minimum 4 Views |
| X-ray, Thoracolumbar, 2 Views |
| X-ray, Thoracic, Lumbar, Cervical and Sacral Spine, 1 View |
| X-ray, Thoracic, Lumbar, Cervical and Sacral Spine, 2 or 3 Views |
| X-ray, Thoracic, Lumbar, Cervical and Sacral Spine, 4 or 5 Views |
| X-ray, Thoracic, Lumbar, Cervical and Sacral Spine, Minimum 6 Views |
| X-ray, Tibia and Fibula, 2 Views |
| X-ray, TMJ, Open and CLosed, Bilateral |
| X-ray, TMJ, Open and Closed, Unilateral |
| X-ray, Toe(s), Minimum 2 Views |
| X-ray, Upper Ext, Infant, Minimum 2 Views |
| X-ray, Wrist, 2 Views |
| X-ray, Wrist, Minimum 3 Views |