2 views, front and back
MG Mammo Screen Bilateral
Tomo
A diagnostic procedure that allows a provider to see the organs and other structures in the abdomen
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus
Abdominal ultrasound of pregnant uterus (less than 14 weeks) single or first fetus
CHEMO ADMIN IVP ADD'L CHARGE
CHEMOTHERAPY ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG
Chemotherapy infusion-each additional hour
Chemotherapy Subcutaneous Injection Charge
Complete ultrasound of the pelvis
CT Neck Soft Tissue w/ + w/o Contrast
CT of abdomen and pelvis without dye
CT of pelvis without dye
CT scan head or brain without dye
CT scan of abdomen and pelvis with contrast
CT scan of neck with dye
CT scan of the thorax with dye
CT scan of the thorax without dye
CT scan, pelvis, with contrast
CT Spine Cervical w/o Contrast
CT Upper Extremity w/o Contrast
CTA HEAD
CTA NECK
Diagnostic mammography, including computer-aided detection (cad) when performed; bilateral
Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral
Diagnostic Radiology (Diagnostic Imaging) Procedures of the Chest
Image of the heart to assess perfusion
Injection of substance into spinal canal of lower back or sacrum using imaging guidance
Limited ultrasound of the breast
Mammography of Both Breasts W Tomo
Mammography of both breasts-2 or more views
Mammography of One Breast/ Tomo
Mammography, Screening, Bilateral W/Tomo
MRI of brain stem without dye
MRI of lower back with and without dye
MRI of lower extremity joint (knee/ankle) without dye
MRI of neck/spine with and without dye
MRI of the neck or spine without dye
MRI of upper extremity without dye
MRI scan of brain before and after contrast
MRI scan of lower spinal canal
MRI Upper Extremity w/o Contrast
One sided or limited bilateral study
Radiologic examination of one side of the chest/ribs
Radiologic examination of the ankle with 3 views
Radiologic examination of the collar bone
Radiologic examination of the finger(s)
Radiologic examination of the foot with 3 or more views
Radiologic examination of the forearm
Radiologic examination of the knee with 1 or 2 views
Radiologic examination of the knee with 3 views
Radiologic examination of the knee with 4 or more views
Radiologic examination of the middle spine, 2 views
Radiologic examination of the middle spine, 3 views
Radiologic examination of the neck/spine, 2-3 views
Radiologic examination of the neck/spine, 4-5 views
Radiologic examination of the pelvis
Radiologic examination of the shoulder
Radiologic examination, elbow; 2 views
Radiologic examination, elbow; 3 or more views
Removal of 1 or more breast growth, open procedure
Scan to measure bone mineral density (BMD) at the spine and hip
Single view
Transfuse Red Blood Cells Leukoreduced
Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function
Ultrasound of abdomen with all areas scanned
Ultrasound of back wall of the abdomen with limited areas viewed
Ultrasound of the pelvis through vagina
Up to 3 views
US Breast Biopsy
X-ray of lower and sacral spine, minimum of 4 views
X-ray of the hand with 2 views
X-ray of the hand with 3 or more views
X-ray of the lower spine 2-3 views
XR Abdomen 2 Views
XR Arthrogram Shoulder
XR Facial Bones 3+ Views
XR Hip 2-3 Views w/AP Pelvis
XR Ribs 2 Views
XR Ribs w/ PA Chest Bilateral
XR Sacroiliac Joints 1 or 2 Views
XR Sacrum/Coccyx 2+ Views
XR Scapula
YUMA Hip Arthrogram Inj
YUMA Lumbar Epidural Steroid Injection (ESI)
YUMA Shoulder Arthrogram Inj