Abdominal ultrasound of pregnant uterus, greater or equal to 14 weeks 0 days, single or first fetus
CONTRAST OPTIRAY 300
CT ABDOMEN/PELVIS W/CONTRAST
CT ABDOMEN/PELVIS W/O CONTRAST
CT BRAIN W/O CONTRAST
CT CERVICAL SP 5-7 W/O CONTRAS
CT CHEST W/O CONTRA
CT CHEST/PE PROTOCOL
CT FACIAL W/O CON
CT LUMBAR SPINE W/O CONTRAST
CT scan, pelvis, with contrast
DX DUAL BONE DENSITY ST
Mammography of one breast
MM DIAGNOSTIC MAMMO/CAD BILATERAL
MM DIGITAL SCREENING MAMMO/CAD BILATERAL
MM TOMO DIAGNOSTIC BILATERAL MAMMO
MM TOMO DIAGNOSTIC UNILATERAL MAMMO
MM TOMO SCREENING MAMMO BILATERAL
MRA HEAD W/O CONTRAST
MRI ABD W/ & W/O CONTRAST
MRI BRAIN W/O CONTRS
MRI BRAIN W&W/O CONT
MRI C-SPINE W/O CONT
MRI C-SPINE W&W/O CO
MRI L-SPINE W/O CONT
MRI L-SPINE W&W/O CO
MRI LOW EXT JOINT W&WO CONT LE
MRI LOW EXT JOINT W&WO CONT RI
MRI LOW EXT NONJOINT W/O CONT
MRI LOWER EXT JOINT W/O CONT L
MRI LOWER EXT JOINT W/O CONT R
MRI LOWER EXT NON-JOINT W&WO C
MRI ORBIT,HEAD NECK W/O CONTRA
MRI PELVIS W/O CONTRAST
MRI PELVIS W&WO CONTRAST
MRI T-SPINE W/O CONT
MRI T-SPINE W&W/O CO
MRI UP EXT NONJOINT W/O CONT L
MRI UP EXT NONJOINT W/O CONT R
MRI UPPER EXT JOINT W&WO CONT
MRI UPPER JOINT W/O CONT LEFT
MRI UPPER JOINT W/O CONT RIGHT
MRI-ABDOMEN W/O CONTRAST
NM BONE 3 PHASE
NM BONE WHOLE
NM GASTRIC EMPTYING SCA
NM HIDA W/EF
NM LUNG PERFUSION
NM MYOCARDIAL/HEART WALL MOTION
NM MYOVIEW
NM N417156020105
NM PARATHYROID PLANAR W/SPECT
NM QUANTATIVE PUL PERFUSION
NM TC 99M ALBUMIN AGGR/MAA, UP TO
NM TC 99M MDP UP TO 30 MILLICURIE
NM TC 99M MEBROFENIN/CHOLETEC, UP
NM TC 99M SESTAMIBI/CARDIOLITE UP
NM TC 99M SULFUR COLLOID, UP TO 2
NM THYROIS SCAN/UPTAKE
Removal of 1 or more breast growth, open procedure
RF FLUORO UNDER 1 HOUR
Ultrasound of abdomen
US ABD (SPECIFY OR
US BREAST UNILAT LT
US BREAST UNILAT RT
US CAROTID DUPLEX DOPPL
US RENAL
US THYROID
US TRANSVAGINAL
XR ABD FLAT/UPRIGHT
XR ABDOMEN FLAT/KUB
XR ANKLE 3 VIEWS LEFT
XR ANKLE 3 VIEWS RIGHT
XR CERVICAL SP/OBL
XR CHEST PA
XR CHEST PA & LATERAL
XR ELBOW 3 VIEWS LEFT
XR ELBOW 3 VIEWS RIGHT
XR FOOT LEFT
XR FOOT RIGHT
XR HAND LEFT
XR HAND RIGHT
XR HIP AP LAT & PELVIS BILATERAL
XR HIP AP UNILATERAL LEFT
XR HIP AP UNILATERAL RIGHT
XR KNEE 3 VIEWS LEFT
XR KNEE 3 VIEWS RIGHT
XR LUMBOSACRAL SPINE
XR LUMBOSACRAL SPINE W/ OBLIQUE
XR SHOULDER INT-EXT LEFT
XR SHOULDER INT-EXT RIGHT
XR THORACIC SPINE
XR WRIST W OBLIQUES LEFT
XR WRIST W OBLIQUES RIGHT