Ct scan of chest without contrast
Limited ultrasound scan of abdomen
Ct scan head or brain without contrast
ULTRASOUND
Diagnostic Radiology
X-ray of hand, minimum of 3 views
X-ray of shoulder, minimum of 2 views
Ct scan of blood vessels of chest with contrast
Mri scan of leg joint without contrast
X-ray of knee, 1-2 views
Vascular & Interventional Radiology
Complete ultrasound scan behind abdominal cavity
Ct scan of abdomen and pelvis with contrast
X-ray of chest, 1 view
X-ray of thigh bone, minimum 2 views
Ct scan of pelvis without contrast
X-ray of chest, 2 views
X-ray of foot, minimum of 3 views
Ultrasound study of arm or leg veins with compression and maneuvers
X-ray of lower and sacral spine, 2-3 views
X-ray of lower leg, 2 views
Ct scan of lower spine without contrast
Ultrasound of both sides of head and neck blood flow
X-ray of ankle, minimum of 3 views
X-ray of hip, 2-3 views
X-ray of hip, 1 view
Physician visit costs
Mri scan of arm joint without contrast
Ct scan of abdomen and pelvis without contrast
X-ray of abdomen, 1 view
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