Ct scan of chest with contrast
X-ray of wrist, minimum of 3 views
Physician visit costs
Diagnostic Radiology
Limited ultrasound scan of abdomen
Vascular & Interventional Radiology
Complete ultrasound scan behind abdominal cavity
Ct scan of lower spine without contrast
Fluoroscopic guidance for insertion or removal of central vein access device
Use of a drug to induce depression of consciousness by physician performing a procedure (5 years or older), initial 15 minutes
X-ray of chest, 2 views
Imaging of urinary tract following injection of a contrast agent
Ct scan of blood vessels of chest with contrast
Ct scan head or brain without contrast
Mri scan of brain without contrast
Ultrasonic guidance for blood vessel access
Nuclear Radiology
Ct scan of upper spine without contrast
X-ray of chest, 1 view
Ultrasound of both sides of head and neck blood flow
Ct scan of abdomen and pelvis with contrast
Pediatric Radiology
Imaging for evaluation of swallowing function
Ct scan of pelvis without contrast
X-ray of foot, minimum of 3 views
X-ray of abdomen, 1 view
Ct scan of chest without contrast
X-ray of knee, 3 views
X-ray of thigh bone, minimum 2 views
Ct scan of face without contrast
Radiology - Vascular & Interventional Radiology
Neuroradiology
X-ray of lower and sacral spine, 2-3 views
Diagnostic Ultrasound
X-ray of shoulder, minimum of 2 views
X-ray of hip, 2-3 views
X-ray of hip, 1 view
Radiology - Body Imaging
Radiology - Nuclear Radiology
Radiology - Neuroradiology
Radiology - Pediatric Radiology
Ultrasound of leg arteries or artery grafts
Body Imaging
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