QUALITY HEALTH PLANS 1000 Plantation Island Dr., … Pay Flyer for Web.pdf · mri 70540 orbits w/o...

MRI70540 ORBITS W/O 39570543 ORBITS W/ & W/O 56070551 BRAIN W/O 40070553 BRAIN W/ & W/O 56070551 BRAIN W/DTI W/O 40070553 BRAIN W/DTI W/ & W/O 56070551 BRAIN AND IACS W/O 40070553 BRAIN AND IACS W/ & W/O 56070551 IACS W/O 40070553 IACS W/ & W/O 56070551 PITUITARY W/O 40070553 PITUITARY W/ & W/O 56070540 SOFT TISSUE NECK W/O 39570543 SOFT TISSUE NECK W/ & W/O 560 CARDIAC 120071552 CHEST WALL (MSK) W/ & W/O 64072141 SPINE CERVICAL W/O 38072156 SPINE CERVICAL W/ & W/O 56072146 SPINE THORACIC W/O 38072157 SPINE THORACIC W/ & W/O 52072148 SPINE LUMBAR W/O 37572158 SPINE LUMBAR W/ & W/O 55073221 SHOULDER W/O 28073223 SHOULDER W/ & W/O 53573221 ELBOW W/O 28073223 ELBOW W/ & W/O 53573221 WRIST W/O 28073223 WRIST W/ & W/O 53573218 HAND W/O 39573220 HAND W/ & W/O 57073721 HIP W/O 28073723 HIP W/ & W/O 53573721 KNEE W/O 28073723 KNEE W/ & W/O 53573718 FOREFOOT W/O 39573720 FOREFOOT W/ & W/O 57573718 MIDFOOT W/O 39573720 MIDFOOT W/ & W/O 57573718 HIND FOOT W/O 39573720 HIND FOOT W/ & W/O 57573721 ANKLE W/O 28073723 ANKLE W/ & W/O 53574181 MRCP W/O 37574181 ABDOMEN W/O 37574183 ABDOMEN W/ & W/O 57572195 PELVIS W/O 40072197 PELVIS W/ & W/O 57573222 SHOULDER ARTHROGRAM 43573222 ELBOW ARTHROGRAM 43573222 WRIST ARTHROGRAM 43573222 HIP ARTHROGRAM 70073722 KNEE ARTHROGRAM 70073722 ANKLE ARTHROGRAM 700

MRA70544 BRAIN W/O 39070548 CAROTIDS W/ 48570547 CAROTIDS W/O 39070549 CAROTIDS W/ & W/O 62071555 CHEST W/ & W/O 46074185 ABDOMEN W/ & W/O 46572198 PELVIS W/ & W/O 44073225 UPPER EXTREMITY W/ & W/O 47073725 LOWER EXTREMITY W/ & W/O 470

BREAST IMAGINGG0202 SCREENING MAMMOGRAM 140 DIAGNOSTIC MAMMOGRAM G0204 BILATERAL 165G0206 LEFT 130G0206 RIGHT 13076645 BREAST ULTRASOUND 9077059 BREAST MRI 61077080 BONE DENSITY 50

CT70450 BRAIN W/O 16570460 BRAIN W/ 21570470 BRAIN W/ & W/O 22070480 TEMPORAL BONES W/O 23070480 ORBITS W/O 23570481 ORBITS W/ 32070482 ORBITS W/ & W/O 35570486 MAXILLOFACIAL W/O 225 70487 MAXILLOFACIAL W/ 27570488 MAXILLOFACIAL W/ & W/O 33070486 SINUSES W/O 22570487 SINUSES W/ 27570488 SINUSES W/ & W/O 33070490 NECK W/O 22570491 NECK W/ 27070492 NECK W/ & W/0 32072125 CERVICAL SPINE W/O 22072126 CERVICAL SPINE W/ 26072127 CERVICAL SPINE W/ & W/O 31572128 THORACIC SPINE W/O 21072129 THORACIC SPINE W/ 26572130 THORACIC SPINE W/ & W/O 31572131 LUMBAR SPINE W/O 21072132 LUMBAR SPINE W/ 26072133 LUMBAR SPINE W/ & W/O 31573200 UPPER EXTREMITY W/O 21073201 UPPER EXTREMITY W/ 25573202 UPPER EXTREMITY W/ & W/O 32571250 CHEST W/O 21071260 CHEST W/ 260 71270 CHEST W/ AND W/O 31572192 PELVIS W/O 17572193 PELVIS W/ 27572194 PELVIS W/ & W/O 30574150 ABDOMEN W/O 18074160 ABDOMEN W/ 28074170 ABDOMEN W/ & W/O 32074176 ABD/PELVIS W/O 23074177 ABD/PELVIS W/ 34574178 ABD/PELVIS W/ & W/O 40573700 LOWER EXTREMITY W/O 21073701 LOWER EXTREMITY W/ 26073702 LOWER EXTREMITY W/ & W/O 33074261 CT COLONOGRAPHY (DIAGNOSTIC) 29074263 CT COLONOGRAPHY (SCREENING) 29075571 CALCIUM SCORING 7574176 RENAL STONE STUDY 23074178 IVP/UROGRAM 40074170 RENAL MASS STUDY 320

CTA70496 BRAIN 41570498 NECK 41571275 CHEST (NON-CORONARY) 40075574 CHEST CORONARY 37574175 ABDOMEN W/ & W/O 405

75635 ABDOMINAL ARTERIES 44573206 UPPER EXTREMITY W/ & W/O 36573706 LOWER EXTREMITY W/ & W/O 40571275 CHEST PULMONARY EMBOLISM 40575635 CTA RUNOFFS 445

PET/CT78608 BRAIN (FDG) 120078492 CARDIAC STRESS TEST (STRESS/REST) 126078815 SKULL TO THIGH (FDG) 120078816 FULL BODY (FDG) 120078816 BONE SCAN (SODIUM FLOURIDE) 1200

ULTRASOUND 76536 HEAD AND NECK 12576604 CHEST B-SCAN 9093306 CARDIAC ECHO 18576536 THYROID 12576700 ABDOMEN COMPLETE 14076705 LIVER/GB/PANCREAS (RUQ) 11076770 KIDNEY/BLADDER 13576805 OBSTETRIC (LAST TRIMESTER) 15076856/76830 PELVIS AND TRANSVAGINAL 20076870/93976 SCROTAL/TESTICULAR 33576872 PROSTATE/TRANSRECTAL 17593975 RENAL ARTERY DOPPLER 36593880 CAROTID DOPPLER 24093970 VENOUS DOPPLER 19093930 ARTERIAL DOPPLER 24093978 AORTA DOPPLER 235 4D KEEPSAKE ULTRASOUND 125

DIGITAL X-RAY70220 SINUS 4070260 SKULL 4V 5071020 CHEST 2V 3071110 RIBS BIL 4574020 ABDOMEN COMPLETE 4074000 KUB PELVIS AND TRANSVAGINAL 2570200 ORBITS 4570150 FACIAL BONES 4570110 MANDIBLE 4072190 PELVIS 4572050 CERVICAL 5072074 THORACIC 4572110 LUMBAR 5073030 SHOULDER 3573060 HUMERUS 5073080 ELBOW 3573090 FOREARM 3073110 WRIST 4073130 HAND 3573140 FINGER 3573510 HIP 4073550 FEMUR 3073564 KNEE 4573564 PATELLA 4573590 TIBIA/FIBULA 3073610 ANKLE 3573630 FOOT 3573660 TOE 3573650 CALCANEUS 3072090 SCOLIOSIS SERIES 5577072 BONE AGE STUDY 2577075 SKELETAL SURVEY 100 STEROID INJECTION 200

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