1
MRI 70540 ORBITS W/O 395 70543 ORBITS W/ & W/O 560 70551 BRAIN W/O 400 70553 BRAIN W/ & W/O 560 70551 BRAIN W/DTI W/O 400 70553 BRAIN W/DTI W/ & W/O 560 70551 BRAIN AND IACS W/O 400 70553 BRAIN AND IACS W/ & W/O 560 70551 IACS W/O 400 70553 IACS W/ & W/O 560 70551 PITUITARY W/O 400 70553 PITUITARY W/ & W/O 560 70540 SOFT TISSUE NECK W/O 395 70543 SOFT TISSUE NECK W/ & W/O 560 CARDIAC 1200 71552 CHEST WALL (MSK) W/ & W/O 640 72141 SPINE CERVICAL W/O 380 72156 SPINE CERVICAL W/ & W/O 560 72146 SPINE THORACIC W/O 380 72157 SPINE THORACIC W/ & W/O 520 72148 SPINE LUMBAR W/O 375 72158 SPINE LUMBAR W/ & W/O 550 73221 SHOULDER W/O 280 73223 SHOULDER W/ & W/O 535 73221 ELBOW W/O 280 73223 ELBOW W/ & W/O 535 73221 WRIST W/O 280 73223 WRIST W/ & W/O 535 73218 HAND W/O 395 73220 HAND W/ & W/O 570 73721 HIP W/O 280 73723 HIP W/ & W/O 535 73721 KNEE W/O 280 73723 KNEE W/ & W/O 535 73718 FOREFOOT W/O 395 73720 FOREFOOT W/ & W/O 575 73718 MIDFOOT W/O 395 73720 MIDFOOT W/ & W/O 575 73718 HIND FOOT W/O 395 73720 HIND FOOT W/ & W/O 575 73721 ANKLE W/O 280 73723 ANKLE W/ & W/O 535 74181 MRCP W/O 375 74181 ABDOMEN W/O 375 74183 ABDOMEN W/ & W/O 575 72195 PELVIS W/O 400 72197 PELVIS W/ & W/O 575 73222 SHOULDER ARTHROGRAM 435 73222 ELBOW ARTHROGRAM 435 73222 WRIST ARTHROGRAM 435 73222 HIP ARTHROGRAM 700 73722 KNEE ARTHROGRAM 700 73722 ANKLE ARTHROGRAM 700 MRA 70544 BRAIN W/O 390 70548 CAROTIDS W/ 485 70547 CAROTIDS W/O 390 70549 CAROTIDS W/ & W/O 620 71555 CHEST W/ & W/O 460 74185 ABDOMEN W/ & W/O 465 72198 PELVIS W/ & W/O 440 73225 UPPER EXTREMITY W/ & W/O 470 73725 LOWER EXTREMITY W/ & W/O 470 BREAST IMAGING G0202 SCREENING MAMMOGRAM 140 DIAGNOSTIC MAMMOGRAM G0204 BILATERAL 165 G0206 LEFT 130 G0206 RIGHT 130 76645 BREAST ULTRASOUND 90 77059 BREAST MRI 610 77080 BONE DENSITY 50 CT 70450 BRAIN W/O 165 70460 BRAIN W/ 215 70470 BRAIN W/ & W/O 220 70480 TEMPORAL BONES W/O 230 70480 ORBITS W/O 235 70481 ORBITS W/ 320 70482 ORBITS W/ & W/O 355 70486 MAXILLOFACIAL W/O 225 70487 MAXILLOFACIAL W/ 275 70488 MAXILLOFACIAL W/ & W/O 330 70486 SINUSES W/O 225 70487 SINUSES W/ 275 70488 SINUSES W/ & W/O 330 70490 NECK W/O 225 70491 NECK W/ 270 70492 NECK W/ & W/0 320 72125 CERVICAL SPINE W/O 220 72126 CERVICAL SPINE W/ 260 72127 CERVICAL SPINE W/ & W/O 315 72128 THORACIC SPINE W/O 210 72129 THORACIC SPINE W/ 265 72130 THORACIC SPINE W/ & W/O 315 72131 LUMBAR SPINE W/O 210 72132 LUMBAR SPINE W/ 260 72133 LUMBAR SPINE W/ & W/O 315 73200 UPPER EXTREMITY W/O 210 73201 UPPER EXTREMITY W/ 255 73202 UPPER EXTREMITY W/ & W/O 325 71250 CHEST W/O 210 71260 CHEST W/ 260 71270 CHEST W/ AND W/O 315 72192 PELVIS W/O 175 72193 PELVIS W/ 275 72194 PELVIS W/ & W/O 305 74150 ABDOMEN W/O 180 74160 ABDOMEN W/ 280 74170 ABDOMEN W/ & W/O 320 74176 ABD/PELVIS W/O 230 74177 ABD/PELVIS W/ 345 74178 ABD/PELVIS W/ & W/O 405 73700 LOWER EXTREMITY W/O 210 73701 LOWER EXTREMITY W/ 260 73702 LOWER EXTREMITY W/ & W/O 330 74261 CT COLONOGRAPHY (DIAGNOSTIC) 290 74263 CT COLONOGRAPHY (SCREENING) 290 75571 CALCIUM SCORING 75 74176 RENAL STONE STUDY 230 74178 IVP/UROGRAM 400 74170 RENAL MASS STUDY 320 CTA 70496 BRAIN 415 70498 NECK 415 71275 CHEST (NON-CORONARY) 400 75574 CHEST CORONARY 375 74175 ABDOMEN W/ & W/O 405 75635 ABDOMINAL ARTERIES 445 73206 UPPER EXTREMITY W/ & W/O 365 73706 LOWER EXTREMITY W/ & W/O 405 71275 CHEST PULMONARY EMBOLISM 405 75635 CTA RUNOFFS 445 PET/CT 78608 BRAIN (FDG) 1200 78492 CARDIAC STRESS TEST (STRESS/REST) 1260 78815 SKULL TO THIGH (FDG) 1200 78816 FULL BODY (FDG) 1200 78816 BONE SCAN (SODIUM FLOURIDE) 1200 ULTRASOUND 76536 HEAD AND NECK 125 76604 CHEST B-SCAN 90 93306 CARDIAC ECHO 185 76536 THYROID 125 76700 ABDOMEN COMPLETE 140 76705 LIVER/GB/PANCREAS (RUQ) 110 76770 KIDNEY/BLADDER 135 76805 OBSTETRIC (LAST TRIMESTER) 150 76856/76830 PELVIS AND TRANSVAGINAL 200 76870/93976 SCROTAL/TESTICULAR 335 76872 PROSTATE/TRANSRECTAL 175 93975 RENAL ARTERY DOPPLER 365 93880 CAROTID DOPPLER 240 93970 VENOUS DOPPLER 190 93930 ARTERIAL DOPPLER 240 93978 AORTA DOPPLER 235 4D KEEPSAKE ULTRASOUND 125 DIGITAL X-RAY 70220 SINUS 40 70260 SKULL 4V 50 71020 CHEST 2V 30 71110 RIBS BIL 45 74020 ABDOMEN COMPLETE 40 74000 KUB PELVIS AND TRANSVAGINAL 25 70200 ORBITS 45 70150 FACIAL BONES 45 70110 MANDIBLE 40 72190 PELVIS 45 72050 CERVICAL 50 72074 THORACIC 45 72110 LUMBAR 50 73030 SHOULDER 35 73060 HUMERUS 50 73080 ELBOW 35 73090 FOREARM 30 73110 WRIST 40 73130 HAND 35 73140 FINGER 35 73510 HIP 40 73550 FEMUR 30 73564 KNEE 45 73564 PATELLA 45 73590 TIBIA/FIBULA 30 73610 ANKLE 35 73630 FOOT 35 73660 TOE 35 73650 CALCANEUS 30 72090 SCOLIOSIS SERIES 55 77072 BONE AGE STUDY 25 77075 SKELETAL SURVEY 100 STEROID INJECTION 200 Self Pay pricing

QUALITY HEALTH PLANS 1000 Plantation Island Dr., … Pay Flyer for Web.pdf · mri 70540 orbits w/o 395 70543 orbits w/ & w/o 560 70551 brain w/o 400 70553 brain w/ & w/o 560 70551

  • Upload
    vankien

  • View
    216

  • Download
    0

Embed Size (px)

Citation preview

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

Precisionimagingcenters.com

AETNA

AVMED

BEECH STREET

BCBS

CHOICECARE

CIGNA

DIAGNOSTIC RADIOLOGY NETWORK

EVOLUTIONS

FIRST HEALTH

FOCUS

GALAXY HEALTH NETWORK

GHI (Carecore)

HEALTHEASE-WELLCARE-STAYWELL

HUMANA

INTEGRATED ADMINISTRATORS

LHI

MCM MAX CARE

MEDCOM

MEDFOCUS

MEDICAID

MEDICARE

MEDSOLUTIONS (apwu, geha, ngs, great west, trustmark)

MEDICARE RAILROAD

ONE CALL CARE

PED-I-CARE

PHCS

PRIME HEALTH SERVICES

PRIME COMP

QUALITY HEALTH PLANS

SELECT MRI

SUNSHINE HEALTH

TECH HEALTH

TRICARE PRIME

TRICARE STANDARD

UNITED HEALTH CARE

If you do not find an insurance companyon this list, please feel free to call.

We will do our best to assist you withany questions you may have.

1000 Plantation Island Dr., Suite 1 St. Augustine, FL 32080

Hours:Mon - Fri: 8:00am - 6:00pm

PHONE: (904) 471-8160FAX: (904) 471-8170

7860 Gate Parkway, Suite 123 Jacksonville, FL 32256

Hours:Mon - Fri: 6:30am - 11pmSaturday: 7:30am - 5pm

PHONE: (904) 996-8100FAX: (904) 996-8101

Self Pay pricing