ABDOMEN ABDOMEN - 1 VIEW ABDOMEN - 2 VIEWS ABDOMEN - 3 VIEWS OR MORE ABDOMEN - OBSTRUCTION SERIES INCLUDING CHEST

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1 cpt listing Group NPI # January 2019

2 GENERAL X-RAY HEAD & NECK EYE LOCAL FOREIGN BODY MANDIBLE - MIN 4 VIEWS MASTOIDS - 3 VIEWS FACIAL BONES - MIN 3 VIEWS NASAL BONES - 3 VIEWS ORBITS - MIN 4 VIEWS PARANASAL SINUSES - MIN 4 VIEWS SKULL - LESS THAN 4 VIEWS SKULL - COMPLETE TEMPOROMANDIBULAR JOINTS - BILAT NECK - SOFT TISSUE SALIVARY GLAND FOR CALCULUS SINUSES WATER S VIEWS CHEST CHEST - SINGLE VIEW CHEST - 2 VIEWS CHEST - MIN 4 VIEWS OR MORE CHEST - 3 VIEWS RIBS - UNILATERAL RIBS - UNILATERAL & PA CHEST RIBS - BILATERAL RIBS - BILATERAL & CHEST STERNUM - MIN 2 VIEWS STERNOCLAVICULAR JOINTS SNIFF TEST UPPER EXTREMITIES CLAVICLE SCAPULA SHOULDER - COMPLETE SHOULDER - ACROMIOCLAVICULAR - BILAT HUMERUS - MIN 2 VIEWS ELBOW - 2 VIEWS ELBOW - COMPLETE FOREARM - MIN 2 VIEWS WRIST - 2 VIEWS WRIST - COMPLETE 3 VIEWS FINGER HAND - MIN 3 VIEWS HAND 2 VIEWS UPPER EXTREMITY INFANT UP TO 12 MONTHS MIN 2 VIEWS SPINE & PELVIS CERVICAL SPINE - 2 OR 3 VIEWS CERVICAL - 4 OR 5 VIEWS CERVICAL - 6 OR MORE VIEWS THORACIC - 2 VIEWS LUMBOSACRAL - MIN 2 OR 3 VIEWS LUMBOSACRAL - MIN 4 VIEWS LUMBOSACRAL - COMPLETE & BENDING VIEWS MIN 6 VIEWS LUMBOSACRAL - BENDING ONLY 2 OR 3 VIEWS PELVIS - 1 OR 2 VIEWS SACROILIAC JOINTS SACRUM & COCCYX SPINE - SINGLE VIEW, SPECIFY LEVEL SPINE - THORACOLUMBAR - 2 VIEWS SPINE, ENTIRE THORACIC AND LUMBAR, INCLUDING CERVICAL AND SACRAL SPINE IF PERFORMED (E.G. SCOLIOSIS EVALUATION) 2 OR 3 VIEWS HIP, UNILATERAL, WITH PELVIS 2-3 VIEWS (SPECIFY RT OR LT) HIP, BILATERAL, WITH PELVIS 2 VIEWS HIP, BILATERAL, WITH PELVIS 3-4 VIEWS FEMUR, MIN OF 2 VIEWS (SPECIFY RT OR LT) LOWER EXTREMITIES KNEE - COMPLETE MIN 3 VIEWS KNEE - 1 OR 2 VIEWS PATELLA KNEE WITH PATELLAR VIEW - 4 OR MORE VIEWS TIBIA & FIBULA ANKLE - LIMITED - LESS THAN 3 VIEWS ANKLE - COMPLETE - MIN 3 VIEWS FOOT - LIMITED - LESS THAN 3 VIEWS FOOT - COMPLETE MIN 3 VIEWS OS CALCIS TOES - MIN 2 VIEWS LOWER EXTREMITY INFANT UP TO 12 MONTHS MIN 2 VIEWS ABDOMEN ABDOMEN - 1 VIEW ABDOMEN - 2 VIEWS ABDOMEN - 3 VIEWS OR MORE ABDOMEN - OBSTRUCTION SERIES INCLUDING CHEST 0 GI TRACT FLUOROSCOPY PHARYNX/CERVICAL ESOPHAGUS PHARYNX/LARYNX (BARIUM SWALLOW) UPPER GI W/O KUB UPPER GI WITH SMALL BOWEL UPPER GI SERIES - DOUBLE CONTRAST SMALL BOWEL - MULTIPLE VIEWS G0120 COLON-RECTAL CANCER SCRN. HIGH RISK - BARIUM ENEMA G0106 COLON-RECTAL CANCER SCRN. - BARIUM ENEMA BARIUM ENEMA BARIUM ENEMA WITH AIR UPPER GI WITH SMALL BOWEL - DOUBLE CONTRAST UPPER GI WITH KUB URINARY TRACT UROGRAPHY (IVP) - LIMITED UROGRAPHY (IVP) WITH NEPHROTOMOGRAMS ILLIAL CONDUIT S & I ONLY ILIAL CONDUIT - INJECTION VOIDING CYSTOGRAPHY URETHROCYSTOGRAPHY RETROGRADE SKELETAL BONE AGE STUDY BONE LENGTH STUDY BONE - SURVEY - LIMITED - METASTASES BONE SURVEY - COMPLETE - METABOLIC BREASTS US GUIDANCE BREAST FNA BX (SPECIFIY RT OR LT) US GUIDED BREAST FNA BX - BILATERAL MAMMOGRAPHY - UNILATERAL DIAGNOSTIC MAMMOGRAPHY - BILATERAL DIAGNOSTIC MAMMOGRAPHY SCREENING GALACTOGRAM INJECTION ULTRASOUND AXILLA GALACTOGRAM, SINGLE DUCT S&I GALACTOGRAM, MULTIPLE DUCTS S&I BREAST CYST ASPIRATION ADDITIONAL BREAST CYST ASPIRATION MAMMOGRAPHY LOCALIZATION (NEEDLE/WIRE) ADDT L LOCALIZATION MAMMOGRAPHIC US GUIDED LOCALIZATION ADDT L US GUIDED LOCALIZATION ARTHROGRAMS TMJ - S & I ONLY TMJ - INJECTION SACROILIAC JOINT INJECTION & IMAGING (ARTHROGRAPHY)

3 LOWER EXTREMITY KNEE ARTHROGRAM - S & I ONLY KNEE ARTHROGRAM - INJECTION HIP ARTHROGRAM - S & I ONLY HIP ARTHROGRAM - INJECTION ANKLE ARTHROGRAM - S & I ONLY ANKLE ARTHROGRAM - INJECTION UPPER EXTREMITY SHOULDER ARTHROGRAM - S & I ONLY SHOULDER ARTHROGRAM - INJECTION ELBOW ARTHROGRAM - S & I ONLY ELBOW ARTHROGRAM - INJECTION WRIST ARTHROGRAM - S & I ONLY WRIST ARTHROGRAM - INJECTION DEXA SPINE-HIP CENTRAL BONE DENSITY - OSTEOPOROSIS VETREBRA FRACTURE ASSESSMENT WITHOUT DEXA MISCELLANEOUS FLUOROSCOPIC GUIDANCE FISTULA X-RAY SINOGRAM INJECTION BX PROSTATE - ANY APPROACH INTRODUCTION CATHETER - SUPERIOR OR INFERIOR (PIC) RADIOLOGIC EXAM - SINGLE PLANE (TOMOGRAMS) FLUOROSCOPIC EXAM UP TO ONE HOUR ULTRASOUND HEAD & NECK REGIONS HEAD, NECK, THYROID, PARATHYROID ULTRASOUND MISCELLANEOUS CHEST EXAM SPINAL CANAL ULTRASOUND AXILLA TESTICULAR SCAN WITH DUPLEX DOPPLER U/S BREAST CYST ASPIRATION U/S GUIDANCE FOR NEEDLE BIOPSY ADDT L LESION ABDOMINAL (UPPER & LOWER) - PELVIC REGIONS BREAST COMPLETE RT OR LT - BILATERAL BREAST LIMITED RT OR LT - BILATERAL ABDOMINAL COMPLETE WITH LIVER ELASTOGRAPHY ABDOMINAL LIMITED WITH LIVER ELASTOGRAPHY ABDOMINAL - LIMITED - SINGLE ORGAN - QUADRANT ABDOMINAL (SURVEY) BLADDER ECHOGRAPHY BLADDER & RENAL (KIDNEYS) FETAL BIOPHYSICAL PROFILE FETAL - LIMITED FOLLOW UP SCAN OB ULTRASOUND 2ND & 3RD TRIMESTER FOLLOW-UP LIMITED PELVIC AREA DOPPLER PELVIC SONOGRAM - NON-OBSTETRICAL PELVIC US LTD FOR FOLLICLE GROWTH PELVIS & TRANSVAGINAL PREGNANCY & TRANSVAGINAL PREGNANT UTERUS - EARLY 1ST TRIMESTER PREGNANT UTERUS - MULTIPLE GESTATION - 1ST TRIMESTER RENAL ABD. AORTA NODES TRANSRECTAL TRANSVAGINAL - NON-OBSTETRICAL EXTREMITY NON-VASCULAR COMPLETE INFANT HIP EXTREMITY NON-VASCULAR LTD ANATOMIC SPECIFIC DOPPLER STUDIES DUPLEX SCAN - CAROTID CIRCULATION ARTERIAL DOPPLER LIMITED BILAT. - UPPER OR LOWER EXTREMITY LEVELS OR UNILAT COMPLETE ARTERIAL DOPPLER BILAT UPPER OR LOWER EXTREMITY FULL EXAM LEVELS WITH ABI S - 3 OR MORE LEVELS ARTERIAL DOPPLER - LOWER EXTREMITY BILAT. DUPLEX ARTERIAL DOPPLER - UNILAT. LOWER EXTREMITY DUPLEX ARTERIAL DOPPLER - UPPER EXTREMITY BILAT. DUPLEX ARTERIAL DOPPLER - UNILAT. UPPER EXTREMITY DUPLEX VENOUS DOPPLER - BILAT. EXTREMITIES UPPER OR LOWER VENOUS DOPPLER - UNILAT. EXTREMITY UPPER OR LOWER DOPPLER VISCERAL - ADD TO ABDOMINAL, SCROTAL, PELVIC, ULTRASOUND WHEN DONE VISCERAL DOPPLER - LIMITED DOPPLER INFERIOR VENA CAVA OR AORTA, OR ILIAC VESSELS PENILE DOPPLER ECHOCARDIOGRAM DOPPLER ECHOCARDIOGRAPHY COLOR FLOW VELOCITY MAPPING D ECHO WITH STRESS & ELECTROCARDIOGRAM NUCLEAR MEDICINE THYROID AREA THYROID IMAGING WITH UPTAKE, MULTIPLE DETERMINATION I-131 THYROID THERAPY PARATHYROID PLANAR IMAGING PARATHYROID SPECT/CT SALIVARY GLAND FUNCTION STUDY BONES BONE/JOINT IMAGING - LIMITED BONE IMAGING - MULTIPLE AREAS BONE IMAGING - WHOLE BODY BONE IMAGING BY THREE PHASE TECHNIQUE BONE MARROW IMAGING - LIMITED AREA BONE MARROW IMAGING - MULTIPLE AREAS BONE MARROW - WHOLE BODY SPECT BONE IMAGING (SPECT) - WHOLE BODY HEART/LUNG AREA GATED BLOOD POOL MUGA OR STRESS FIRST PASS FOR (RVEF) AND GATED BLOOD POOL MYOCARDIAL PERFUSION REST OR STRESS - PLANAR SINGLE MYOCARDIAL PERFUSION STRESS/REDISTRIBUTION - PLANAR MULTI MYOCARDIAL PERFUSION SPECT REST/STRESS WITH WALL MOTION, EJECTION FRACTION - SINGLE STUDY MYOCARDIAL PERFUSION SPECT REST/STRESS WITH WALL MOTION, EJECTION FRACTION - MULTIPLE BRAIN/HEAD AREA BRAIN IMAGING SPECT GI LIVER/SPLEEN IMAGE - STATIC LIVER/SPLEEN SCAN W/FLOW MECKEL S DIVERTICULUM SCAN GI BLEEDING SCAN LIVER - DISIDA SCAN W/O CCK LIVER - DISIDA SCAN W/CCK LIVER IMAGING + FLOW (HEMANGIOMA) SPECT + PLANA LIVER IMAGING (SPECT) GASTRIC EMPTYING STUDY

4 GU GALLBLADDER IMAGING - (HDA SCAN) W/O CCK GALLBLADDER IMAGING - (HDA SCAN) W/CCK KIDNEY PARENCHYMA IMAGING - FOR RENAL MASS TESTICULAR SCAN KIDNEY IMAGING & VASCULAR FLOW & FUNCTION STUDY RENAL IMAGING (WITH LASIX) CAPTOPRIL RENAL SCAN - PT. GETS 2 MAG3 DOSES TUMOR & INFLAMMATION BREAST MIBI TECHNICIAN GALLIUM TUMOR - MULTIPLE AREAS GALLIUM TUMOR - WHOLE BODY GALLIUM INFECTION - MULTIPLE AREAS GALLIUM INFECTION - WHOLE BODY WHOLE BODY WITH SPECT TAGGED WHITE BLOOD CELL IMAGING - LIMITED TAGGED WHITE BLOOD CELL IMAGING - WHOLE BODY NUCLEAR MEDICINE MISCELLANEOUS LYMPHATICS LYMPH NODES GASTRIC EMPTYING IMAGING STUDY WITH SMALL BOWEL TRANSIT GASTRIC EMPTYING IMAGING STUDY WITH SMALL BOWEL TRANSIT, MULTIPLE DAYS PET/CT SCAN PET/CT SKULL BASE TO THIGH PET FOR BRAIN IMAGING METABOLIC EVALUATION PET FOR BRAIN IMAGING PERFUSION EVALUATION PET FOR BRAIN IMAGING SEIZURE EVALUATION PET MYOCARD IMAG MULTI RES/STRESS PET MYOCARD PERF SINGLE STUDY RES/STRESS PET MYCARDIAL IMAG METABOLIC EVALUATION PET/CT WHOLE BODY CT SCAN HEAD - AREA CT HEAD OR BRAIN W/O CONTRAST CT HEAD W/CONTRAST CT HEAD & FURTHER SECTION W/O & W CONTRAST CT ORBITS W/O CONTRAST CT ORBITS W/CONTRAST CT ORBIT, SELLA, OUTER MIDDLE EAR/INNER EAR W/O CONTRAST & CONTRAST CT MAXILLOFACIAL WITH CONTRAST CT MAXILLOFACIAL W/O CONTRAST & CONTRAST CT SOFT TISSUE NECK W/O CONTRAST CT ANGIOGRAPHY HEAD CT ANGIOGRAPHY NECK CHEST CT CHEST W/O CONTRAST CT CHEST W/CONTRAST GO297 CT LOW DOSE LUNG SCREENING ABDOMEN/PELVIS CT ABDOMEN W/O CONTRAST CT ABDOMEN W/CONTRAST CT ABDOMEN W & W/O CONTRAST CT ABDOMEN & PELVIS CT ABDOMEN & PELVIS W/CONTRAST CT ABDOMEN & PELVIS W/O & WITH CONTRAST CT PELVIS CT PELVIS W/CONTRAST CT PELVIS W/O & WITH CONTRAST CT COLONOGRAPHY, DIAGNOSTIC CT COLONOGRAPHY, SCREEING SPINE CT CERVICAL SPINE W/O CONTRAST CT CERVICAL SPINE W/CONTRAST CT THORACIC SPINE W/O CONTRAST CT THORACIC SPINE W/CONTRAST CT LUMBAR W/O CONTRAST CT LUMBAR W/CONTRAST NECK AND/OR EXTREMITIES CT NECK W/O CONTRAST CT NECK W/CONTRAST CT UPPER EXTREMITY CT UPPER EXTREMITY W/CONTRAST CT UPPER EXTREMITY W/O & W/CONTRAST CT SCANOGRAM CT LOWER EXTREMITY W/O CONTRAST CT LOWER EXTREMITY W/CONTRAST CT LOWER EXTREMITY W/O & W/CONTRAST CT ARTHROGRAM KNEE (SPECIFY RT OR LT) CTA CHEST & PELVIS CT ANGIOGRAPHY CHEST CT ANGIOGRAPHY PELVIS CTA ABDOMEN W/O & WITH DYE CTA ABDOMEN/PELVIS CTA EXTREMITY CTA ABDOMINAL AORTA BILAT ILIOFEMORAL RUNOFF CTA UPPER EXTREMITY CTA LOWER EXTREMITY MRI & MRA BRAIN BRAIN - WITH/WITHOUT CONTRAST BRAIN FOR IAC - WITH CONTRAST FACE/ORBITS/NECK FACE/ORBITS/NECK - WITH/WITHOUT CONTRAST MRA HEAD MRA W/O & WITH CONTRAST HEAD MRA NECK W/O CONTRAST MRA NECK W/O & WITH CONTRAST SPINAL CORD - MYELOPATHY MRA SPINAL CANAL & CONTENTS - WITH OR WITHOUT CONTRAST CERVICAL CERVICAL - WITH/WITHOUT CONTRAST THORACIC THORACIC - WITH/WITHOUT CONTRAST LUMBAR LUMBAR - WITH/WITHOUT CONTRAST MRI PELVIS (PROSTATE) WITH/WITHOUT CONTRAST & MRI PELVIS (PROSTATE) W/O CONTRAST + 3D RECON UPPER NON - JOINT UPPER NON - JOINT - W/O & W/CONTRAST UPPER JOINT UPPER JOINT - WITH/WITHOUT CONTRAST MRA UPPER EXTREMITY ABDOMEN ABDOMEN - WITH/WITHOUT CONTRAST MRA ABDOMEN PELVIS PELVIS - WITH/WITHOUT CONTRAST PELVIS - WITH ENDORECTAL COIL WITH CONTRAST MRA PELVIS MRI SPINAL CANAL & CONTENTS W/O CONTRAST & CONTRAST LOWER NON - JOINT LOWER NON - JOINT - WITH/WITHOUT CONTRAST LOWER JOINT LOWER JOINT - WITH/WITHOUT CONTRAST HIPS - LIMITED FOR FX MRA LOWER EXTREMITY

5 TMJ TMJ WITH/WITHOUT OR WITHOUT MARROW BONE MARROW HEART CHEST CHEST - WITH/WITHOUT CONTRAST MRA CHEST - WITH CONTRAST MRI - CARDIAC FOR MORPHOLOGY - W/O CONTRAST MRI - CARDIAC FOR FUNCTION - WITH/WITHOUT MORPHOLOGY - COMPLETE STUDY - MULTIPLE CHAMBERS MRI - CARDIAC FOR FUNCTION - STRESS IMAGING MRI - CARDIAC FOR VELOCITY FLOW MAPPING CT HEART, W/O CONTRAST MATERIAL, QUANTITATIVE EVALUATION OF CORONARY CALCIUM CT HEART, W/O CONTRAST MATERIAL, FOR EVALUATION OF CARDIAC STRUCTURE AND MORPHOLOGY (INCLUDING 3D IMAGING POST PROCESSING, ASSESSMENT OF CARDIAC FUNCTION, AND EVALUATION OF VENOUS STRUCTURES, IF PERFORMED) CT HEART, W/O CONTRAST MATERIAL, FOR EVALUATION OF CARDIAC STRUCTURE AND MORPHOLOGY IN THE SETTING OF CONGENITAL HEART DISEASE (INCLUDING 3D IMAGING POST PROCESSING, ASSESSMENT OF LV CARDIAC FUNCTION, RV STRUCTURE AND FUNCTION AND EVALUATION OF VENOUS STRUCTURES, IF PERFORMED) CT ANGIOGRAPHY, HEART, CORONARY ARTERIES AND BYPASS GRAFTS (WHEN PRESENT), WITH CONTRAST MATERIAL, INCLUDING 3D POST PROCESSING (INCLUDING EVALUATION OF CARDIAC STRUCTURE AND MORPHOLOGY, ASSESSMENT OF CARDIAC FUNCTION, AND EVALUATION OF VENOUS STRUCTURES, IF PERFORMED) MRI BREAST MRI BREAST UNILATERAL (SPECIFY RT OR LT) W/O MRI BREAST UNILATERAL (IMPLANT EVALUATION) (SPECIFY RT OR LT) MRI BREAST BL W/O MRI BREAST BL (IMPLANT EVALUATION) MRI BREAST UNILATERAL W & W/O (SPECIFY RT OR LT) MRI BREAST BL W & W/O MRI ARTHOGRAM MRI GUIDANCE TISSUE ABLATION MR ARTHROGRAM KNEE MR ARTHROGRAM SHOULDER LYMPHANGIOGRAPHY LYMPHANGIOGRAPHY EXTREMITY, UNI LYMPHANGIOGRAPHY, EXTREMITY ONLY, BILATERAL INJECTION LYMPHATIC SYSTEM

6 Cherry Hill & Women s Center FAX: Cross Keys & Women s Center FAX: Greentree & Women s Center FAX: Haddonfield & Women s Center FAX: Pennsauken FAX: Route Fax: Turnersville & Women s Center FAX: Voorhees FAX: Washington Twp FAX: Women s Center at Virtua FAX: Women s Center at Voorhees FAX: West Deptford & Women s Center FAX:

CPT CODES. Ph: (307) Fax: (307) CATSCAN IV Contrast: 87.00

CPT CODES. Ph: (307) Fax: (307) CATSCAN IV Contrast: 87.00 Ph: (307) 382-4282 Fax: (307) 382-4291 CPT CODES CATSCAN IV Contrast: 87.00 74150 Abdomen w/o contrast $ 809.00 74160 Abdomen w/ contrast $1175.00 w/ contrast: $1262.00 74170 Abdomen w_w/o contrast $1324.00