📍 Babol, Meydan Keshvari☎ 011-3553
Mehregan Shomal Medical Imaging Center

International Patient Tariffs

Medical Imaging Tariffs 1405 — Mehregan Shomal Medical Imaging Center

Amounts are displayed from the center’s official international-patient tariff file (Private Tariff ×3).

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Global CodeService DescriptionInternational Patient Tariff (IRR)
700005Radiography , AP and lateral views - Skull24,186,000
700010Radiography skull view Towne, Hirtz or each - view other(eachexposure14,260,500
700015Radiography sella turcica (sella turcica) - localized lateral14,260,500
700030Radiography mastoid unilateral view Schuller or - Stenvers or trans orbital (each exposure15,511,500
700035Radiography facial bones (AP view )14,260,500
700040Radiography facial bones (AP view - and lateral25,018,500
700045Radiography bone special nasal - view lateral right and left on one film16,192,500
700050Radiography sinus anterior face (view - Waters or Caldwell14,260,500
700055Radiography sinus anterior face (view - Waters and lateral24,991,500
700060Radiography jaw bone (view oblique or - AP or lateral each side14,260,500
700065Radiography dental each film (peri apical or - bite wing9,633,000
700070Radiography series(10 film) - Complete dental62,289,000
700075Radiography series (in face that - 14 film requested performed be) Complete dental79,647,000
700080Radiography - Occlusal dental15,511,500
700085Radiography - Panoramic dental23,503,500
700090Radiography - Cephalometric22,726,500
700095Radiography temporomandibular joint (each side - one film14,260,500
700100Radiography temporomandibular joint- each side - with mouth open and closed (two films24,991,500
700105Radiography temporomandibular joint - two side - with mouth open and closed (4 exposure37,947,000
700110Radiography soft tissue neck or nasopharynx- - one view14,260,500
700125Radiography sialography unilateral each gland - salivary (at least 4 image78,604,500
700135Radiography shoulder one view (bone - view axial or lateral ) each film scapula, clavicle, joint acromioclavicular with14,886,000
700140Radiography chest AP view or lateral - and or each view other (one film15,984,000
700145Radiography chest AP view and lateral - to manner also time29,632,500
700155Fluoroscopy only17,707,500
700165Radiography ribs view oblique or AP one - film14,886,000
700170Radiography ribs (one side- two view -2 - film27,105,000
700175Radiography bone sternum (view oblique or - lateral - one film14,260,500
700180Radiography bone sternum (view oblique and - lateral to manner also time- 2 film25,854,000
700185Mammography) mammography unilateral (on2 film special45,087,000
700190Mammography view, one region - Magnified42,312,000
700195Mammography) mammography bilateral (on4 film special74,373,000
700200Mammography each film additional direction localization17,097,000
700205Mammography galactography(unilateral)47,076,000
700211Mammography with contrast187,650,000
700212Digital tomosynthesis breast, unilateral140,400,000
700213Digital tomosynthesis breast, bilateral164,025,000
700214Tomosynthesis one view additional83,400,000
700215Radiography portable at home(each image)68,248,500
700220Radiography hip joint bilateral or view - frog-leg (pelvis16,609,500
700225Radiography hip joint AP view or oblique - each image15,663,000
700230Radiography pelvis (each film)17,026,500
700235Radiography joint sacroiliac each - exposure(including of AP and oblique15,663,000
700240Radiography bone sacrum and vertebra - coccyx- two views26,896,500
700245Radiography plain abdomen supine - one film17,653,500
700250Radiography plain abdomen supine and standing two - film32,943,000
700255Radiography plain abdomen standing- one film17,445,000
700260Radiography esophagus with swallow contrast material (at least 4 - exposure34,152,000
700265Radiography stomach and duodenum (at least 4 - image70,302,000
700270Radiography esophagus, stomach and duodenum (at least 6 - image86,911,500
700275Radiography transit bowel small - at least4 image76,386,000
700280Radiography barium enema (at least 4 image )91,456,500
700285Radiography barium enema double contrast (at least - 6 image100,546,500
700290Radiography head cystography oral (at least 2 - image34,873,500
700295Angiography (CT tube ) each film - radiography chol36,070,500
700300Angiography of route skin; each - film radiography chol56,712,000
700305Endoscope ( ); each film ERCP cholangiofootnecrography retrograde of via56,238,000
700310Required and complete (with or without ) PVC urography excretory film with each number image77,562,000
700325Pyelography retrograde bilateral (each image )44,241,000
700330Pyelography retrograde unilateral (each image )28,800,000
700335(with each numberimage required and complete ) pyelography or nephrography anti grade unilateral104,401,500
700340Each numberimage required and complete ) pyelography or nephrography anti grade bilateral (with152,245,500
700345Ultrasound or 043007 use is performed; but if this nephrostomy previous of codes 533007 and in face performing pyelography or nephrography or - 533007 and 043007 additional is performed fluoroscopy performing , code aforementioned to codes procedure to assistance needle under guidance91,066,500
700350Radiography cystography with contrast material - retrograde47,955,000
700355Radiography urethrography with contrast material - retrograde54,670,500
700360Radiography urethrocystography with contrast material - retrograde63,261,000
700365Scopy . . . VCUG urethrocystography in while urine performing with80,080,500
700370Radiography plain abdomen direction measurement of age and or - status fetus each exposure21,309,000
700375Radiography hysterosalpingography93,825,000
700380Radiography fistulography with fee injection65,052,000
700395Radiography transit colon Colon - CTT TransitTime76,386,000
700400Defecography185,719,500
700405Vasography534,622,500
700410Radiography spine neck (two views AP - and lateral25,018,500
700415Radiography spine neck (4 film AP, - lateral and oblique left and right41,283,000
700420Radiography spine neck (flexion, - extension, oblique) each exposure16,276,500
700425Radiography special odontoid22,197,000
700430Radiography spine posterior AP and lateral31,066,500
700435Radiography spine esophagus AP and lateral31,066,500
700440Radiography spine esophagus 4 film AP, lateral - and oblique left and right57,129,000
700445Radiography standing spine (AP and lateral - - on2 film38,155,500
700450Each film each image additional ( ) or oblique and Bending …24,186,000
700455Radiography dorsolumbar- AP and lateral33,985,500
700460Radiography lumbosacral - two views35,445,000
700465Radiography localized - each region to alone17,625,000
700466Radiography all spine or extremity EOS - lower or upper in position different148,800,000
700467Radiography whole body in position EOS - different184,950,000
700470(cervical) myelography of each region column vertebra105,360,000
700475(thoracic) myelography of each region column vertebra105,360,000
700480Myelography of each region column vertebra - (lumbar)102,030,000
700485Myelography of dorsolumbar - with also complete127,899,000
700490Also complete myelography spine neck posterior esophagus with –165,690,000
700495Arthrography shoulder with air and contrast material74,943,000
700500Radiography bone arm ( 2 direction on one - film17,707,500
700505Radiography bone arm or forearm or elbow one - direction (one film14,260,500
700510Radiography joint elbow (two views- on one - film17,625,000
700515Radiography bone forearm ( two views- on - one film17,625,000
700520Radiography wrist- one view14,260,500
700525Radiography wrist - two views18,013,500
700530Each film additional wrist (scaphoid and ) …13,761,000
700535Radiography bones sole hand- one view14,260,500
700540Radiography bones sole hand two views –18,013,500
700545Radiography measurement of age bony- each image22,726,500
700550Radiography digits each hand - one view14,260,500
700555Radiography digits each hand - two views17,236,500
700560Arthrography wrist96,483,000
700565Radiography bone femur (AP and lateral - - on two films29,815,500
700570Radiography bone femur (two exposure- on - one film19,222,500
700575Radiography scanogram (for measurement of shortening - extremity with line traction graduated50,538,000
700580Radiography joint knee( two views, on one - film17,625,000
700585Radiography joint knee standing (AP and - lateral - on two films24,186,000
700590Radiography joint knee AP standing - on - one film18,223,500
700595Radiography view intercondylar or view - special patella- one film13,761,000
700600Radiography leg foot one exposure on- one - film (cast or traction19,807,500
700605Radiography leg foot (two exposure - on one - film23,949,000
700610Radiography ankle- one view17,097,000
700615Radiography ankle - two views20,641,500
700620Radiography footshoulder foot14,260,500
700625Radiography foot17,707,500
700630Radiography foot standing( AP or half AP - - one film21,504,000
700635Radiography foot (AP and half AP - on - one film22,726,500
700640Arthrography knee with air and contrast material72,375,000
700645Radiography digits each foot - one view15,540,000
700650Radiography digits each foot - two views17,097,000
700655Radiography( ) unilateral view Alignment47,406,000
700660Radiography( ) bilateral view Alignment67,575,000
700666Printing repeat image imaging8,550,000
700900) Photon bone densitometry ( Single107,523,000
700905Bone densitometry ( ) Photon Dual124,929,000
700910To age (10) years of age Survey Bone43,954,500
700915Two image additional ( AP and lateral lumbar) above age (10) years of age with Survey Bone67,989,000
700920Radiography densitometry Densitometry Bone - bone(one or two region124,929,000
700925Bones whole body densitometry Densitometry Bone143,001,000
701000Angiography cervical carotid bilateral(four - vessel brain639,300,000
701005Angiography vertebral cervical and or intracranial639,300,000
701010Angiography one eye including kidney cost - film, printing, interpretation80,566,500
701015Angiography abdominal aorta with selective- one kidney461,400,000
701020Angiography abdominal aorta with selective- two kidney539,250,000
701025Angiography vessels iliac- bilateral429,450,000
701030Angiography evaluation of vessels kidney transplant performed500,250,000
701035Angiography translumbar and or trans axial604,500,000
701040Angiography brachial528,000,000
701045Angiography elbow429,450,000
701050Angiography evaluation of entire length aorta chest - - and abdomen to two bifurcation aorta396,000,000
701055Umbilical cord, and..) SMA splenoportography via vessels (celiac,352,494,000
701060And ) … splenoportography of route percutaneous (liver,spleen273,039,000
701065For eachartery and one projection upper, renal and superior renal) with seriography arthrography abdomen selective (celiac,mesenteric467,602,500
701070For each artery additional upper, renal and superior renal) with seriography arthrography abdomen selective (celiac,mesenteric220,852,500
701075Each projection additional superior mesenteric, renal and high renal) for arthrography abdomen selective (celiac,101,905,500
701080Venography superior vena cava with seriography with - supervision and report radiologist271,246,500
701085Venography inferior vena cava with seriography with - supervision and report radiologist271,246,500
701090Venography superior vena cava without seriography195,960,000
701095Venography inferior vena cava without seriography195,960,000
701100Splenoportography of via spleen326,896,500
701105With seriography and one projection arteriography arch aorta chest - or abdomen424,800,000
701110Seriography and one projection breast internal, bronchial each side with selective such as carotid internal,external vertebral, arteriography artery neck,chest469,020,000
701115Angiography cervicocerebral with catheter including - radiologist vessels with supervision and report origin472,500,000
701120For each projection additional84,490,500
701125Angiography one extremity- one side with needle - direct seriography314,100,000
701130Angiography one extremity- two side in one session - with needle direct upper or lower383,550,000
701135Angiography one lower extremity with catheter of side - contralateral539,400,000
701140Angiography one upper extremity with catheter539,400,000
701145Angiography each two lower extremity of below artery - renal with seriography472,500,000
701150Angiography each two upper extremity with arch aorta - nonselective429,450,000
701155Venography selective vein renal or high renal - or hepatic or testis with seriography390,507,000
701160Venography unilateral selective vein adrenal384,568,500
701165Venography selective unilateral jugular, - parathyroid with seriography385,513,500
701170Venography sinus vein (petrosal-sagittal - lower) or jugular385,513,500
701175Venography selective bilateral jugular, parathyroid - with seriography474,273,000
701180Venography jugular or parathyroid without - seriography- unilateral241,074,000
701185Venography bilateral in one session (to condition - AP367,531,500
701190Venography lower extremity (of foot to pelvis) unilateral367,531,500
701195Venography lower extremity- bilateral in one - session to condition AP515,811,000
701200Venography upper extremity- unilateral311,832,000
701205Venography extremity upper- bilateral364,249,500
701210Angiography lower extremity - lymph427,876,500
701215Angiography upper extremity - lymph467,658,000
701220Angiography extremity peripheral unilateral with - report and supervision radiologist lymph467,658,000
701225And measurement pressure) cavernosography complete (including before and after injection311,832,000
701235Angiography brain four vessel brain to method - digital including carotid two side and vertebral660,000,000
701240Angiography carotid artery to method digital - unilateral368,230,500
701245Angiography carotid artery to method digital - bilateral423,750,000
701250Angiography vertebral artery to method digital - unilateral376,500,000
701255Angiography vertebral artery to method digital - bilateral471,000,000
701260Angiography pulmonary - digital660,000,000
701265Aortaography to method digital423,750,000
701270Digital angiography aorta to method trans - lumbar1,128,600,000
701275Angiography visceral-selectiveor superselective(with - or without aortaogram743,550,000
701280Angiography arterial celiac - digital612,750,000
701285Angiography hepatic artery - digital660,000,000
701290Angiography superior mesenteric artery - digital603,000,000
701295Digital angiography renal artery (one - sided309,787,500
701300Angiography renal artery (bilateral) - digital417,645,000
701310And ); of via vessels SMA … splenoportography digital(celiac, umbilical cord,612,750,000
701315And ); of route skin … splenoportography digital(liver, spleen264,000,000
701320Angiography iliac (pelvis) - digital612,750,000
701325Venography . . IVC - digital423,750,000
701330Angiography upper extremity unilateral - digital528,000,000
701335Angiography upper extremity bilateral - digital707,250,000
701340Angiography lower extremity- unilateral - digital660,000,000
701345Angiography lower extremity - bilateral - digital876,750,000
701350Digital angiography lower extremity- unilateral - with with aortaogram971,250,000
701355Digital angiography spinal cord including vessels - lumbar bilateral bilateral and all vessels between rib - and arteries vertebral sub clavian trunk thyrocervical1,584,000,000
701360Angiography pudendal- unilateral - digital471,000,000
701365Angiography pudendal- bilateral - digital660,000,000
701370Digital venography upper extremity ( ); one SVC - sided348,750,000
701375Digital venography upper extremity ( ); two SVC - sided528,000,000
701500Ultrasound brain neonates22,285,500
701505Scan B with or without Scan A Unquantitative18,868,500
701510To alone Quantitative A Scan18,868,500
701515Ultrasound to per each eye ( scan and A B - scan with also22,896,000
701521Ultrasound thyroid to with lymph nodes - neck (soft tissue neck39,877,500
701530Ultrasound salivary glands (parotid submandibular)16,062,000
701535Ultrasound evaluation for fluid in pleural space or ascites- - each each15,285,000
701540Ultrasound breast to with spaces - axial with probe special unilateral –43,140,000
701545Ultrasound breast to with spaces - axial with probe special bilateral –48,210,000
701546Elastography breast96,150,000
701550Ultrasound chest18,868,500
701555Ultrasound abdomen (liver, gallbladder, spleen, - kidneys, pancreas34,831,500
701556Ultrasound of patients trauma in department - emergency ( ) FAST34,831,500
701560Ultrasound liver, gallbladder and ducts - biliary22,285,500
701570Ultrasound gallbladder and biliary ducts - external hepatic16,062,000
701590Ultrasound kidneys18,868,500
701595Ultrasound pancreas16,062,000
701600Ultrasound spleen16,062,000
701605Ultrasound retroperitoneum or abdominal aorta non - Doppler17,338,500
701610Ultrasound appendix19,479,000
701611Ultrasound pelvis including bladder full and empty, - ovary prostate and vesicle seminal and or uterus and29,218,500
701615Ultrasound kidneys and urinary tract (including - bladder full27,843,000
701620Ultrasound kidneys and urinary tract and bladder - full and empty ( with measurement of residual urinary29,040,000
701625Ultrasound kidneys and urinary tract and - residual urinary) prostate and bladder- full and empty ( with measurement of41,764,500
701626Ultrasound abdomen and pelvis52,995,000
701655Ultrasound uterus and ovary of on abdomen26,745,000
701660Ultrasound evaluation for pregnancy external of uterus22,896,000
701661Ultrasound length cervix of on abdomen17,790,000
701665Ultrasound testes25,702,500
701666Ultrasound penis25,702,500
701667Ultrasound in men (evaluation of Infertility - anomaly duct and ) EJ VD41,764,500
701670Ultrasound testis footin undescended27,843,000
701680Ultrasound adrenal- one or bilateral18,868,500
701685Ultrasound prostate (transrectal)41,764,500
701690Ultrasound uterus and ovaries (transvaginal)35,010,000
701691Ultrasound length cervix transvaginal26,685,000
701695Ultrasound reflux stomach to esophagus27,843,000
701696Ultrasound intussusception bowel27,843,000
701700Ultrasound hip neonates one or bilateral27,843,000
701705Ultrasound soft tissue superficial or deep each - site body with specified region case AP27,843,000
701706Ultrasound each joint26,400,000
701707Ultrasound tendon26,400,000
701715Ultrasound pregnancy (including age, status placenta, - fetus and heartbeat heart34,831,500
701716Ultrasound pregnancy transvaginal55,686,000
701717Ultrasound lung maturity fetus22,896,000
701718Ultrasound transvaginal evaluation for pregnancy - external uterus( ) EP41,764,500
701720Ultrasound biophysical profile (evaluation of - movement, tone, breathing fetus and amniotic fluid41,764,500
701724Ultrasound pregnancy to with diagnosis of - congenital malformations fetus68,100,000
701725Ultrasound for diagnosis of malformation - congenital fetus45,792,000
701726Ultrasound stenosis hiphypertrophic pylorus neonate27,843,000
701727Ultrasound lumbosacral neonate27,843,000
701730Ultrasound and or (codes related to NT NB - not be) to face separately eligible report and billing measurement of pregnancy in this code included performed is and52,800,000
701731Ultrasound and anomaly three trimester first NT61,830,000
701732Ultrasound placenta of assessment accreta50,739,000
701735Ultrasound for evaluation of status fetus - multiple gestation- each fetus additional22,896,000
701736Doppler ultrasound evaluation of growth fetus and IUGR - non41,764,500
701740Color Doppler ultrasound arteries neck - twocarotid and two vertebral and veins jugular92,400,000
701745Color Doppler ultrasound arteries lower extremity - unilateral87,675,000
701750Color Doppler ultrasound arteries lower extremity two - sided145,200,000
701755Color Doppler ultrasound arteries upper extremity - unilateral79,200,000
701760Color Doppler ultrasound arteries upper extremity two - sided145,200,000
701765Doppler ultrasound vein peripheral unilateral - color79,200,000
701770Doppler ultrasound vein peripheral bilateral - color132,000,000
701775Color Doppler ultrasound artery vein- one - extremity132,000,000
701780Doppler ultrasound artery vein two extremity - color211,200,000
701785Color Doppler ultrasound each organ abdomen or - tumors abdomen or pelvis each each92,400,000
701790Doppler ultrasound kidneys or testes - color92,400,000
701795Doppler ultrasound kidney transplanted - color81,840,000
701800Doppler ultrasound liver or lesions tumor - color105,600,000
701805Color Doppler ultrasound uterus and ovary of via - vaginal92,400,000
701810Color Doppler ultrasound uterus pregnant (uterus, placenta - and fetus92,400,000
701815Color Doppler ultrasound penis ( ) including penis - kidney steps required and injection footfootvein132,000,000
701820Color Doppler ultrasound penis ( ) without penis - injection footfootvein79,200,000
701825Ultrasound of shoulder or knee21,675,000
701826Doppler ultrasound soft-tissue masses - color43,350,000
701827Color Doppler ultrasound portal, vein spleen and - evaluation of collaterals79,200,000
701830Hysterosonography56,550,000
701835Doppler ultrasound color prostate to method - transrectal92,400,000
701865Ultrasound trans cranial ( ) TCD - Doppler79,200,000
701870Ultrasound (scan duplex artery TCCS - footparenchyma and nuclei brain) sided and veins neck with with visualization external brain including carotid and vertebral two105,600,000
701880Doppler ultrasound and veins iliac IVC - color66,000,000
701882Color Doppler ultrasound aorta and artery - iliac79,200,000
701884Doppler ultrasound dialysis fistula - color105,600,000
701886Doppler ultrasound varicose veins lower extremity one - perforator incompetent with mapping saphenous and femoral and saphenous andpopliteal and sided evaluation of veins superficial anddeep valve105,600,000
701887Doppler ultrasound varicose veins lower extremity sided - perforator incompetent with mapping saphenous and femoral and saphenous and popliteal and evaluation of veins superficial and deep valve171,600,000
701892Ultrasound compression compression pseudoaneurysm with probe79,200,000
701895Ultrasound bone densitometry25,248,000
900781Echocardiography - first fetus - Fetal158,400,000
900782Echocardiography - each additional fetus - Fetal52,800,000
702275CT scan 3D any body region and - face144,618,000
702340CT scan aorta with reconstruction - angio82,035,000
702470CT scan primary) reconstruction metal artifact (additional on cost CT18,516,000
702475Scan primary) reconstruction each region (additional on cost CT18,516,000
702480Sialo CT- one view with fee injection35,082,000
702485CT angiography multi detector 64 slice - or more coronary arteries665,610,000
702490CT angiography multi detector 64 - not be) angiography less of 64 slice eligible report (for evaluation of coronary arteries, CT unilateral or bilateral slice or more for evaluation of other vessels401,850,000
702492CT scan , heart, without material contrast, with - evaluation of quantitative calcium coronary115,182,000
702495Angiography of carotid arteries (extracranial) - CT135,756,000
702500Angiography of intracranial arteries - CT143,736,000
702505Angiography of renal arteries (kidney donor evaluation) - CT139,252,500
702510Angiography of thoracic aorta - CT130,987,500
702515Angiography of abdominal aorta - CT123,219,000
702520Angiography of other organs - CT115,744,500
702525CT angiography abdomen without contrast material - and withcontrast material118,297,500
702530CT angiography upper extremity with andwithout material - contrast-sections subsequent118,297,500
702535CT angiography lower extremity with and without - contrast material118,297,500
702540CT scan all Resolution High - injection lung in one breath (5 milli meter )- without58,210,500
702545CT scan functional lung with calculations - capacities respiratory ( ) CT Pulmo74,007,000
702550CT angioportalography liver135,756,000
702555CT scan direction evaluation of perfusion tissue- - gas xenon ( ) CT Xenon149,130,000
702560CT scan endoscopy- each organ - VirtualEndoscopy138,453,000
702565CT scan of brain without contrast76,047,000
702570CT scan of brain with contrast86,682,000
702575CT scan of brain with and without contrast132,445,500
702580CT scan brain coronal and axial without - injection129,337,500
702585CT scan brain coronal and axial with contrast injection147,508,500
702590CT scan brain coronal and axial with and without - injection221,499,000
702595CT scan sections coronal sagittal or - oblique129,337,500
702600CT scan posterior fossa with sections thin - with or without injection78,655,500
702605CT scan posterior fossa with sections thin - with and without injection88,950,000
702610CT scan orbit -year- posterior fossa - inner ear external or middle without injection76,906,500
702615CT scan face and sinus- one view - coronal or axial) without injection76,047,000
702620CT region maxillo facial without injection76,047,000
702630CT scan face and sinus one view with - injection76,213,500
702635CT scan face and sinus one view - - with and without injection127,506,000
702640CT scan region maxillo facial with contrast injection86,668,500
702645CT scan region maxillo facial with and - without injection130,392,000
702650CT scan face and sinus -two views- - without injection133,462,500
702655CT scan face and sinus two views with - injection147,508,500
702660CT scan face and sinus- two views with - and without injection221,610,000
702665CT scan dynamic pituitary for - microadenoma80,416,500
702670CT scan orbit each view without injection59,416,500
702675CT scan orbit each view with contrast injection71,127,000
702680CT scan orbit (each view - with and without - injection104,268,000
702685CT scan orbit two views without injection91,287,000
702690CT scan orbit two views with contrast injection97,279,500
702695CT scan orbit two views with and without - injection150,150,000
702700CT scan orbit - year- posterior fossa - inner ear external or middle with contrast injection106,932,000
702705CT scan orbit -year posterior fossa with and - with or without injection without injection inner ear external or middle146,107,500
702710CT scan inner ear one view without - injection57,315,000
702715CT scan ear one view with contrast injection61,486,500
702720CT scan ear one view with and without - injection92,104,500
702725CT scan inner ear coronal and axial - bone petrous95,455,500
702730CT scan inner ear posterior fossa two - direction95,455,500
702735CT scan ear two views with contrast injection100,800,000
702740CT scan ear two views with and without injection145,137,000
702745Cisternography brain in one view86,070,000
702750Cisternography brain in two views107,895,000
702760CT scan mandible or upper, axial with - reconstruction sagittal andcoronal114,727,500
702765CT scan complete series axial TMJ - andcoronal and sagittal135,654,000
702770CT scan series ear for transplant cochlear - with film zoom99,270,000
702775CT scan neck without injection78,394,500
702780CT scan neck with contrast injection86,125,500
702785CT scan neck -with and without injection131,400,000
702790CT scan dynamic neck86,125,500
702795CT scan larynx one view 2mm - without injection57,315,000
702800CT scan larynx one view 2mm - with contrast injection63,085,500
702805CT scan larynx one view 2 mm - with and without injection95,385,000
702810CT scan larynx two views86,125,500
702815CT scan lung and mediastinum without injection80,394,000
702819CT scan chest to purpose - diagnosis of 91- COVID94,885,500
702820CT scan lung and mediastinum with contrast injection87,568,500
702825CT scan lung and mediastinum with and without injection131,997,000
702835CT scan mediastinum or lung with contrast injection - dynamic90,375,000
702840CT scan with resolution resolution high CT scan high-resolution resolution upper or HRCT - ultra - without injection UHR94,885,500
702845CT scan with resolution resolution high CT scan high-resolution resolution upper or HRCT - ultra - with contrast injection UHR111,946,500
702850CT scan with resolution resolution high CT scan high-resolution resolution upper or HRCT - ultra - with andwithout injection UHR165,396,000
702855CT scan abdomen with contrast injection95,455,500
702860CT scan abdomen without injection91,896,000
702865CT scan abdomen with and without injection149,878,500
702870CT scan abdomen and pelvis without injection136,024,500
702875CT scan abdomen and pelvis with contrast injection143,866,500
702876CT scan enterography141,480,000
702880CT scan abdomen and pelvis - with and without injection223,746,000
702885CT scan pelvis without injection86,125,500
702890CT scan pelvis with contrast injection91,743,000
702895CT scan pelvis with and without injection142,203,000
702900CT scan 2and4milli meter each one of - renal) alone(pancreas,kidneys,spleen and glands high organs abdomen with or without injection - each one to57,315,000
702905CT scan pelvis without injection contrast material - or pelvis bony86,070,000
702915Dynamic(liver) individual and dedicated abdomen with contrast injection CT evaluation of 2and 4milli meter organs86,125,500
702920CT scan other regions of spine - without injection85,500,000
702925CT scan spine thoracic region - without injection85,500,000
702930CT scan spine cervical region - without injection85,500,000
702935CT scan spine lumbar region - without injection85,500,000
702940CT scan other regions of spine - with contrast injection111,225,000
702945CT scan other regions of spine - with and without injection132,075,000
702950CT scan spine lumbar region with - injection111,225,000
702955CT scan spine thoracic region - with contrast injection111,225,000
702960CT scan spine cervical region with - injection111,225,000
702965CT scan spine thoracic region - with and without injection132,075,000
702970CT scan spine cervical region with - and without injection132,075,000
702975CT scan spine lumbar region with and - without injection132,075,000
702980CT scan myelo one view for two vertebra - and one disc150,150,000
702985CT scan each segment of extremity70,663,500
702990CT scan upper extremity without contrast70,663,500
702995CT scan upper extremity with contrast83,289,000
703000CT scan upper extremity without and with - contrast98,959,500
703005CT scan lower extremity without contrast70,635,000
703010CT scan lower extremity with contrast83,289,000
703015CT scan lower extremity with and without - contrast98,959,500
703020CT scan and calculation ante version hip with - knee78,394,500
703025CT scan each joint in one view66,946,500
703030CT scan and calculation mineralization - bone95,455,500
703035CT scan (without injection or with contrast injection dynamic and protocol evaluation of hemangioma hepatic including CT - delayed105,120,000
703040; each quadrant CT Beam Cone93,150,000
703042Temporal mandibular bilateral ; direction evaluation of joint CT Beam Cone103,575,000
703044Bony with and without injection ; direction evaluation of lesions CT Beam Cone129,300,000
703060Angiography anesthesia for performing services - or Scan CT - CT0
704000MRI Proton - bilateral iTMG (to as example109,015,500
704005MRI proton - without contrast material brainstem (to as example ) brain including109,015,500
704010MRI proton - lymphadenofootCT mediastinal) without contrast material thoracic (to as example for evaluation (to as example ) chest109,015,500
704015MRI proton - without contrast material and contents it cervical region spinal (to as example ) canal109,015,500
704020MRI spinal - lumbar without contrast (without contrast material ) canal and contents it region109,015,500
704025MRI proton - contrast contents it thoracic without material Spinal (to as example ) canal109,015,500
704030MRI proton - contrast material (to as example ) pelvis without109,015,500
704035MRI - joints without contrast material upper extremity arm or forearm to non of109,015,500
704040MRI - each joint upper extremity without contrast material109,015,500
704045MRI proton - without contrast material (to as example ) lower extremity109,015,500
704050MRI Proton - lower extremity without contrast material (to as example ) each joint109,015,500
704055MRI proton - contrast material (to as example ) abdomen without109,015,500
704060MRI - contrast orbit, face, and or neck without material109,015,500
704065MRI brainstem - brain including with contrast material131,172,000
704070MRI - chest with contrast material131,172,000
704075MRI spinal - cervical with contrast material131,172,000
704080MRI - thoracic with contrast material131,172,000
704085MRI - lumbar region with contrast material131,172,000
704090MRI proton - contrast (to as example ) pelvis with material131,172,000
704095MRI - contrast upper extremity to non of joints with material131,172,000
704100MRI - each joint upper extremity with contrast material131,172,000
704105MRI - example ) proton lower extremity with contrast material (to as131,172,000
704110MRI - to as example ) Proton each joint lower extremity with contrast material131,172,000
704115MRI - proton abdomen with contrast material (to as example131,172,000
704120MRI - contrast orbit, face, and or neck with material184,389,000
704125MRI - brain with and without contrast material184,389,000
704130MRI - breast unilateral with and without contrast material181,614,000
704135MRI - breast bilateral with and without contrast material217,864,500
704140MRI - chest with and without contrast material184,389,000
704145Contrast material chest including myocardium with and without MR184,389,000
704150MRI - cervical with and without contrast material184,389,000
704155MRI - thoracic with and without contrast material184,389,000
704160MRI - lumbar region with and without contrast material184,389,000
704165MRI proton - without contrast material (to as example ) pelvis with and184,389,000
704167MRI - fetus181,614,000
704170MRI - contrast material upper extremity to non of joints with and without184,389,000
704175MRI - contrast each joint upper extremity with and without material184,389,000
704180MRI proton - with and without contrast material (to as example ) lower extremity184,389,000
704185MRI Proton - lower extremity with and without contrast material (to as example ) each joint184,389,000
704190MRI proton - without contrast material (to as example ) abdomen with and184,389,000
704195MRI - contrast material orbit, face, and or neck with and without184,389,000
704200Mammography - bilateral ) MR133,170,000
704205Mammography - unilateral) MRM MR110,347,500
704210Urography( dynamic) MRU187,108,500
704215Arthrography MR187,108,500
704220Contrast neck without contrast material or with material MR172,719,000
704225Contrast head(brain) without contrast material or with material MR172,719,000
704230MR spinal - without contrast material canal and contents it with or172,719,000
704235Angiography ) pelvis with or without contrast material MR172,719,000
704240Angiography ) upper extremity with or without MR - contrast material172,719,000
704245Angiography ) lower extremity with orwithout MR - contrast material172,719,000
704250Angiography ) abdomen with or without materials MR - contrast172,719,000
704255Angiography ) neck without contrast material and MR - after of it with contrast material with other sequence184,389,000
704260Venography ) MR172,719,000
704265(spectroscopy) MRS178,162,500
704270MRI - dynamic each part body except heart165,180,000
704275MRI function - morphology study complete – cardiac for with and or without165,180,000
704280MRI - contrast cardiac for morphology without material165,180,000
704285MRI - cardiac for morphology with contrast material165,180,000
704290MRI mapping flow velocity - for165,180,000
704295MRI - scopy169,065,000
704300Angiography ( ) MRCP - chol169,065,000
704305( urography isone) MR169,065,000
704310Different, language and memory activity to as example motor extremity protocol brain with or without at least 4 region functional imaging including BOLD386,772,000
704312With two onon NEXT without at least 60 gradient or 30 direction tractography) including protocol brain with or functional imaging (with DTI193,386,000
704314Lesion and control normal and 135- CSI with and without, 135- ,30- of regions SVS SVS imaging including protocol brain MRS386,772,000
704316MRI Perfusion brain imaging physiologic - for method or DCE DSC with and without; -2 , -1 dynamic EPI T EPI T including protocols brain280,699,500
704318MRI MAPPING and imaging brain TUMOR - one of methods or Perfusion MRS brain with and without; / , , DWIADC FLAIR including protocol337,357,500
704320MRI MAPPING and imaging brain STROKE - 3( - , T D MRA CE Perfusion with and without; , / , DSC DWIADC FLAIR including protocols brain193,386,000
704322MRI MAPPING brain imaging SEIZURE - 3( - , T D MRA CE Perfusion with and without; , / , DSC DWIADC FLAIR including protocols brain386,772,000