for uninsured services - Saskatchewan Medical Association

SECTION X:DIAGNOSTIC RADIOLOGYTechnicalTechnical Interpretation andComponent Component InterpretationSpine and Pelvis130X Cervical $67.70 $25.20 $92.90131X Thoracic $55.90 $20.90 $76.80132X Lumbar $67.70 $25.20 $92.90133X Sacro-iliac joints $35.00 $20.50 $55.50134X Sacrum and coccyx $35.00 $20.50 $55.50135X Scoliosis survey (limited) $32.10 $15.90 $48.00136X Oblique views of spine, add $26.80 $12.90 $39.70137X Lumbar spine with flexion and $64.70 $30.10 $94.80extension138X Cervical spine with flexion and $64.70 $30.10 $94.80extension140X Scoliosis survey -- full $55.10 $30.10 $85.20141X Myelogram $147.50 $83.50 $231.00142X Discogram $147.30 $76.70 $224.00143X Pelvis $37.20 $16.70 $53.90144X Pelvis and one or both hips $62.80 $23.40 $86.20145X Smith-Peterson pinning $120.90 $66.30 $187.20Thorax150X Chest $53.10 $22.20 $75.30151X Thoracic inlet $33.80 $14.60 $48.40152X Ribs $40.50 $15.90 $56.40153X Clavicle $35.50 $13.80 $49.30154X Sternum or sterno-clavicular $35.50 $14.60 $50.10joints157X Bronchogram (unilateral) $76.30 $33.40 $109.70158X Chest films with fluoroscopy $43.80 $28.40 $72.20159X Heart survey and/or cardiac $44.10 $21.40 $65.50pacemaker evaluationExtremities160X Acromio-clavicular joint $35.50 $14.60 $50.10161X Shoulder $38.40 $16.40 $54.80361X Shoulder -- specialty view -- 4 (views) $49.70 $17.50 $67.20unilateral162X Humerus $35.40 $13.90 $49.30163X Elbow $35.40 $13.90 $49.30164X Forearm -- radius and ulna $35.40 $13.90 $49.30165X Wrist $35.40 $13.90 $49.30166X Carpals $35.40 $13.90 $49.30167X Hand $42.90 $18.20 $61.10168X Scapula $35.50 $15.00 $50.50170X Femur $37.70 $15.00 $52.70171X Knee $42.90 $18.20 $61.10172X Tibia and fibula $35.50 $15.00 $50.50173X Ankle $40.40 $17.20 $57.60SMA FEE GUIDE - X2 - October 1, 2011