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SECTION X:DIAGNOSTIC RADIOLOGYFee663X Portacath, infusaport, hemocath, Hick-Broviac $312.00 10 L<strong>for</strong> chemotherapy or long-term T.P.N. (PORT)- insertion (composite fee)COMPUTED TOMOGRAPHYHead700X no contrast $88.00701X with contrast $117.00702X with and without contrast $148.00Neck - skull base to thoracic inlet703X no contrast $117.00704X with contrast $133.00705X with and without contrast $148.00Thorax706X no contrast $133.00707X with contrast $148.00708X with and without contrast $176.00Abdomen709X no contrast $133.00710X with contrast $149.00711X with and without contrast $176.00Pelvis712X no contrast $133.00713X with contrast $149.00714X with and without contrast $176.00Spine - cervical, thoracic, or lumbar715X no contrast $125.00716X with contrast $139.00717X with and without contrast $155.00Extremity - arm or leg718X no contrast $117.00719X with contrast $133.00720X with and without contrast $149.00MAGNETIC RESONANCE IMAGING800X Head - Multislice SE $133.00801X Repeat another plane or sequence to max to 3 $58.60Neck (area below the brain and above the chest)802X Multislice SE $133.00803X Repeat another plane or sequence to max to 3 $58.60SMA FEE GUIDE - X8 - October 1, 2011
SECTION X:DIAGNOSTIC RADIOLOGYFeeThorax or Abdomen or Pelvis804X Multislice SE $149.00805X Repeat another plane or sequence to max to 3 $74.00Extremities807X Multislice SE $117.00808X Repeat another plane or sequence to max to 3 $58.60One Spine Zone809X Multislice SE $117.00810X Repeat another plane or sequence to max to 3 $58.60Two adjoining spine zones811X Multislice SE $117.00812X Repeat another plane or sequence to max to 3 $58.60Three adjoining spine zones813X Multislice SE $192.00814X Repeat another plane or sequence to max to 3 $88.00Note:1. Multislice SE refers to a multislice spin echo sequence whetherit is one or two echoes. This applies to a combination of aT1W1 and T2W1. Only one such sequence can be billedper patient at one sitting.2. Repeat refers to another plane or different pulse sequence, but may notexceed three of these.3. Maximum billing will be <strong>for</strong> four sequences no matter how manyare done.SMA FEE GUIDE - X9 - October 1, 2011
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SMA Fee Guide (for uninsured servic
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INTRODUCTION / PREAMBLEAn understan
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