for uninsured services - Saskatchewan Medical Association

SECTION X:DIAGNOSTIC RADIOLOGYTechnicalTechnical Interpretation andComponent Component Interpretation232X -- retrograde $57.80 $16.10 $73.90233X I.V.P. -- with voiding $154.40 $49.60 $204.00cystourethrogram234X Voiding cystourethrogram $142.80 $65.20 $208.00235X Drip infusion pyelogram $169.00 $69.00 $238.00239X Urethrogram (retrograde) $58.20 $24.20 $82.40Obstetrics and GynaecologyFoetus240X -- scout film $30.60 $18.60 $49.20241X -- maturity and/or position $30.60 $18.60 $49.20243X Pelvimetry $53.60 $27.80 $81.40244X Utero-salpingogram $57.40 $30.80 $88.20245X Intrauterine blood transfusion $51.60 $27.80 $79.40Miscellaneous -- without contrast media300X Diagnostic Mammography (unilateral) $121.00 $77.00 $198.00(repeats within 42 days by report)312X Repeat mammography for $191.00 $50.00 $241.00radiological localization ofnon-palpable breast lesion301X Soft tissues of the neck $40.50 $15.00 $55.50302X -- Laryngogram $73.60 $39.40 $113.00Planigraphy303X -- first cut $47.60 $19.00 $66.60304X -- each additional cut $17.20 $10.00 $27.20306X Cinefluorograph or videotape $25.70 $31.00307X Cardiac catheterization $64.80 $39.20 $104.00Miscellaneous -- with contrast media320X Fistula or sinus tract $49.20 $17.40 $66.60321X Sialogram $106.40 $58.60 $165.00322X Arthrogram $127.00 $56.00 $183.00323X Lymphangiography -- upper and $271.40 $45.40 $316.80lower extremities, includingpelvis, chest and abdomen324X Dacryocystography $51.60 $26.80 $78.40325X Venogram $98.00 $44.00 $142.00327X Selective cavogram $103.60 $43.40 $147.00328X Azygography $103.60 $43.40 $147.00329X Ventriculogram or encephalogram $103.60 $43.40 $147.00Arteriography330X -- peripheral $103.60 $43.40 $147.00331X -- cerebral $123.00 $57.00 $180.00Aortography332X -- aortic $103.60 $43.40 $147.00SMA FEE GUIDE - X4 - April 1, 2012