2010 HCPCS Schedule - DE Medical Assistance Program

71130 X-RAY EXAM OF BREASTBONE 3 $36.88
71250 CT THORAX W/O DYE 3 $259.30
71260 CT THORAX W/DYE 3 $314.37
71270 CT THORAX W/O & W/DYE 3 $387.15
71275 CT ANGIOGRAPHY, CHEST 3 $446.92
71550 MRI CHEST W/O DYE 3 $432.65
71551 MRI CHEST W/DYE 3 $522.13
71552 MRI CHEST W/O & W/DYE 3 $664.08
71555 MRI ANGIO CHEST W OR W/O DYE 3 $604.81
72010 X-RAY EXAM OF SPINE 3 $70.47
72020 X-RAY EXAM OF SPINE 3 $23.74
72040 X-RAY EXAM OF NECK SPINE 3 $37.12
72050 X-RAY EXAM OF NECK SPINE 3 $51.74
72052 X-RAY EXAM OF NECK SPINE 3 $64.92
72069 X-RAY EXAM OF TRUNK SPINE 3 $35.61
72070 X-RAY EXAM OF THORACIC SPINE 3 $33.09
72072 X-RAY EXAM OF THORACIC SPINE 3 $37.63
72074 X-RAY EXAM OF THORACIC SPINE 3 $44.06
72080 X-RAY EXAM OF TRUNK SPINE 3 $35.23
72090 X-RAY EXAM OF TRUNK SPINE 3 $47.49
72100 X-RAY EXAM OF LOWER SPINE 3 $39.01
72110 X-RAY EXAM OF LOWER SPINE 3 $53.64
72114 X-RAY EXAM OF LOWER SPINE 3 $71.21
72120 X-RAY EXAM OF LOWER SPINE 3 $48.83
72125 CT NECK SPINE W/O DYE 3 $259.30
72126 CT NECK SPINE W/DYE 3 $314.02
72127 CT NECK SPINE W/O & W/DYE 3 $380.87
72128 CT CHEST SPINE W/O DYE 3 $259.30
72129 CT CHEST SPINE W/DYE 3 $314.02
72130 CT CHEST SPINE W/O & W/DYE 3 $382.38
72131 CT LUMBAR SPINE W/O DYE 3 $259.30
72132 CT LUMBAR SPINE W/DYE 3 $313.27
72133 CT LUMBAR SPINE W/O & W/DYE 3 $381.62
72141 MRI NECK SPINE W/O DYE 3 $439.52
72142 MRI NECK SPINE W/DYE 3 $531.96
72146 MRI CHEST SPINE W/O DYE 3 $439.52
72147 MRI CHEST SPINE W/DYE 3 $532.35
72148 MRI LUMBAR SPINE W/O DYE 3 $433.63
72149 MRI LUMBAR SPINE W/DYE 3 $525.34
72156 MRI NECK SPINE W/O & W/DYE 3 $679.91
72157 MRI CHEST SPINE W/O & W/DYE 3 $679.91
72158 MRI LUMBAR SPINE W/O & W/DYE 3 $669.22
72159 MR ANGIO SPINE W/O&W/DYE 3 $662.17
72170 X-RAY EXAM OF PELVIS 3 $26.22
72190 X-RAY EXAM OF PELVIS 3 $39.78
72191 CT ANGIOGRAPH PELV W/O&W/DYE 3 $442.02
72192 CT PELVIS W/O DYE 3 $247.80
72193 CT PELVIS W/DYE 3 $297.85
72194 CT PELVIS W/O & W/DYE 3 $380.17