fee schedule 2009 new - DE Medical Assistance Program

77013 3 CT GUIDE FOR TISSUE ABLATION 605.39
77014 3 CT SCAN FOR THERAPY GUIDE 186.67
77021 3 MR GUIDANCE FOR NEEDLE PLACE 491.14
77022 3 MRI FOR TISSUE ABLATION 740.48
77031 3 STEREOTACT GUIDE FOR BRST BX 255.59
77032 3 GUIDANCE FOR NEEDLE, BREAST 67.56
77051 3 COMPUTER DX MAMMOGRAM ADD-ON 15.11
77052 3 COMP SCREEN MAMMOGRAM ADD-ON 15.11
77053 3 X-RAY OF MAMMARY DUCT 95.35
77054 3 X-RAY OF MAMMARY DUCTS 129.42
77055 3 MAMMOGRAM, ONE BREAST 83.98
77056 3 MAMMOGRAM, BOTH BREASTS 106.08
77057 3 MAMMOGRAM, SCREENING 84.28
77058 3 MRI, ONE BREAST 868.08
77059 3 MRI, BOTH BREASTS 999.91
77071 3 X-RAY STRESS VIEW 34.52
77072 3 X-RAYS FOR BONE AGE 23.96
77073 3 X-RAYS, BONE LENGTH STUDIES 41.71
77074 3 X-RAYS, BONE SURVEY, LIMITED 68.92
77075 3 X-RAYS, BONE SURVEY COMPLETE 98.56
77076 3 X-RAYS, BONE SURVEY, INFANT 79.06
77077 3 JOINT SURVEY, SINGLE VIEW 49.35
77078 3 CT BONE DENSITY, AXIAL 86.28
77079 3 CT BONE DENSITY, PERIPHERAL 84.63
77080 3 DXA BONE DENSITY, AXIAL 83.76
77081 3 DXA BONE DENSITY/PERIPHERAL 34.67
77082 3 DXA BONE DENSITY, VERT FX 33.52
77083 3 RADIOGRAPHIC ABSORPTIOMETRY 31.92
77084 3 MAGNETIC IMAGE, BONE MARROW 394.56
77261 3 RADIATION THERAPY PLANNING 68.33
77262 3 RADIATION THERAPY PLANNING 103.20
77263 3 RADIATION THERAPY PLANNING 153.49
77280 3 SET RADIATION THERAPY FIELD 190.51
77285 3 SET RADIATION THERAPY FIELD 320.01
77290 3 SET RADIATION THERAPY FIELD 467.57
77295 3 SET RADIATION THERAPY FIELD 930.51
77299 5 RADIATION THERAPY PLANNING 0.00
77300 3 RADIATION THERAPY DOSE PLAN 77.65
77301 3 RADIOTHERAPY DOSE PLAN, IMRT 2,057.45
77305 3 TELETX ISODOSE PLAN SIMPLE 87.33
77310 3 TELETX ISODOSE PLAN INTERMED 117.87
77315 3 TELETX ISODOSE PLAN COMPLEX 162.34
77321 3 SPECIAL TELETX PORT PLAN 155.32
77326 3 BRACHYTX ISODOSE CALC SIMP 147.85
77327 3 BRACHYTX ISODOSE CALC INTERM 212.14
77328 3 BRACHYTX ISODOSE PLAN COMPL 295.54
77331 3 SPECIAL RADIATION DOSIMETRY 62.51
77332 3 RADIATION TREATMENT AID(S) 81.64
77333 3 RADIATION TREATMENT AID(S) 85.65
77334 3 RADIATION TREATMENT AID(S) 173.89