69436
Tympanostomy (requiring insertion of ventilating tube), general anesthesia
2 076,00
70030
Eye radiology, foreign body detection
416,00
70100
Mandible radiology, up to two views
347,00
70120
Mastoids radiology, up to two views
188,00
70170
Dacryocystography, radiological supervision and interpretation
257,00
70200
Orbits radiology, up to two views
248,00
70210
Paranasal sinuses radiology, up to two views
245,00
70240
Sella turcica radiology
342,00
70250
Skull radiology, up to two views
171,00
70332
TMJ arthrography, including injection and interpretation
441,00
70336
TMJ (temporomandibular joint(s)) MRI
3 078,00
70360
Neck, soft tissue radiology, trachea
552,00
70390
Salivary glands radiology, sialography
519,00
70540
Orbit, face and neck, without contrast material
70551
Brain/brain stem MRI, without contrast material
71020
Chest radiology, up to two views
159,00
71023
Chest radiology, up to two views, with fluoroscopy
486,00
71100
Ribs radiology, up to two views
239,00
71120
Sternum radiology, up to two views
71550
Thorax MRI, without contrast material
2 976,00
72010
Spine radiology, entire, up to two views
72040
Cervical spine radiology, up to two views
72070
Thoracic spine radiology, up to two views
72080
Thoracolumbar spine radiology, up to two views
72100
Lumbosacral spine radiology, up to two views
72141
Cervical spine, MRI, per patient
72146
Thoracic spine, MRI, per patient
72148
Lumbar spine, MRI, per patient
72170
Pelvis radiology, up to two views
192,00
72200
SIJ radiology, up to two views
72270
Myelography
1 971,00
73000
Clavicle radiology
204,00
73010
Scapula radiology
73030
Shoulder radiology, complete, one side, up to two views
73040
Shoulder arthrography, including injection and interpretation
73060
Humerus radiology, up to two views
73070
Elbow radiology, up to two views
73085
Elbow arthrography, including injection and interpretation
73090
Forearm radiology, up to two views
73092
Upper extremity radiology, infant, up to two views
73100
Wrist radiology, up to two views
73115
Wrist, arthrography, including injection and interpretation
73120
Hand radiology, up to two views
73140
Finger(s) radiology, up to two views
73221
Upper extremity joints MRI, without contrast material, per patient
73500
Hip radiology, unilateral, one view
73520
Hip radiology, bilateral, including pelvis
73525
Hip arthrography, including injection and interpretation
73542
SIJ arthrography, including injection and interpretation
73550
Femur radiology, up to two views
73560
Knee radiology, up to two views, per side
73562
Knee radiology, third or more additional views
73580
Knee arthrography, including injection and interpretation
73590
Tibia and fibula radiology, up to two views
73592
Lower extremity radiology, infant, up to two views
73610
Ankle radiology, complete, one side
73615
Ankle arthrography, including injection and interpretation
73620
Foot radiology, up to two views
73721
Lower extremity joints MRI, without contrast material, per patient
74000
Abdomen radiology, without contrast material
74181
Abdomen, MRI, per patient
74220
Esophagus radiology
609,00
74230
Swallowing function, with cineradiography/videoradiography
971,00
74241
UGI fluoroscopy and/or radiology, with/without delayed films
1 020,00
74245
UGI fluoroscopy, including serial films
1 260,00
74249
Abdomen radiology, small intestine follow-through
74270
Barium enema
725,00
74280
Air barium enema, with/without glucagon
1 164,00
74290
Cholecystography, oral contrast
606,00
74360
Esophageal dilation, using imaging guidance
8 102,00
74400
IVP, with or without tomography
899,00
74420
Urography, retrograde
737,00
74450
Urethrocystography, retrograde, radiological supervision and interpretation
572,00
74455
Urethrocystography, radiological supervision and interpretation
714,00
74740
Hysterosalpingography, radiology
743,00
75552
MRI cardiac morphology, per patient
8 204,00
75554
Cardiac FMRI; with/without morphology, complete study, per patient
75803
Lymphangiography, extremities
2 867,00
75822
Phlebography, venography, including injection and imaging
965,00
76000
Fluoroscopy
158,00
76120
Cineradiography/videoradiography, video capsule
7 287,00
76140
Interpretation/consultation on imaging made elsewhere
76390
MRS,Magnetic resonance spectroscopy, per patient
76512
Ophthalmic US (ultrasound)
76514
Ophthalmic US, corneal pachymetry, determination of corneal thickness, per patient
132,00
76536
Head and neck soft tissues US, with image documentation
480,00
76604
Chest US, including mediastinum, with image documentation
825,00
76645
Breasts and chest wall US, with image documentation
335,00
76700
Abdomen US, with image documentation
76805
Fetal anatomic US, with image documentation
1 235,00
76813
Fetal nuchal translucency US, per one fetus, with image documentation
506,00
76814
Fetal nuchal translucency US, per each additional fetus, with image documentation
