X120

PDF page 369 / D11

DIAGNOSTIC RADIOLOGY
 GASTROINTESTINAL TRACT
                                                                                                       H      P
     Palatopharyngeal analysis
   X105 - cine or videotape ................................................................          29.50   40.25
     Pharynx and oesophagus
   X106 - cine or videotape ................................................................          29.50   40.25
   X107 Oesophagus when X103, X104, X108 or X109 not claimed...                                       26.70   32.80
     Oesophagus, stomach and duodenum
   X108 - including survey film, if taken .............................................               46.30   41.65
   X104 - double contrast, including survey film, if taken...................                         48.50   50.65
   X103 - double contrast, including survey film, if taken, and small
          bowel ..................................................................................    60.95   63.75
   X110 Hypotonic duodenogram.........................................................                39.35   35.95
   X109 Oesophagus, stomach and small bowel .................................                         59.10   54.35
     Small bowel only
   X111 - when only examination performed during patient’s visit.....                                 26.40   23.80
     Colon
   X112 - barium enema including survey film, if taken .....................                          48.40   32.10
   X113 - air contrast, primary or secondary, including survey films, if
           taken...................................................................................   61.30   54.35
     Gallbladder
   X114 - one or multiple day examinations.......................................                     29.95   12.65
   X120 - one or multiple day examinations with preliminary plain film                                39.80   12.65
   X116 T-tube cholangiogram .............................................................            21.70   10.80
   X117 Operative cholangiogram........................................................               21.70   12.10
   X123 Operative pancreatogram or ERCP........................................                       21.70    9.80

Master, record 6568. Record Layout PDF, page 1.

X12020260401999999990000000000000000498000000000000000000000000000000126500

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.