X175

PDF page 373 / D15

DIAGNOSTIC RADIOLOGY
 SPECIAL EXAMINATIONS
                                                                                                H              P
     Abdominal, thoracic, cervical or cranial angiogram by catheterization
       Using single films
   X179 - non-selective ...................................................................... 29.60           15.85
   X180 - selective (per vessel, to a maximum of 4) ..........................                 38.95           31.35
       Using film changer, cine or multiformat camera
   X181 - non-selective ......................................................................        59.65    47.35
   X182 - selective (per vessel, to a maximum of 4) ..........................                        79.30    57.40
   X140 - selective (5 or more vessels)..............................................                317.35   185.60
     Carotid angiogram by direct puncture
   X160 - unilateral.............................................................................     48.90    34.00
   X161 - bilateral...............................................................................    78.60    69.65
     Peripheral angiogram
   X174 - unilateral.............................................................................     29.80    23.75
   X175 - bilateral...............................................................................    39.35    47.35
   X198 Splenoportogram ....................................................................          59.10    24.65
   X199 Translumbar aortogram ..........................................................              59.10    24.65
     Vertebral angiogram - direct puncture or retrograde brachial injection
   X132 - unilateral.............................................................................  48.90       34.00
   X133 - bilateral............................................................................... 79.90       51.05
   X156 Arthrogram, tenogram or bursogram ......................................                      26.25    30.00
   X200 - with fluoroscopy and complete positioning throughout by
           physician ............................................................................     36.70    69.80
     Bronchogram
   X158 - unilateral.............................................................................     28.95    25.10
   X159 - bilateral...............................................................................    38.40    34.60
   X162 Cerebral stereotaxis................................................................          59.20    25.20

Master, record 6623. Record Layout PDF, page 1.

X17520260401999999990000000000000000492500000000000000000047350000000473500

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