NUCLEAR MED
SERVICE CHARGE CODE	SERVICE DESCRIPTION	SERVICE CHARGE PRICE
4000000	INTRATHECAL LUMBAR PUNCT	59.44
4000001	NM-VENOGRAM, UNILATERAL	256.10
4000003	NM-ISOTOPE I, 6 MCI	188.85
4000004	NM-CARDIAC BLD POOL, 1ST, MULTI	335.33
4000005	NM-AUTOMATED DATA, >30 MIN	370.94
4000006	NM-GASTRIC MUCOSA IMAGING	282.53
4000007	NM-TESTICULAR, W/ BLD FLOW	479.17
4000008	NM-METS I-131, MULTIPLE	154.46
4000009	NM-TX THYROID, SUBSEQUENT	357.73
4000010	NM-MYOCARDIAL, PLANAR, EJECT	335.33
4000011	NM-MYOCARDIAL PERF, MULTI	269.30
4000012	NM-VENOGRAM, BILATERAL	256.10
4000013	NM-MYOCARD PERF, SPECT, MULTI	335.33
4000014	NM-VENOUS FIBRINOGEN	256.10
4000015	NM-MYOCARDIAL PERF, SINGLE	256.10
4000016	NM-WHOLE BODY BONE SCAN	335.33
4000017	NM-MYOCARD PERF, SPECT, SINGLE	335.33
4000018	NM-PULMO VENT, AERO, MULTI	221.65
4000019	NM-MYOCARDIAL, PLAN, SPECT	335.33
4000020	NM-LIVER IMAGING, STATIC	174.85
4000021	NM-THYROID STIMUL OR SUPPR	330.17
4000022	NM-TX THYROID, METS	370.94
4000023	NM-BRAIN IMG, COMP, STATIC	768.29
4000024	NM-TX THYROID, SUPPRESS	264.14
4000025	NM-BONE MARROW, LIMITED	167.67
4000026	NM-THERAPY THYROID CA	370.94
4000027	NM-VASCULAR FLOW STUDY	256.10
4000028	NM-LIVER & SPLEEN, STATICS	268.41
4000029	NM-URETERAL REFLUX STUDY	485.78
4000031	NM-MYOCARDIAL, PLAN, QUALI/T	282.51
4000032	NM-AUTOMATED DATA, <30 MIN	357.73
4000033	NM-CARDIAC BLD POOL, GATED, SINGLE	282.51
4000035	NM-CARDIAC BLD POOL, 1ST, SINGLE	335.33
4000036	NM-METS THYROID, LIMITED	240.14
4000037	NM-RENAL TRANSPLANT SCAN	498.98
4000038	NM-TUMOR LOCALIZATION	384.14
4000039	NM-THYROID IMG, W/ UPTAKE, SINGLE	268.41
4000040	NM-KIDNEY IMG, FLOW/FUNCTION	498.98
4000041	NM-BRAIN IMG, COMP, V-FLOW	768.29
4000042	NM-THREE-PHASE BONE SCAN	450.17
4000043	NM-MYOCARD PERF, WALL MOTION	256.10
4000044	NM-THYROID UPTAKE, MULTIPLE	330.17
4000045	NM-PULMO PERF, SINGLE BREATH	396.20
4000046	NM-LIVER IMAGING, V-FLOW	294.28
4000047	NM-MYOCARD PERF, EJECTION	335.33
4000048	NM-THYROID IMG, W/ UPTAKE, MULTI	282.53
4000049	NM-ISOTOPE I, EACH ADD MCI	13.21
4000050	NM-RADIOPHARM SIMPLE TC04	144.73
4000051	NM-RADIOPHARM COMPOUND	192.97
4000052	NM-DTPA AEROSOL EVAL	233.55
4000053	NM-PERFUSION VENT VQ SCAN	419.05
4000056	NM-GASTRIC EMPTYING	251.65
4001500	NM-RADIOACTIVE I UPTAKE	231.12
4005363	NM-HEPATOBILIARY SCAN	483.37
4005370	NM-THYROID SCAN	240.14
4005387	NM-BONE SCAN, MULTIPLE	646.42
4050050	NM-THYROID THERAPY	265.79
4050208	NM-I-131 WHOLE BODY SQ	1,126.54
4050210	NM-TESTICULAR	268.41
4050211	NM-SHUNT EVALUATION	265.86
4050212	NM-GASTRO-ESOPHAGEAL REFLUX	232.06
4050213	NM-ESOPHAGEAL TRANSIT	189.47
4050214	NM-GALIUM COMPLETE	1,067.21
4050215	NM-RENOGRAM	837.24
4050216	NM-CYSTOGRAM	237.45
4078607	NM-BRAIN IMAGING, SPECT	851.27
4082153	NM-LIVER/SPLEEN SCAN	434.17
4083003	NM-BONE SCAN, LIMITED	385.94
4084027	NM-CARD BLOOD POOL/FL	241.21
4085800	NM-PULM PERFUSION ST	530.66
4086055	NM-BRAIN SCAN, STATIC	482.42
4086063	NM-BRAIN SCAN, W/ VAS FLOW	726.37
4087012	NM-KIDNEY SCAN, W/ VAS FLOW	495.26
4087814	NM-GI BLEED SCAN/MECKLES	434.17
4090780	NM-ISOT PULMO PERF	241.21
4095001	NM-RADIOPHARM THALLIUM	368.84
4095002	NM-TC CARDIOLITE	470.77
4095003	NM-BONE SPECT IMAGE	180.66
4095006	NM-RADIOPHARM SPECIAL	466.77
4096002	NM-GALLIUM RADIOPHARMACEUTIC	118.68