94-26081. Medical Services Reimbursement Rates for Fiscal Year 1995  

  • [Federal Register Volume 59, Number 204 (Monday, October 24, 1994)]
    [Unknown Section]
    [Page 0]
    From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
    [FR Doc No: 94-26081]
    
    
    [[Page Unknown]]
    
    [Federal Register: October 24, 1994]
    
    
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    DEPARTMENT OF DEFENSE
    Office of the Secretary
    
     
    
    Medical Services Reimbursement Rates for Fiscal Year 1995
    
        Notice is hereby given that the Deputy Comptroller (Financial 
    Systems) in a memorandum dated September 2, 1994, established the 
    following reimbursement rates for inpatient and outpatient medical care 
    to be provided in FY 1995.
    
    Inpatient, Outpatient, and Other Rates and Charges
    
                                                I. Inpatient Rates\1\,\2\                                           
    ----------------------------------------------------------------------------------------------------------------
                                                                                              Interagency           
                                                                               International     other              
                                                                                  Military      federal             
                                Per inpatient day                              Education and     agency      Other  
                                                                                  Training     sponsored            
                                                                                  (IMET)       patients             
    ----------------------------------------------------------------------------------------------------------------
    A. Burn Center...........................................................       $2,053        $3,532      $3,781
    B. Surgical Care Services (Cosmetic Surgery).............................          473         1,057       1,122
    C. All Other Inpatient Services (Based on Diagnosis Related Groups (DRG)                                        
     Charges\3\..............................................................  .............  ...........  .........
    ----------------------------------------------------------------------------------------------------------------
    Explanations at end of docket.                                                                                  
    
    
                                  1. FY 1995 Direct Care Inpatient Reimbursement Rates                              
    ----------------------------------------------------------------------------------------------------------------
                                                                                   Interagency  Full cost    Third  
                         Adjusted Standard Amount                         IMET                               party  
    ----------------------------------------------------------------------------------------------------------------
    Large urban.......................................................     $1,670      $3,679      $3,908     $3,908
    Other urban.......................................................      1,954       3,997       4,267      4,267
    Rural.............................................................      2,085       4,744       5,066      5,066
    Overseas..........................................................      2,146       4,794       5,089      5,089
    ----------------------------------------------------------------------------------------------------------------
    
    2. Overview
    
        The FY 1995 inpatient rates are based on the cost per DRG which is 
    the inpatient full reimbursement rate per hospital discharge, weighted 
    to reflect the intensity of the principal diagnosis involved. The 
    average costs per Relative Weighted Product (RWP) for large urban, 
    other urban, rural, and overseas facilities will be published annually 
    as an inpatient standardized amount. (See item 1 above). A relative 
    weight for each DRG using the standardized amount will be the same as 
    the DRG weights published annually for hospital reimbursement rates 
    under the Civilian Health and Medical Program of the Uniformed Services 
    (CHAMPUS) pursuant to 32 CFR 199.14(a)(1) which includes adjustments 
    for outliers, area wages, and indirect medical education. An example of 
    how to apply DoD costs to a DRG standardized weight to arrive at DoD 
    costs is contained in part 3 of Section I.C., below.
    
    3. Example of Adjusted Standardized Amounts for Procedures Performed
    
    Large Urban Area--Example
        a. The cost to be recovered is DoD's cost for medical services 
    provided in a large urban area. Billings will be at the third party 
    rate.
        b. DRG: Nervous System infection except viral meningitis Relative 
    Weight of Procedure 1.8427
        c. The DoD adjusted standardized amount to be recovered is $3,908 
    (i.e., the third party rate as shown in the table).
        d. DoD cost to be recovered is the RWP factor (1.8427) in item 3b, 
    above, times the amount ($3,908) in 3c, above.
        Cost to be recovered is $7,201.
    
                                               II. Outpatient Rates\1\\2\                                           
    ----------------------------------------------------------------------------------------------------------------
                                                                            International   Interagency &           
                                                                              Military      other Federal           
         MEPRS code*                 Per Visit Clinical Service             Education And      agency-       Other  
                                                                              Training        sponsored             
                                                                               (IMET)         patients              
    ----------------------------------------------------------------------------------------------------------------
                                                    A. Medical Care                                                 
                                                                                                                    
    ----------------------------------------------------------------------------------------------------------------
    BAA.................  Internal medicine..............................             $72            $144       $153
    BAC.................  Cardiology.....................................              57             114        121
    BAF.................  Endocrinology..................................              64             129        138
    BAG.................  Gastroenterology...............................              68             137        145
    BAH.................  Hematology.....................................              99             199        210
    BAJ.................  Nephrology.....................................              67             135        143
    BAK.................  Neurology......................................              59             118        126
    BAM.................  Oncology.......................................              54             108        116
    BAN.................  Pulmonary disease..............................              59             118        125
    BAO.................  Rheumatology...................................              61             123        130
    BAP.................  Dermatology....................................              42              85         91
    BAQ.................  Infectious disease.............................              46              92         98
    BAR.................  Physical medicine..............................              56             113        120
    BAB.................  Allergy........................................              22              44         49
    BAE.................  Diabetes.......................................              25              50         54
    BAI.................  Hypertension...................................              26              52         56
    BAL.................  Nutrition......................................              16              33         35
                                                                                                                    
    ----------------------------------------------------------------------------------------------------------------
                                                    B. Surgical Care                                                
                                                                                                                    
    ----------------------------------------------------------------------------------------------------------------
    BBA.................  General surgery................................              67             135        141
    BBB.................  Cardiovascular/Thoracic surgery................              81             162        169
    BBC.................  Neurosurgery...................................              93             187        195
    BBD.................  Ophthalmology..................................              53             107        112
    BBE.................  Organ transplant...............................             128             257        268
    BBF.................  Otolaryngoloy..................................              60             121        126
    BBG.................  Plastic surgery................................              77             154        160
    BBH.................  Proctology.....................................              54             108        114
    BBI.................  Urology........................................              75             150        158
    BBJ.................  Pediatric surgery..............................              30              60         64
    ----------------------------------------------------------------------------------------------------------------
                                                                                                                    
                                       C. Obstetrical and Gynecological (OB-GYN)                                    
                                                                                                                    
    ----------------------------------------------------------------------------------------------------------------
    BCA.................  Family planning................................              49              99        105
    BCB.................  Gynecology.....................................              50             100        106
    BCC.................  Obstetrics.....................................              46              93         99
    ----------------------------------------------------------------------------------------------------------------
                                                                                                                    
                                                    D. Pediatric Care                                               
                                                                                                                    
    ----------------------------------------------------------------------------------------------------------------
    BDA.................  Pediatric......................................              40              80         86
    BDB.................  Adolescent.....................................              39              78         83
    BDC.................  Well baby......................................              25              50         55
    ----------------------------------------------------------------------------------------------------------------
                                                                                                                    
                                                   E. Orthopaedic Care                                              
                                                                                                                    
    ----------------------------------------------------------------------------------------------------------------
    BEA.................  Orthopaedic....................................              67             134        140
    BEC.................  Hand surgery...................................              37              74         78
    BED/BLC.............  Neuromuscularskeletal..........................              26              52         55
    BEE.................  Orthopaedic appliance..........................              44              88         93
    BEF.................  Podiatry.......................................              36              72         77
    ----------------------------------------------------------------------------------------------------------------
                                                                                                                    
                                        F. Psychiatric and/or Mental Health Care                                    
                                                                                                                    
    ----------------------------------------------------------------------------------------------------------------
    BFB.................  Psychology.....................................              49              99        104
    BFC.................  Child guidance.................................              39              79         84
    BFA/BFD.............  Mental health..................................              54             108        114
    BFE.................  Social work....................................              40              81         86
    BFF.................  Substance abuse rehabilitation.................              41              82         87
    ----------------------------------------------------------------------------------------------------------------
                                                                                                                    
                                                 G. Primary Medical Care                                            
                                                                                                                    
    ----------------------------------------------------------------------------------------------------------------
    BGA/BHA.............  Family practice/primary........................              45              90         96
    BHB.................  Medical examination............................              43              86         91
    BHC.................  Optometry......................................              30              60         64
    BHD.................  Audiology clinic...............................              25              50         54
    BHE.................  Speech pathology...............................              39              78         82
    BHF.................  Community health...............................              35              70         75
    BHG.................  Occupational health............................              36              72         76
    BHI.................  Immediate care clinic..........................              59             119        125
    ----------------------------------------------------------------------------------------------------------------
                                                                                                                    
                                                H. Emergency Medical Care                                           
                                                                                                                    
    ----------------------------------------------------------------------------------------------------------------
    BIA.................  Emergency care clinic..........................              72             144        151
    ----------------------------------------------------------------------------------------------------------------
                                                                                                                    
                                                I. Flight Medicine Clinic                                           
                                                                                                                    
    ----------------------------------------------------------------------------------------------------------------
    BJA.................  Flight medicine................................              63             126        132
    ----------------------------------------------------------------------------------------------------------------
                                                                                                                    
                                               J. Underseas Medicine Care                                           
                                                                                                                    
    ----------------------------------------------------------------------------------------------------------------
    BKA.................  Underseas medicine clinic......................              42              85         90
    ----------------------------------------------------------------------------------------------------------------
                                                                                                                    
                                               K. Rehabilitative Services                                           
                                                                                                                    
    ----------------------------------------------------------------------------------------------------------------
    DHB.................  Occupational therapy...........................              24              48         51
    DHD.................  Physical therapy...............................              17              35         38
    ----------------------------------------------------------------------------------------------------------------
                                                                                                                    
                                                   L. Same Day Surgery                                              
                                                                                                                    
    ----------------------------------------------------------------------------------------------------------------
                          Same day surgery...............................             169             340        361
    ----------------------------------------------------------------------------------------------------------------
    *The Medical Expense and Performance Reporting System (MEPRS) code is a three digit code which defines the      
      summary account and the subaccount within a functional category in the DoD medical system. An example of this 
      hierarchal arrangement is as follows:                                                                         
    
    
                                                                            
            Outpatient Care (Functional Category)               MEPRScode   
                                                                            
    Medical Care (Summary Account)........................  BA              
    Internal Medicine (Subaccount)........................  BAA             
                                                                            
    MEPRS codes are used to ensure that consistent financial and operating  
      performance data is reported in the DoD military medical system.      
    Explanations at end of docket.                                          
    
    
                                              III. Other Rates and Charges                                          
    ----------------------------------------------------------------------------------------------------------------
                                                                       International   Interagency,                 
                                                                         Military      other federal                
                                                                       Education and      agency           Other    
                                                                         Training        sponsored                  
                                                                          (IMET)         patients                   
    ----------------------------------------------------------------------------------------------------------------
    A. Immunizations................................................              $9             $18             $19
    B. Hyperbaric services:                                                                                         
        1-60 minutes................................................              81             163             169
        61-120 minutes..............................................             162             325             338
        121-180 minutes.............................................             243             488             506
        181-240 minutes.............................................             324             650             675
    C. Family member rate (Formerly military dependents rate).......  ..............            9.50  ..............
    ----------------------------------------------------------------------------------------------------------------
    (Note: Charges may be prorated based on usage)                                                                  
    
    D. Third Party Drug Reimbursement Rates\4\
    
        Upon request, a complete list of the FY 1995 third party drug 
    reimbursement rates may be obtained in electronic format. All requests 
    for this information should be addressed to: Third Party Collection 
    Program Officer, OASD(HA)/HSO&R/OMS, The Pentagon, Rm 3E343, 
    Washington, DC 20301-1200.
        The following is a listing of the dosage form description used in 
    connection with pharmaceuticals being dispensed. See note 4 to 
    reimbursable rates for cost of dispensing drugs.
    
    ----------------------------------------------------------------------------------------------------------------
         Dosage form                  Description                                  Interpretation                   
    ----------------------------------------------------------------------------------------------------------------
    AA..................  Aerosol............................  Aerosol (ML).                                        
    AB..................  Aerosol............................  Aerosol (GM).                                        
    AC..................  Aerosol............................  Aerosol (EA).                                        
    AD..................  Aer Refill.........................  Aerosol Refill (ML).                                 
    AE..................  Aer Refill.........................  Aerosol Refill (EA).                                 
    AF..................  Foam...............................  Aerosol Foam.                                        
    AG..................  Aer Refill.........................  Aerosol Refill (GM).                                 
    AH..................  Aer Adap...........................  Aerosol w/Adapter (ML).                              
    AI..................  Aer W/Adap.........................  Aerosol w/Adapter (EA).                              
    AJ..................  Aer Adap...........................  Aerosol wo/Adapter (GM).                             
    AK..................  AR Powder..........................  Aerosol Powder (EA).                                 
    AL..................  Ampul-Neb..........................  Ampul for Nebulization (ML).                         
    AM..................  Mist...............................  Aerosol, Mist.                                       
    AN..................  Vial-Neb...........................  Vial Nebulizer.                                      
    AP..................  Aero Powd..........................  Aerosol Powder (GM).                                 
    AQ..................  Spray..............................  Spray (GM).                                          
    AR..................  Spray Rfi..........................  Spray Refill (ML).                                   
    AS..................  Spray..............................  Aerosol, Spray (ML).                                 
    AT..................  Spray/Pump.........................  Aerosol, Spray w/Pump (ML).                          
    AW..................  Foam/appl..........................  Aerosol, Foam with applicator.                       
    CA..................  Capsule............................  Capsule (hard, soft, etc.)                           
    CE..................  Capsule EC.........................  Capsule, Enteric Coated.                             
    CK..................  Sprinkle...........................  Sprinkle Capsule.                                    
    CP..................  Cap Pellet.........................  Pellets in Capsule.                                  
    CS..................  Capsule SA.........................  Capsule, Sustained Action.                           
    CT..................  Capsule SA.........................  Capsule, Degradable Controlled-Release.              
    EA..................  Each...............................  Each.                                                
    EB..................  Bar................................  Bar.                                                 
    EC..................  Cake...............................  Cake.                                                
    ED..................  Med. Soap..........................  Soap, Medicated (EA).                                
    EE..................  Liq Soap...........................  Soap, Liquid.                                        
    EF..................  Dental Cone........................  Dental Cone.                                         
    EG..................  Med. Dress.........................  Dressing, Medicated (EA).                            
    EH..................  Stick..............................  Stick.                                               
    EJ..................  Plaster............................  Plaster.                                             
    EK..................  Poultice...........................  Poultice.                                            
    EL..................  Med. Swab..........................  Swab, Medicated.                                     
    EM..................  Med. Gauze.........................  Guaze, Medicated.                                    
    EN..................  Med. Tape..........................  Tape, Medicated.                                     
    EP..................  Med. Soap..........................  Soap, Medicated (ML).                                
    ER..................  Med. Soap..........................  Soap, Medicated (GM).                                
    ES..................  Med. Dress.........................  Dressing, Medicated (GM).                            
    ET..................  Med. Pad...........................  Pads, Medicated (EA).                                
    GA..................  Gas................................  Gas.                                                 
    GH..................  Inhaler............................  Inhaler (ML).                                        
    GI..................  Inhaler............................  Inhaler (EA).                                        
    GJ..................  Inhaler kit........................  Inhaler Kit (EA).                                    
    GZ..................  Inhaler............................  Inhaler (GM).                                        
    HA..................  Infus. Btl.........................  Infusion Bottle (EA).                                
    HB..................  Infus. Btl.........................  Infusion Bottle (ML).                                
    HC..................  Pipette............................  Pipette (EA).                                        
    HD..................  Pipette............................  Pipette (ML).                                        
    HE..................  Allergen...........................  Allergen.                                            
    HH..................  Ampul..............................  Ampul (ML).                                          
    HI..................  Cartridge..........................  Cartridge (EA).                                      
    HJ..................  Cartridge..........................  Cartridge (ML).                                      
    HM..................  IV Soln............................  Intravenous Solution                                 
    HN..................  Piggyback..........................  Intravenous Solution, Piggyback (EA).                
    HP..................  Piggyback..........................  Intravenous Solution, Piggyback (ML).                
    HQ..................  Disp Syrin.........................  Disposable Syringe (ML).                             
    HR..................  Ampul..............................  Ampul (EA).                                          
    HS..................  Vial...............................  Vial (SDV, MDV or Additive) (EA).                    
    HT..................  Skin Test..........................  Skin Test.                                           
    HU..................  Plast. Bag.........................  Plastic Bag, Injection (EA).                         
    HV..................  Vial...............................  Vial (SDV, MDV or Additive) (ML).                    
    HW..................  Add. Syrin.........................  Additive Syringe.                                    
    HX..................  Disp Syrin.........................  Disposable Syringe (EA).                             
    HY..................  IP Soln............................  Intraperitoneal Solution.                            
    HZ..................  Plast. Bag.........................  Plastic Bag, Injection (ML).                         
    JA..................  Jelly..............................  Jelly.                                               
    JB..................  Jel................................  Jel (ML).                                            
    JC..................  Gel................................  Gel (ML).                                            
    JD..................  Jel................................  Jel (GM).                                            
    JE..................  Beads..............................  Beads.                                               
    JG..................  Gel................................  Gel (ML).                                            
    JH..................  Pudding............................  Pudding (EA).                                        
    JJ..................  Pudding............................  Pudding (GM).                                        
    JV..................  Gel/Appl...........................  Gel with Applicator.                                 
    JW..................  Jelly/Appl.........................  Jelly with Applicator.                               
    KA..................  Cream..............................  Cream.                                               
    KL..................  Lubricant..........................  Lubricant.                                           
    KP..................  Paste..............................  Paste.                                               
    KT..................  Toothpaste.........................  Toothpaste.                                          
    KW..................  Cream/Appl.........................  Cream with Applicator.                               
    OA..................  Ointment...........................  Ointment.                                            
    OW..................  Oint/Appl..........................  Ointment with Applicator.                            
    PA..................  Powder.............................  Powder (GM).                                         
    PB..................  Leaves.............................  Leaves (GM).                                         
    PC..................  Crystals...........................  Crystals.                                            
    PE..................  Powder Effer.......................  Powder Effervescent.                                 
    PF..................  Flakes.............................  Flakes.                                              
    PG..................  Granules...........................  Granules, Powder-like, Non-effervescent.             
    PL..................  Cleanser...........................  Cleanser.                                            
    PM..................  Lump...............................  Lump.                                                
    PP..................  Packet.............................  Packet.                                              
    PS..................  Adh. Patch.........................  Adhesive Patch, Medicated.                           
    PT..................  Tooth Powd.........................  Tooth Powder.                                        
    PU..................  Powder.............................  Powder (EA).                                         
    QA..................  Suppos.............................  Suppository.                                         
    QB..................  Insert.............................  Insert.                                              
    SA..................  Solution...........................  Solution, Topical EENT                               
    SB..................  FI Extract.........................  Fluid Extract                                        
    SC..................  Oral Susp..........................  Suspension, Oral (final dose form) (ML).             
    SD..................  Douche.............................  Douche.                                              
    SE..................  Elixir.............................  Elixir                                               
    SF..................  Enema..............................  Enema (ML).                                          
    SG..................  Enema..............................  Enema (EA).                                          
    SH..................  Expect.............................  Expectorant.                                         
    SI..................  Liniment...........................  Liniment.                                            
    SJ..................  Solution...........................  Solution, Oral.                                      
    SK..................  Lotion.............................  Lotion (ML).                                         
    SL..................  Liquid.............................  Liquid.                                              
    SM..................  Mouthwash..........................  Mouthwash.                                           
    SN..................  Powder.............................  Powder (ML).                                         
    SO..................  Drops..............................  Drops.                                               
    SP..................  Spirit.............................  Spirit.                                              
    SQ..................  Oil................................  Oil.                                                 
    SR..................  Suspension.........................  Suspension, Topical.                                 
    SS..................  Shampoo............................  Shampoo.                                             
    ST..................  Syrup..............................   Syrup.                                              
    SU..................  Emulsion...........................  Emulsion.                                            
    SV..................  Gran Eff...........................  Grnules, Effervescent.                               
    SW..................  Irrig Soln.........................  Solution, Irrigating.                                
    SX..................  Tincture...........................  Tincture.                                            
    SY..................  Oral Conc..........................  Concentrate, Oral.                                   
    SZ..................  Lotion.............................  Lotion (GM).                                         
    TA..................  Tablet.............................  Tablet (compressed, sugar coated caplets)            
    TB..................  Tablet Sol.........................  Tablet, Soluble                                      
    TC..................  Tab Chew...........................  Tablet, Chewable.                                    
    TD..................  Disk...............................  Disk.                                                
    TE..................  Tablet EC..........................  Tablet, Enteric Coated.                              
    TF..................  Tablet, Eff........................  Tablet, Effervescent.                                
    TG..................  Gum................................  Gum.                                                 
    TH..................  Tablet Hyp.........................  Tablet, Hypodermic.                                  
    TL..................  Lozenge............................  Lozenge.                                             
    TN..................  Granules...........................  Granules, Oral Tablet-like or Packets.               
    TP..................  Pellet.............................  Pellet.                                              
    TR..................  Tab Part...........................  Particles in tablet, pH dependent.                   
    TS..................  Tablet SA..........................  Tablet, Sustained Action.                            
    TT..................  Troche.............................  Troche.                                              
    TU..................  Tab Subl...........................  Tablet, Sublingual.                                  
    TV..................  Tab Buccal.........................  Tablet, Buccal.                                      
    TW..................  Wafer..............................  Wafer.                                               
    TX..................  Pill...............................  Pill.                                                
    TY..................  Tab Buc SA.........................  Tablet, Buccal Sustained Action.                     
    UN..................  Unit...............................  Unit.                                                
    WH..................  Whip...............................  Whip.                                                
    YA..................  Needle.............................  Needle, Reusable.                                    
    YB..................  Bulk...............................  Bulk.                                                
    YC..................  Syringe............................  Syringe, Reusable.                                   
    YD..................  Diaphragm..........................  Diaphragm.                                           
    YE..................  Dressing...........................  Dressing.                                            
    YF..................  Lense..............................  Lense.                                               
    YG..................  Gauze..............................  Gauze, Non-Medicated.                                
    YH..................  Dis Needle.........................  Needle, Disposable.                                  
    YI..................  IUD................................  Intrauterine Device.                                 
    YJ..................  Crwl Syrin.........................  Syringe, Cornwall.                                   
    YK..................  Kit................................  Kit.                                                 
    YL..................  Disp Syrin.........................  Syring, Empty Disposable.                            
    YM..................  Pad................................  Pad.                                                 
    YN..................  Tampon.............................  Tampon.                                              
    YP..................  IP Set.............................  Intraperitoneal Admin. Sets--Paraphernalia.          
    YQ..................  IV Set.............................  Intravenous Admin. Sets--Paraphernalia.              
    YR..................  Strip..............................  Strip.                                               
    YS..................  Suture.............................  Suture.                                              
    YT..................  Tape...............................  Tape.                                                
    YU..................  Irrig Set..........................  Irrigation Set.                                      
    YV..................  Sponge.............................  Sponge.                                              
    YW..................  Swab...............................  Swab, non-Medicated.                                 
    YX..................  IV Access..........................  Intravenous Admixture Accessories.                   
    YZ..................  Blood Set..........................  Blood Administration Set.                            
    ZA..................  Miscell............................  Miscellaneous.                                       
    ZB..................  Box................................  Box.                                                 
    ZC..................  Bottle.............................  Bottle.                                              
    ZD..................  Combo. Pkg.........................  Combination Package.                                 
    ZE..................  Carton.............................  Carton.                                              
    ZP..................  Package............................  Package.                                             
    ZT..................  Tray...............................  Tray.                                                
    ----------------------------------------------------------------------------------------------------------------
    Explanations at end of docket.                                                                                  
    
    E. High Cost Services Requested By External Providers\5\
    
                                                                                                                    
    ----------------------------------------------------------------------------------------------------------------
                                                                  International      Interagency                    
       Resource based                                               military        other Federal                   
    relative value scale            Service provided              education and   agency sponsored        Other     
                                                                 training (IMET)      patients                      
    ----------------------------------------------------------------------------------------------------------------
    0040................  Chest, PA/Lat/Bilat Decub...........               $34               $68               $72
    0063................  Chest, Portable.....................                35                70                74
    0783................  Bilat Ankles & Stress Views.........                41                82                87
    1090................  Bilat Hips & Dan Miller.............                43                85                90
    1250................  Skeletal Survey.....................               120               240               254
    1251................  Skeletal Survey (Exam)..............                73               146               155
    1252................  Skeletal Survey (Read)..............                47                94               100
    1253................  Arthritic Survey....................                87               173               184
    1254................  Arthritic Survey (Exam).............                55               110               117
    1255................  Arthritic Survey (Read).............                32                64                67
    1256................  Metastatic Bone Survey..............               120               240               254
    1257................  Metastatic Bone Survey (Exam).......                73               146               155
    1258................  Metastatic Bone Survey (Read).......                47                94               100
    3000................  Upper GI Series.....................                34                68                72
    3003................  UGI, Air Contrast...................                36                72                77
    3046................  UGI, Other..........................                34                68                72
    3050................  Barium Enema........................                37                74                78
    3053................  BE, Air Contrast....................                50               100               106
    3056................  BE, Thru Colostomy..................                50               100               106
    3096................  BE, Other...........................                37                74                78
    3109................  Enteroclysis........................                53               106               113
    3110................  Enteroclysis (Exam).................                32                64                67
    3133................  Cholangiogram, Operative............                51               102               108
    3134................  Cholangiogram, Operative (Exam).....                38                76                80
    3136................  Cholangiogram, Transhepatic.........               100               200               213
    3137................  Cholangiogram, Transhepatic (E).....                38                76                80
    3138................  Cholangiogram, Transhepatic (R).....                63               125               132
    3140................  Cholangiogram, Percutaneous.........               100               200               213
    3141................  Cholangiogram, Percutaneous (E).....                38                76                80
    3142................  Cholangiogram, Percutaneous (R).....                63               125               132
    3143................  Percutaneous Biliary Drain..........               128               255               271
    3144................  Percutaneous Biliary Drain (E)......                32                64                67
    3145................  Percutaneous Biliary Drain (R)......                96               192               204
    3160................  ERCP................................               128               255               270
    3161................  ERCP (Exam).........................                32                64                67
    3162................  ERCP (Read).........................                96               191               203
    3173................  Bronchoscopy, Unilateral............                55               109               116
    3175................  Bronchoscopy, Unilateral, (Read)....                37                74                79
    3176................  Bronchoscopy, Bilateral.............                67               134               142
    3178................  Bronchoscopy, Bilateral, (Read).....                40                80                86
    3180................  Hysterosalpingogram.................                40                80                85
    3183................  Fallopian Tube Dilatation...........               208               416               442
    3184................  Fallopian Tube Dilatation (E).......               104               208               221
    3185................  Fallopian Tube Dilatation (R).......               104               208               221
    3200................  Lymphangio, Bilat Extrem............               236               471               501
    3201................  Lymphangio, Bilat Extrem (Exam).....               125               250               265
    3202................  Lymphangio, Bilat Extrem (Read).....               111               222               236
    3203................  Lymphangio, Extremity...............               132               263               279
    3204................  Lymphangio, Extremity (Exam)........                63               125               132
    3205................  Lymphangio, Extremity (Read)........                69               138               147
    3210................  Lymphangio, Pelvic, Unilat..........               132               263               279
    3211................  Lymphangio, Pelvic, Unilat (Exam)...                63               125               132
    3212................  Lymphangio, Pelvic, Unilat (Read)...                69               138               147
    3213................  Lymphangio, Pelvic, Bilat...........               236               471               500
    3214................  Lymphangio, Pelvic, Bilat (Exam)....               125               250               265
    3215................  Lymphangio, Pelvic, Bilat (Read)....               111               221               235
    3216................  Lymphangio, Abd, Unilat.............               132               263               279
    3217................  Lymphangio, Abd, Unilat (Exam)......                63               125               132
    3218................  Lymphangio, Abd, Unilat (Read)......                69               138               147
    3220................  Lymphangio, Abd, Bilat..............               236               471               500
    3221................  Lymphangio, Abd, Bilat (Exam).......               125               250               265
    3222................  Lymphangio, Abd, Bilat (Read).......               111               221               235
    3230................  Venogram, Bilat Extremity...........               133               265               281
    3231................  Venogram, Bilat Extremity (Exam)....                92               183               194
    3232................  Venogram, Bilat Extremity (Read)....                41                82                87
    3233................  Venogram, Lt Extremity..............                74               148               157
    3234................  Venogram, Lt Extremity (Exam).......                46                92                97
    3240................  Venogram, Inf Cav W/Serial..........               116               231               246
    3241................  Venogram, Inf Cav W/Serial (E)......                46                92                97
    3242................  Venogram, Inf Cav W/Serial (R)......                70               140               148
    3243................  Venogram, Sup Cav W/Serial..........               116               231               246
    3244................  Venogram, Sup Cav W/Serial (E)......                46                92                97
    3245................  Venogram, Sup Cav W/Serial (R)......                70               140               148
    3246................  Venogram, Bilat Renal...............               191               381               405
    3247................  Venogram, Bilat Renal (Exam)........                92               183               194
    3248................  Venogram, Bilat Renal (Read)........                99               198               210
    3250................  Venogram, Lt Renal..................               126               252               268
    3251................  Venogram, Lt Renal ((Exam)..........                46                92                97
    3252................  Venogram, Lt Renal (Read)...........                80               160               170
    3253................  Venogram, Rt Renal..................               126               252               268
    3254................  Venogram, Rt Renal (Exam)...........                46                92                97
    3255................  Venogram, Rt Renal (Read)...........                80               160               170
    3256................  Venogram, Bilat Adrenal.............               191               381               405
    3257................  Venogram, Bilat Adrenal (Exam)......                92               183               194
    3258................  Venogram, Bilat Adrenal (Read)......                99               198               210
    3260................  Venogram, Lt Adrenal................               126               252               268
    3261................  Venogram, Lt Adrenal (Exam).........                46                92                97
    3262................  Venogram, Lt Adrenal (Read).........                80               160               170
    3263................  Venogram, Rt Adrenal................               126               252               268
    3264................  Venogram, Rt Adrenal (Exam).........                46                92                97
    3265................  Venogram, Rt Adrenal (Read).........                80               160               170
    3266................  Venogram, Azygos (Select)...........               126               252               268
    3267................  Venogram, Azygos (Select) (Exam)....                46                92                97
    3268................  Venogram, Azygos (Select) (Read)....                80               160               170
    3270................  Venogram, Azygos (Nonselect)........               116               231               245
    3271................  Venogram, Azygos (Nonselect) (E)....                46                92                97
    3272................  Venogram, Azygos (Nonselect) (R)....                70               139               148
    3273................  Venogram, Intraosseous..............                91               182               193
    3274................  Venogram, Intraosseous (Exam).......                46                92                97
    3275................  Venogram, Intraosseous (Read).......                45                90                95
    3276................  Venogram, Sinus.....................               126               252               268
    3277................  Venogram, Sinus (Exam)..............                46                92                97
    3278................  Venogram, Sinus (Read)..............                80               160               170
    3280................  Venogram, Jugular...................               126               252               268
    3281................  Venogram, Jugular (Exam)............                46                92                97
    3282................  Venogram, Jugular (Read)............                80               160               170
    3283................  Venogram, Sup Sag Sinus.............               101               202               215
    3284................  Venogram, Sup Sag Sinus (Exam)......                46                92                97
    3285................  Venogram, Sup Sag Sinus (Read)......                55               110               117
    3286................  Venogram, Epidural..................               126               252               268
    3287................  Venogram, Epidural (Exam)...........                46                92                97
    3288................  Venogram, Epidural (Read)...........                80               160               170
    3290................  Venogram, Orbital...................                74               148               157
    3291................  Venogram, Orbital (Exam)............                46                92                97
    3300................  Perc Transhep Porto W/Hemo..........               219               437               464
    3301................  Perc Transhep Porto W/Hemo (E)......               104               208               221
    3302................  Perc Transhep Porto W/Hemo (R)......               115               229               243
    3303................  Perc Transhep Porto W/O Hemo........               220               439               465
    3304................  Perc Transhep Porto W/O Hemo (E)....               104               208               221
    3305................  Perc Transhep Porto W/O Hemo (R)....               115               229               243
    3310................  Hepat Veno, Wed/Free W/Hemo.........               185               369               391
    3311................  Hepat Veno, Wed/Free W/Hemo (E).....               104               208               221
    3312................  Hepat Veno, Wed/Free W/Hemo (R).....                80               160               170
    3313................  Hepat Veno, Wed/Free W/O Hemo.......               185               369               391
    3314................  Hepat Veno, Wed/Free W/O Hemo (E)...               104               208               221
    3315................  Hepat Veno, Wed/Free W/O Hemo (R)...                80               160               170
    3320................  Venous Sampling Thru Cath...........                59               118               125
    3321................  Venous Sampling Thru Cath (E).......                46                92                97
    3330................  Transcath TX, Embol W/Angio.........               273               545               579
    3331................  Transcath TX, Embol W/Angio (E).....               104               208               221
    3332................  Transcath TX, Embol W/Angio (R).....               169               337               358
    3333................  Transcath TX, Infus W/Angio.........               273               545               579
    3334................  Transcath TX, Infus W/Angio (E).....               104               208               221
    3335................  Transcath TX, Infus W/Angio (R).....               169               337               358
    3340................  Percu Place IVC Filter..............               268               535               567
    3341................  Percu Place IVC Filter (Exam).......                83               166               177
    3342................  Percu Place IVC Filter (Read).......               184               368               390
    3350................  Transcath Intrav Occ, Temp..........               273               545               579
    3351................  Transcath Intrav Occ, Temp (E)......               104               208               221
    3352................  Transcath Intrav Occ, Temp (R)......               169               337               358
    3353................  Transcath Intrav Occ, Perm..........               273               545               579
    3354................  Transcath Intrav Occ, Perm (E)......               104               208               221
    3355................  Transcath Intrav Occ, Perm (R)......               169               337               358
    3356................  Transcath Retriev, Perc, FX V/A.....               203               406               431
    3357................  Transcath Retriev, Perc, FX V/AE....               104               208               221
    3358................  Transcath Retriev, Perc, FX V/AR....                99               198               210
    3360................  Percu Transl Angio, Perip, Art......               273               545               579
    3361................  Percu Transl Angio, Perip, Art (E)..               104               208               221
    3362................  Percu Transl Angio, Perip, Art (R)..               169               337               358
    3363................  Percu Transl Angio, q Ad Per........               220               439               465
    3364................  Percu Transl Angio, q Ad Per (E)....               104               208               221
    3365................  Percu Transl Angio, q Ad Per (R)....               116               231               245
    3366................  Percu Transl Angio, Vicer A.........               308               614               652
    3367................  Percu Transl Angio, Vicer A (E).....               104               208               221
    3368................  Percu Transl Angio, Vicer A (R).....               203               406               431
    3370................  Transcath BX........................               173               345               367
    3371................  Transcath BX (Exam).................               104               208               221
    3372................  Transcath BX (Read).................                69               138               146
    3380................  Perc Transhep Bil Drain W/Con.......               219               437               464
    3381................  Perc Transhep Bil Drain W/Cone......               104               208               221
    3382................  Perc Transhep Bil Drain W/Conr......               115               229               243
    3383................  Per Pl Cath For Inop Bil Obs........               247               493               524
    3384................  Per Pl Cath For Inop Bil Obse.......               104               208               221
    3385................  Per Pl Cath For Inop Bil Obsr.......               143               285               303
    3400................  Aortogram, Thoracic (Wo/Ser)........               183               365               388
    3401................  Aortogram, Thoracic (Wo/Ser) (E)....               104               208               221
    3402................  Aortogram, Thoracic (Wo/Ser) (R)....                79               157               167
    3403................  Aortogram, Thoracic (W/Ser).........               198               396               420
    3404................  Aortogram, Thoracic (W/Ser) (E).....               104               208               221
    3405................  Aortogram, Thoracic (W/Ser) (R).....                94               188               200
    3406................  Aortogram, Translum (W/Ser).........               183               365               388
    3407................  Aortogram, Translum (Wo/Ser) (E)....               104               208               221
    3408................  Aortogram, Translum (Wo/Ser) (R)....                79               157               167
    3410................  Aortogram, Translum (W/Ser).........               198               396               420
    3411................  Aortogram, Translum (W/Ser) (E).....               104               208               221
    3412................  Aortogram, Translum (W/Ser) (R).....                94               188               200
    3413................  Aortogram, Abd Cath (Wo/Ser)........               183               365               388
    3414................  Aortogram, Abd Cath (Wo/Ser) (E)....               104               208               221
    3415................  Aortogram, Abd Cath (Wo/Ser) (R)....                79               157               167
    3416................  Aortogram, Abd Cath (W/Ser).........               198               396               420
    3417................  Aortogram, Abd Cath (W/Ser) (E).....               109               216               231
    3418................  Aortogram, Abd Cath (W/Ser) (R).....                99               196               210
    3420................  Aortogr, Abd & Bil Ilfem, Cath......               207               411               435
    3421................  Aortogr, Abd & Bil Ilfem, Cath (E)..               109               216               231
    3422................  Aortogr, Abd & Bil Ilfem, Cath (R)..               103               204               218
    3430................  Angiogram...........................               213               423               448
    3431................  Angiogram (Exam)....................               109               216               231
    3432................  Angiogram (Read)....................               109               216               231
    3433................  Angiogram, Cerebral.................               228               452               478
    3434................  Angiogram, Cerebral (Exam)..........               109               216               231
    3435................  Angiogram, Cerebral (Read)..........               124               246               261
    3436................  Angiogram, Angioplasty (Art)........               213               423               448
    3437................  Angiogram, Angioplasty (Art)(Ex)....               109               216               231
    3438................  Angiogram, Angioplasty (Art)(Re)....               109               216               231
    3440................  Angiogram, Angioplasty (Ven)........               213               423               448
    3441................  Angiogram, Angioplasty (Ven)(Ex)....               109               216               231
    3442................  Angiogram, Angioplasty (Ven)(Re)....               109               216               231
    3443................  Angiogram, Pulmonary................               232               460               487
    3444................  Angiogram, Pulmonary (Exam).........               109               216               231
    3445................  Angiogram, Pulmonary (Read).........               128               254               270
    3446................  Angiogram, Venous Phase.............               155               309               328
    3447................  Angiogram, Venous Phase (Exam)......               104               208               221
    3448................  Angiogram, Venous Phase (Read)......                50               100               107
    3450................  Angiogram, Vena Cava................               219               437               464
    3451................  Angiogram, Vena Cava (Exam).........               104               208               221
    3452................  Angiogram, Vena Cava (Read).........               115               229               243
    3453................  Angiogram, Portal Vein..............               240               479               508
    3454................  Angiogram, Portal Vein (Exam).......               104               208               221
    3455................  Angiogram, Portal Vein (Read).......               136               271               287
    3456................  Angiogram, Renal Vein...............               240               479               508
    3457................  Angiogram, Renal Vein (Exam)........               104               208               221
    3458................  Angiogram, Renal Vein (Read)........               136               271               287
    3460................  Angiogram, Renal Vein Renins........               208               416               442
    3461................  Angiogram, Renal Vein Renins (E)....               104               208               221
    3462................  Angiogram, Renal Vein Renins (R)....               104               208               221
    3463................  Angiogram, Subclavian Vein..........               208               416               442
    3464................  Angiogram, Subclavian Vein (Ex).....               104               208               221
    3465................  Angiogram, Subclavian Vein (Re).....               104               208               221
    3466................  Angiogram, Testicular...............               208               416               442
    3467................  Angiogram, Testicular (Exam)........               104               208               221
    3468................  Angiogram, Testicular (Read)........               104               208               221
    3470................  Angiogram, Embolization.............               208               416               442
    3471................  Angiogram, Embolization (Exam)......               104               208               221
    3472................  Angiogram, Embolization (Read)......               104               208               221
    3473................  Angiogram, Cerebral.................               223               445               473
    3474................  Angiogram, Cerebral (Exam)..........               104               208               221
    3475................  Angiogram, Cerebral (Read)..........               119               237               252
    3490................  Angiogram, Ea Add Run...............                42                84                88
    3500................  Arteriogram, Lt Carotid.............               208               416               442
    3501................  Arteriogram, Lt Carotid (Exam)......               104               208               221
    3502................  Arteriogram, Lt Carotid (Read)......               104               208               221
    3503................  Arteriogram, Lt Vertebral...........               208               416               442
    3504................  Arteriogram, Lt Vertebral (Exam)....               104               208               221
    3505................  Arteriogram, Lt Vertebral (Read)....               104               208               221
    3506................  Arteriogram, Lt Carot & Vert........               313               624               662
    3507................  Arteriogram, Lt Carot & Vert (E)....               208               416               442
    3508................  Arteriogram, Lt Carot & Vert (R)....               104               208               221
    3510................  Arteriogram, Rt Carotid.............               208               416               442
    3511................  Arteriogram, Rt Carotid (Exam)......               104               208               221
    3512................  Arteriogram, Rt Carotid (Read)......               104               208               221
    3513................  Arteriogram, Rt Vertebral...........               208               416               442
    3514................  Arteriogram, Rt Vertebral (Exam)....               104               208               221
    3515................  Arteriogram, Rt Vertebral (Read)....               104               208               221
    3516................  Arteriogram, Rt Carot & Vert........               313               624               662
    3517................  Arteriogram, Rt Carot & Vert (E)....               208               416               442
    3518................  Arteriogram, Rt Carot & Vert (R)....               104               208               221
    3520................  Arteriogram, Bilat Carotid..........               313               624               662
    3521................  Arteriogram, Bilat Carotid (Exam)...               208               416               442
    3522................  Arteriogram, Bilat Carotid (Read)...               104               208               221
    3523................  Arteriogram, Bilat Vertebral........               313               624               662
    3524................  Arteriogram, Bilat Vertebral (E)....               208               416               442
    3525................  Arteriogram, Bilat Vertebral (R)....               104               208               221
    3526................  Arteriogram, Bilat Carot & Ver......               417               832               883
    3527................  Arteriogram, Bilat Carot & Ver (Ex).               313               624               662
    3528................  Arteriogram, Bilat Carot & Ver (Re).               104               208               221
    3530................  Arteriogram, Brachial...............               208               416               442
    3531................  Arteriogram, Brachial (Exam)........               104               208               221
    3532................  Arteriogram, Brachial (Read)........               104               208               221
    3533................  Arteriogram, Subclavian.............               208               416               442
    3534................  Arteriogram, Subclavian (Exam)......               104               208               221
    3535................  Arteriogram, Subclavian (Read)......               104               208               221
    3536................  Arteriogram, Gastroduodenal.........               208               416               442
    3537................  Arteriogram, Gastroduodenal (E).....               104               208               221
    3538................  Arteriogram, Gastroduodenal (R).....               104               208               221
    3540................  Arteriogram, Lt Gastric.............               208               416               442
    3541................  Arteriogram, Lt Gastric (Exam)......               104               208               221
    3542................  Arteriogram, Lt Gastric (Read)......               104               208               221
    3543................  Arteriogram, Hepatic................               208               416               442
    3544................  Arteriogram, Hepatic (Exam).........               104               208               221
    3545................  Arteriogram, Hepatic (Read).........               104               208               221
    3546................  Arteriogram, Celiac Axis............               208               416               442
    3547................  Arteriogram, Celiac Axis (Exam).....               104               208               221
    3548................  Arteriogram, Celiac Axis (Read).....               104               208               221
    3550................  Arteriogram, Iliac..................               208               416               442
    3551................  Arteriogram, Iliac (Exam)...........               104               208               221
    3552................  Arteriogram, Iliac (Read)...........               104               208               221
    3553................  Arteriogram, IMA....................               208               416               442
    3554................  Arteriogram, IMA (Exam).............               104               208               221
    3555................  Arteriogram, IMA (Read).............               104               208               221
    3556................  Arteriogram, SMA....................               208               416               442
    3557................  Arteriogram, SMA (Exam).............               104               208               221
    3558................  Arteriogram, SMA (Read).............               104               208               221
    3560................  Arteriogram, IMA & SMA..............               313               624               662
    3561................  Arteriogram, IMA & SMA (Exam).......               208               416               442
    3562................  Arteriogram, IMA & SMA (Read).......               104               208               221
    3563................  Arteriogram, Renal..................               208               416               442
    3564................  Arteriogram, Renal (Exam)...........               104               208               221
    3565................  Arteriogram, Renal (Read)...........               104               208               221
    3566................  Arteriogram, Femoral Runoff.........               208               416               442
    3567................  Arteriogram, Femoral Runoff (E).....               104               208               221
    3568................  Arteriogram, Femoral Runoff (R).....               104               208               221
    3576................  Arteriogram/Intervent, Other........               208               416               442
    3577................  Arteriogram/Intervent, Oth (E)......               104               208               221
    3578................  Arteriogram/Intervent, Oth (R)......               104               208               221
    3600................  IVP.................................                32                64                67
    3603................  IVP, Hypertensive...................                35                69                73
    3610................  IVP, Infusion.......................                35                70                74
    3613................  IVP, Retrograde.....................                40                79                84
    3614................  IVP, Retrograde (Exam)..............                32                64                67
    3616................  IVP W/Tomograms.....................                37                74                79
    3620................  Renal Cyst Puncture.................               146               291               308
    3621................  Renal Cyst Puncture (Exam)..........                83               166               177
    3622................  Renal Cyst Puncture (Read)..........                62               124               132
    3623................  Nephrostomy.........................               225               449               477
    3624................  Nephrostomy (Exam)..................               104               208               221
    3625................  Nephrostomy (Read)..................               121               241               256
    3626................  Nephrotomograms, No Contrast........                54               108               115
    3627................  Nephrotomograms, No Contrast (E)....                42                84                88
    3630................  Nephrostogram.......................               225               449               477
    3631................  Nephrostogram (Exam)................               104               208               221
    3632................  Nephrostogram (Read)................               121               241               256
    3636................  Cystogram, Retrograde...............                32                64                68
    3640................  Cystogram, Vcug.....................                35                70                74
    3643................  Cystogram, Chain....................                32                64                68
    3646................  Urethrogram, Retrograde.............                32                64                68
    3650................  Peri-Urethrogram....................                32                64                68
    3653................  Basket Extraction...................               208               416               442
    3654................  Basket Extraction (Exam)............               104               208               221
    3655................  Basket Extraction (Read)............               104               208               221
    3656................  Stent Replacement/Removal...........               104               208               221
    3673................  Mammogram, (Localization)...........                55               109               116
    3674................  Mammogram, (Localization) (Exam)....                32                64                67
    3676................  Mammillary Stereotaxic Biopsy.......                53               105               111
    3677................  Mammillary Stereotaxic Biop (E).....                32                64                67
    3693................  Mammogram, Bilat (Localize).........                80               160               170
    3694................  Mammogram, Bilat (Localize) (Ex)....                45                89                95
    3695................  Mammogram, Bilat (Localize) (Re)....                36                72                76
    3696................  Mammillary Ductogram, Bilat.........                70               140               149
    3697................  Mammillary Ductogram, Bilat (Exam)..                44                88                94
    3700................  Myelogram, Cervical.................               128               256               272
    3701................  Myelogram, Cervical (Exam)..........                49                98               104
    3702................  Myelogram, Cervical (Read)..........                79               158               168
    3703................  Myelgram, Thoracic..................               128               256               272
    3704................  Myelogram, Thoracic (Exam)..........                49                98               104
    3705................  Myelogram, Thoracic (Read)..........                79               158               168
    3706................  Myelogram, Lumbar...................               126               252               268
    3707................  Myelogram, Lumbar (Exam)............                47                94               100
    3708................  Myelogram, Lumbar (Read)............                79               158               168
    3713................  Myelogram, Other....................               128               256               272
    3714................  Myelogram, Other (Exam).............                49                98               104
    3715................  Myelogram, Other (Read).............                79               158               168
    3716................  Arthrogram, Wrist...................                48                96               102
    3720................  Arthrogram, Elbow...................                55               109               116
    3723................  Arthrogram, Shoulder................                55               109               116
    3726................  Arthrogram, Ankle...................                55               109               116
    3730................  Arthrogram, Knee....................                64               128               135
    3731................  Arthrogram, Knee (Exam).............                32                64                67
    3732................  Arthrogram, Knee (Read).............                32                64                68
    3733................  Arthrogram, Hip.....................                55               109               116
    3736................  Arthrogram, TMJ.....................                60               120               128
    3738................  Arthrogram, TMJ (Read)..............                35                70                74
    3770................  Sialogram...........................                45                89                95
    3773................  Sialogram, Parotidm.................                45                89                95
    3776................  Sialogram, Submandibular............                45                89                95
    3780................  Laryngogram.........................                48                95               101
    3790................  Sinogram............................                58               116               124
    3792................  Sinogram (Read).....................                42                84                88
    3800................  Fistulagram.........................                58               116               124
    3802................  Fistulagram, (Read).................                42                84                88
    3810................  Dacrocystogram, (Bilat).............                65               130               138
    3812................  Dacrocystogram, (Bilat) (Read)......                43                85                90
    3813................  Dacrocystogram, Unilat..............                33                65                69
    3896................  Specials, Other.....................                58               116               124
    3897................  Specials, Other (Exam)..............                42                84                88
    3898................  Special, Other (Read)...............                58               116               124
    3980................  Tomogram, Single Plane..............                54               108               115
    3981................  Tomogram, Single Plane (Exam).......                42                84                88
    3983................  Tomogram, Cmplx Motion (Unil).......               108               216               230
    3984................  Tomogram, Cmplx Motion (Unil) (E)...                83               166               177
    3986................  Tomogram, Cmplx Motion (Bilat)......               125               250               265
    3987................  Tomogram, Cmplx Motion (Bilat) (E)..               100               200               212
    4000................  US, Head............................                37                74                79
    4100................  US, Pelvis..........................                35                69                73
    4120................  US, Kidney (Unilat).................                41                82                87
    4126................  US, Bilat Kidney....................                58               115               122
    4127................  US, Bilat Kidney (Exam).............                32                64                68
    4140................  US, Pancreas........................                43                85                90
    4160................  US, Spleen..........................                43                85                90
    4180................  US, Liver...........................                43                85                90
    4200................  US, Breast (Bilat)..................                51               192               108
    4210................  US, Superficial Lesions.............                37                74                79
    4300................  US, Knee (Bilat)....................                62               123               131
    4301................  US, Knee (Bilat) (Exam).............                33                66                71
    4400................  US. Abdominal Aorta.................                43                85                90
    4440................  US, Iliacs..........................                37                74                79
    4480................  US, Renals..........................                41                82                87
    4520................  US, Abdomen (Complete)..............                93               185               196
    4521................  US, Abdomen (Complete) (Exam).......                50               100               106
    4522................  US, Abdomen (Complete) (Read).......                43                85                90
    4540................  US, Testicular......................                33                66                71
    4560................  US, Gall Bladder....................                43                85                90
    4563................  US, Biliary Ducts...................                43                85                90
    4580................  US, Pelvis..........................                35                69                73
    4600................  US, OB..............................                48                96               102
    4620................  US, Gestational Age.................                38                75                79
    4640................  US, Fetal Evaluation................                42                84                88
    4660................  US, Amniocentesis...................                61               122               129
    4662................  US, Amniocentesis (Read)............                43                85                90
    4700................  US, Dynamic Mass Study..............               124               247               262
    4702................  US, Dynamic Mass Study (Read).......               105               210               223
    4720................  US, Cyst Aspiration.................                84               167               177
    4722................  US, Cyst Aspiration (Read)..........                65               130               137
    4726................  US, Thoracenthesis..................                56               112               119
    4728................  US, Thoracenthesis (Read)...........                38                75                79
    4729................  US, Biopsy..........................                83               166               176
    4731................  US, Biopsy (Read)...................                65               130               139
    4996................  US, Other...........................                35                69                73
    5000................  CT, Head/Brain (W/O Contrast).......                83               166               176
    5001................  CT, Head/Brain (W/O Contrast) (E)...                63               126               135
    5003................  CT, Head/Brain (W/Contrast).........               102               204               217
    5004................  CT, Head/Brain (W/Contrast) (Ex)....                76               152               161
    5006................  CT, Head/Brain (W W/O Contrast).....               166               332               352
    5007................  CT, Head/Brain (W W/O Contrast) (E).                95               190               202
    5020................  CT, Post Fossa (W/O Contrast).......                93               186               197
    5021................  CT, Post Fossa (W/O Contrast) (E)...                63               126               134
    5023................  CT, Post Fossa (W/Contrast).........               108               216               230
    5024................  CT, Post Fossa (W/Contrast) (Ex)....                76               152               161
    5025................  CT, Post Fossa (W/Contrast) (Re)....                32                64                68
    5026................  CT, Post Fossa (W/Wo Contrast)......               129               257               273
    5027................  CT, Post Fossa (W/Wo Contrast) E....                95               190               202
    5028................  CT, Post Fossa (W/Wo Contrast) R....                34                68                72
    5040................  CT, Sella Wo/Contrast...............                93               186               196
    5041................  CT, Sella Wo/Contrast (Exam)........                63               126               134
    5043................  CT, Sella W/Contrast................               108               216               228
    5044................  CT, Sella W/Contrast (Exam).........                76               152               161
    5045................  CT, Sella W/Contrast (Read).........                32                64                69
    5046................  CT, Sella Wo/W Contrast.............               129               257               273
    5047................  CT, Sella Wo/W Contrast (Exam)......                95               190               202
    5048................  CT, Sella Wo/W Contrast (Read)......                34                68                73
    5080................  CT, Orbits Wo/Contrast..............                93               186               197
    5081................  CT, Orbits Wo/Contrast (Exam).......                63               126               134
    5083................  CT, Orbits W/Contrast...............                93               186               197
    5084................  CT, Orbits W/Contrast (Exam)........                63               126               134
    5086................  CT, Orbits Wo/W Contrast............               129               257               273
    5087................  CT, Orbits Wo/W Contrast (Exam).....                95               190               202
    5088................  CT, Orbits Wo/W Contrast (Read).....                34                68                73
    5100................  CT, Sinus Wo/ Contrast..............                90               179               190
    5101................  CT, Sinus Wo/Contrast (Exam)........                63               126               134
    5103................  CT, Sinus W/Contrast................               106               212               225
    5104................  CT, Sinus W/Contrast (Exam).........                76               152               161
    5106................  CT, Sinus Wo/W Contrast.............               128               256               272
    5107................  CT, Sinus Wo/W Contrast (Exam)......                95               190               201
    5108................  CT, Sinus Wo/W Contrast (Read)......                33                66                70
    5120................  CT, IAMS/IACS Wo/Contrast...........                93               186               196
    5121................  CT, IAMS/IACS Wo/Contrast (Exam)....                63               126               134
    5123................  CT, IAMS/IACS W/Contrast............               108               216               230
    5124................  CT, IAMS/IACS W/Contrast (Exam).....                76               152               161
    5125................  CT, IAMS/IACS W/Contrast (Read).....                32                64                68
    5126................  CT, IAMS/IACS Wo/W Contrast.........               129               257               274
    5127................  CT, IAMS/IACS Wo/W Contrast (E).....                95               190               202
    5128................  CT, IAMS/IACS Wo/W Contrast (R).....                34                68                72
    5140................  CT, Facial Wo/Contrast..............                90               179               190
    5141................  CT, Facial Wo/Contrast (Exam).......                63               126               134
    5143................  CT, Facial W/Contrast...............               106               212               225
    5144................  CT, Facial W/Contrast (Exam)........                76               152               161
    5146................  CT, Facial W/Wo Contrast............               128               256               273
    5147................  CT, Facial W/Wo Contrast (Exam).....                95               190               202
    5148................  CT, Facial W/Wo Contrast (Read).....                33                66                70
    5160................  CT, Coronals Wo/Contrast............                83               166               176
    5161................  CT, Coronals Wo/Contrast (Exam).....                63               126               134
    5163................  CT, Coronals W/Contrast.............               102               204               217
    5164................  CT, Coronals W/Contrast (Exam)......                76               152               160
    5166................  CT, Coronals Wo/W Contrast..........               125               249               264
    5167................  CT, Coronals Wo/W Contrast (Ex).....                95               190               201
    5170................  CT, Temporals Wo/Contrast...........                93               186               197
    5171................  CT, Temporals Wo/Contrast (Exam)....                63               126               135
    5173................  CT, Temporals W/Contrast............               106               212               225
    5174................  CT, Temporals W/Contrast (Exam).....                76               152               161
    5175................  CT, Temporals W/Contrast (Read).....                32                64                69
    5176................  CT, Temporals Wo/W Contrast.........               129               257               273
    5177................  CT, Temporals Wo/W Contrast (E).....                95               190               202
    5178................  CT, Temporals Wo/W Contrast (R).....                34                68                72
    5200................  CT, Brain Biopsy....................               129               257               273
    5201................  CT, Brain Biopsy (Exam).............                95               190               202
    5202................  CT, Brain Biopsy (Read).............                34                68                72
    5300................  CT, Chest...........................               151               301               321
    5301................  CT, Chest (Exam)....................               119               237               252
    5302................  CT, Chest (Read)....................                32                64                68
    5303................  CT, Chest Biopsy....................               151               301               320
    5304................  CT, Chest Biopsy (Exam).............               119               237               252
    5305................  CT, Chest Biopsy (Read).............                32                64                68
    5400................  CT, C-Spine Wo/Contrast.............               106               212               224
    5401................  CT, C-Spine Wo/Contrast (Exam)......                79               158               168
    5403................  CT, C-Spine W/Contrast..............               165               329               348
    5404................  CT, C-Spine W/Contrast (Exam).......                95               190               202
    5406................  CT, C-Spine Wo/W Contrast...........               148               296               315
    5407................  CT, C-Spine Wo/W Contrast (Exam)....               119               237               252
    5420................  CT, T-Spine Wo/Contrast.............               106               212               225
    5421................  CT, T-Spine Wo/Contrast (Exam)......                79               158               169
    5423................  CT, T-Spine W/Contrast..............               123               246               261
    5424................  CT, T-Spine W/Contrast (Exam).......                95               190               202
    5426................  CT, T-Spine Wo/W Contrast...........               148               296               314
    5427................  CT, T-Spine Wo/W Contrast (Exam)....               119               237               252
    5440................  CT, L-Spine Wo/Contrast.............               106               212               225
    5441................  CT, L-Spine Wo/Contrast (Exam)......                79               158               168
    5443................  CT, L-Spine W/Contrast..............               123               246               262
    5444................  CT, L-Spine W/Contrast (Exam).......                95               190               202
    5446................  CT, L-Spine Wo/W Contrast...........               148               296               314
    5447................  CT, L-Spine Wo/W Cntrst (E).........               119               237               252
    5463................  CT, Spinal Stenosis.................               123               246               261
    5464................  CT, Spinal Stenosis (Exam)..........                95               190               202
    5500................  CT, Routine ABD Wo/Contrast.........               103               206               218
    5501................  CT, Routine ABD Wo/Cntrst (E).......                76               152               161
    5503................  CT, Routine ABD W/Contrast..........               121               242               256
    5504................  CT, Routine ABD W/Cntrst (E)........                92               183               194
    5506................  CT, Routine ABD Wo/W Contrast.......               147               293               312
    5507................  CT, Routine ABD Wo/W Cntrst (E).....               114               227               241
    5508................  CT, Routine ABD Wo/W Cntrst (R).....                33                66                70
    5523................  CT, Invasive Procedure..............               187               373               397
    5524................  CT, Invasive Procedure (Exam).......               111               221               235
    5525................  CT, Invasive Procedure (Read).......                77               153               162
    5540................  CT, Liver W/O Contrast..............               103               206               219
    5541................  CT, Liver W/O Contrast (Exam).......                76               152               161
    5543................  CT, Liver W Contrast................               121               242               257
    5544................  CT, Liver W Contrast (Exam).........                92               183               194
    5546................  CT, Liver Wo/W Contrast.............               147               293               312
    5547................  CT, Liver Wo/W Contrast (Exam)......               114               227               241
    5548................  CT, Liver Wo/W Contrast (Read)......                33                66                70
    5560................  CT, Pancreas Wo/Contrast............               103               206               219
    5561................  CT, Pancreas Wo/Contrast (Exam).....                76               152               161
    5563................  CT, Pancreas Wo/Contrast............               121               242               257
    5564................  CT, Pancreas Wo/Contrast (Exam).....                92               183               193
    5566................  CT, Pancreas Wo/Contrast............               147               293               311
    5567................  CT, Pancreas Wo/Contrast (Ex).......               114               227               240
    5568................  CT, Pancreas Wo/Contrast (RE).......                33                66                70
    5580................  CT, Kidney Wo/Contrast..............               103               206               220
    5581................  CT, Kidney Wo/Contrast (Exam).......                76               152               161
    5583................  CT, Kidney W/Contrast...............               121               242               257
    5584................  CT, Kidney W/Contrast (Exam)........                92               183               195
    5586................  CT, Kidney Wo/W Contrast............               147               293               311
    5587................  CT, Kidney Wo/W Contrast (Exam).....               114               227               241
    5588................  CT, Kidney Wo/W Contrast (Read).....                33                66                70
    5600................  CT, Pelvis Wo/Contrast..............               103               206               219
    5601................  CT, Pelvis Wo/Contrast (Exam).......                76               152               161
    5603................  CT, Pelvis W/Contrast...............               121               242               257
    5604................  CT, Pelvis W/Contrast (Exam)........                92               183               195
    5606................  CT, Pelvis Wo/W Contrast............               147               293               311
    5607................  CT, Pelvis Wo/W Contrast (Exam).....               114               227               241
    5608................  CT, Pelvis Wo/W Contrast (Read).....                33                66                70
    5700................  CT, Extremity Wo/Contrast...........                92               183               194
    5701................  CT, Extremity Wo/Contrast (Exam)....                66               132               140
    5703................  CT, Extremity W/Contrast............               106               212               224
    5704................  CT, Extremity W/Contrast (Exam).....                79               158               168
    5706................  CT, Extremity Wo/W Contrast.........               128               255               270
    5707................  CT, Extremity Wo/W Contrast (E).....               100               199               211
    5720................  CT, Ortho Bone Study................                45                90                97
    5721................  CT, Ortho Bone Study (Exam).........                40                79                84
    5800................  CT, Reconstruction..................               142               283               300
    5820................  CT, Review..........................                71               142               152
    5840................  CT, Therapy Planning................               142               283               300
    5996................  CT, Other...........................               154               308               327
    5997................  CT, Other (Exam)....................                83               166               176
    5998................  CT, Other (Read)....................                71               142               151
    6009................  Thyroid Scn/Upt, Single Det.........                40                80                85
    6012................  Thy Scn/Upt, Mult Det...............                43                86                91
    6018................  Thyroid Image W/Flow................                40                80                86
    6021................  Thy Metascan: Ltd Area..............                47                93                99
    6024................  Parathyroid.........................                43                86                91
    6027................  Thy Metascan: Mult Areas............                65               130               138
    6028................  Thy Metascan: Mult Areas (E)........                45                90                96
    6030................  Thy Metascan: Whole Body............                88               175               186
    6031................  Thy Metascan: Whole Body (E)........                65               130               137
    6033................  Adrenal Image: Cortical.............                83               166               176
    6034................  Adrenal Image: Cortical (E).........                65               130               137
    6036................  Bone Marrow Image: Ltd Area.........                38                75                80
    6039................  Bone Marrow Image: Multi Area.......                56               112               120
    6040................  Bone Marrow Image: Multi Area (E)...                38                76                81
    6042................  Bone Marrow Image: Whole Body.......                68               135               143
    6043................  Bone Marrow Image: Whole Body (E)...                49                98               105
    6048................  Plasma Volume Mult Sample...........                36                72                76
    6054................  Red Cell Vol Mult Sample............                43                85                90
    6055................  Red Cell Vol Mult Sample (E)........                35                70                74
    6057................  WB Vol: W/Plasma & RBC Vol..........                66               132               140
    6058................  WB Vol: W/Plasma & RBC Vol (E)......                56               112               119
    6060................  Red Cell Survival Study.............                49                98               104
    6061................  Red Cell Survival Study (E).........                35                69                74
    6063................  RBC Surv: W/Spleen & Hep Sequest....                74               147               156
    6064................  RBC Surv: W/Spleen & Hep Seq (E)....                59               118               125
    6066................  RBC Spleen & Hepatic Sequest........                62               123               131
    6067................  RBC Spleen & Pepatic Seq (E)........                48                95               101
    6069................  Plasma Iron Disappearance...........                52               103               109
    6070................  Plasma Iron Disapp (E)..............                44                88                92
    6072................  Iron Oral Absorption................                49                98               104
    6073................  Iron Oral Absorption (E)............                39                78                82
    6075................  Iron Red Cell Utilization...........                74               147               156
    6076................  Iron Red Cell Util (E)..............                64               128               137
    6078................  Spleen Imaging Only.................                38                75                80
    6081................  Spleen Imaging Only: W/Flow.........                46                92                98
    6082................  Spleen Imaging Only: W/Flow (E).....                35                70                75
    6084................  Platelet Survival...................               103               206               219
    6085................  Platelet Survival (E)...............                89               177               188
    6087................  WBC Localization: LTD...............                60               119               126
    6088................  WBC Localization: LTD (E)...........                41                82                87
    6090................  WBC Localization: Whole Body........               138               276               293
    6091................  WBC Localization: Whole Body (E)....               118               235               249
    6093................  Rad Nuclide Lymphangiogram..........                65               130               139
    6094................  Rad Nuclide Lymphangiogram (E)......                49                98               104
    6096................  Liver Imaging: Static...............                39                78                83
    6099................  Liver Imaging: W/Flow...............                47                94               100
    6100................  Liver Imaging: W/Flow (E)...........                35                70                74
    6102................  Liver Imaging: Spect................                88               176               186
    6103................  Liver Imaging: Spect (E)............                71               142               151
    6105................  Liver/Spleen Imaging: Static........                47                94               100
    6106................  Liver/Spleen Imag: Static (E).......                35                70                75
    6108................  Liver/Spleen Imaging: Flow..........                55               110               117
    6109................  Liver/Spleen Imaging: Flow (E)......                42                84                89
    6111................  Liver FXN: W/Hepbil Agent/Dyn.......                57               113               120
    6112................  Liver FXN: W/Hepbil Agnt/Dyn (E)....                45                90                95
    6114................  Hepatobiliary: Duct & GB............                64               128               135
    6115................  Hepatobiliary: Duct & GB (E)........                44                88                94
    6117................  Liver-Lung Imaging..................                60               120               128
    6118................  Liver-Lung Imaging (E)..............                48                96               102
    6120................  Salivary Gland: Static Only.........                37                74                79
    6123................  Salivary Gland: Dynamic.............                50               100               107
    6124................  Salivary Gland: Dynamic (E).........                38                76                81
    6126................  Salivary Gland: Function............                54               108               114
    6127................  Salivary Gland: Function (E)........                43                85                90
    6129................  Esophageal Motility.................                52               104               110
    6130................  Esophageal Motility (E).............                35                70                74
    6132................  Gastric Mucosa Imaging..............                65               130               139
    6133................  Gastric Mucosa Imaging (E)..........                49                98               104
    6135................  Gastroesophageal Study..............                67               134               142
    6136................  Gastroesophageal Study (E)..........                51               102               109
    6138................  Gastric Emptying Study..............                68               136               144
    6139................  Gastric Emptying Study (E)..........                50                99               105
    6147................  Schillings Stage 1 & 2 (Dicopac)....                34                68                72
    6150................  GI ASP Blood Loss Loc...............                55               110               117
    6151................  GI ASP Blood Loss Loc (E)...........                39                78                82
    6153................  Acute GI Blood Loss Imaging.........                82               163               173
    6154................  Acute GI Blood Loss Imaging (E).....                59               118               125
    6156................  GI Blood Loss: Stool Count..........                48                96               102
    6157................  GI Blood Loss: Stool Count (E)......                39                78                83
    6159................  Bowel Imag (ECT Meckels)............                53               106               112
    6160................  Bowel Imag (ECT Meckels) (E)........                37                74                78
    6162................  Perit-Venous Shunt (Leveen).........                58               115               122
    6163................  Perit-Venous Shunt (Leveen) (E).....                33                66                71
    6165................  Bone Imaging: LTD Area..............                45                89                95
    6168................  Bone Imaging: Multi Area............                63               126               134
    6169................  Bone Imaging: Multi Area (E)........                44                88                94
    6171................  Bone Imaging: Whole Body............                70               140               149
    6172................  Bone Imaging: Whole Body (E)........                52               103               110
    6177................  Bone, 3 Phase.......................                78               156               166
    6178................  Bone, 3 Phase (E)...................                58               115               122
    6180................  Bone Spect..........................                95               190               202
    6181................  Bone Spect (E)......................                71               142               151
    6189................  Joint Imaging, Ltd Area.............                46                92                98
    6190................  Joint Imaging, Ltd Area (E).........                34                68                72
    6192................  Joint Imaging, Multi Area...........                61               122               129
    6193................  Joint Imaging, Multi Area (E).......                43                86                92
    6195................  Card Blood Pool, FXN Imag...........                43                86                92
    6196................  Card Blood Pool, FXN Imag (E).......                33                65                69
    6201................  Cardiac Shunt Detection.............                45                90                96
    6204................  Cardiac Flow (Angiocard)............                55               110               117
    6205................  Cardiac Flow (Angiocard) (E)........                44                88                93
    6207................  Vascular Flow (Venography)..........                34                68                72
    6210................  VEN Thrombosis (Fibrinogen).........                65               130               138
    6211................  VEN Thrombosis (Fibrinogen) (E).....                48                96               102
    6213................  Rad Nuc Venogram: Unilat............                50               100               106
    6214................  Rad Nuc Venogram: Unilat (E)........                32                64                68
    6216................  Rad Nuc Venogram: Bilat.............                69               138               147
    6217................  Rad Nuc Venogram: Bilat (E).........                48                96               102
    6219................  Myocard Perf/Qual Rest..............                49                98               103
    6222................  Myoc Perf/Qual, RE&EX/Pharm.........                86               172               182
    6223................  Myoc Perf/Qual, RE&EX/Pharm (E).....                57               114               121
    6225................  Myocard Perf/Quant Rest.............                62               123               131
    6226................  Myocard Perf/Quant Rest (E).........                40                80                86
    6228................  Yoc Perf/Quant RE&EX/Pharm..........               101               202               215
    6229................  Myoc Perf/Quant RE&EX/Pharm (E).....                71               142               151
    6231................  Myocard Perf/Spect Rest.............               111               221               235
    6232................  Myocard Perf/Spect Rest (E).........                85               170               181
    6234................  Myoc Perf/Spect RE&EX/Pharm.........               176               352               374
    6235................  Myoc Perf/Spect RE&EX/Pharm (E).....               143               285               302
    6236................  Myoc Perf/Spect RE&EX/Pharm (R).....                34                68                72
    6237................  Myocard Imfarct IMG: Qual...........                48                96               102
    6238................  Myocard Imfarct IMG: Qual (E).......                32                64                67
    6240................  Myocard Imfarct IMG: Quant..........                55               110               117
    6241................  Myocard Imfarct IMG: Quant (E)......                38                76                80
    6243................  Myoc Infarct IMG: W/1St Pass........                63               126               133
    6244................  Myoc Infarct IMG: W/1St Pass (E)....                44                88                94
    6246................  Myoc Infarct Img: Spect.............                85               169               179
    6247................  Myco Infarct Img: Spect (E).........                63               126               134
    6249................  Cardiac Output......................                55               110               117
    6250................  Cardiac Output (E)..................                45                89                95
    6252................  Gated Rest: Wall MTN&EF.............                85               170               180
    6253................  Gated Rest: Wall MTN&EF (E).........                63               126               134
    6255................  Gated Rest: Wall MTN® EF.........                89               178               189
    6256................  Gated Rest: Wall MTN® EF (E).....                66               132               140
    6258................  Gtd Rest: Wall MTN, REG EF, VV......                97               193               205
    6259................  Gtd Rest: Wall MTN, REG EF, VV (E)..                73               146               155
    6261................  Gated Ex/Phrm: Quan, Wall MTN.......               142               283               300
    6262................  Gated Ex/Phrm: Quan, Wall MTN (E)...               114               227               241
    6264................  Gtd Rst, Ex/Phrm: Wall MTN, EF......               147               294               312
    6265................  Gtd Rst, Ex/Phrm: Wall MTN EF (E)...               120               239               254
    6267................  Gtd Rst, Ex/Phrm: Wm, EF, VV........               160               319               338
    6268................  Gtd Rst, Ex/Phrm: Wm, EF, VV (E)....               131               261               277
    6273................  1st Pass, Wall MTN&EF...............                86               172               183
    6274................  1st Pass, Wall MTN&EF (E)...........                63               126               134
    6276................  1st Pass, Wall MTN, EF, VVD.........                97               193               205
    6277................  1st Pass, Wall MTN, EF, VVD (E).....                73               146               155
    6279................  1st Pass, Ex/Pharm, Wl MTN..........               142               283               300
    6280................  1st Pass, Ex/Pharm, Wl MTN (E)......               114               227               241
    6282................  1st Pass, Ex/Ph, Wl MTN, VV.........               147               294               312
    6283................  1st Pass, Ex/Ph, Wl MTN, VV (E).....               120               239               254
    6285................  1st Pass, Ex/Ph, Wl MTN, EF, VV.....               160               319               338
    6286................  1st Pass, Ex/Ph, Wl MTN, EF, VV (E).               131               261               277
    6288................  1st Pass, Rest, Ser, Any Comb.......                63               125               132
    6289................  1st Pass, Rest Ser, Any Comb (E)....                42                84                88
    6291................  Lung Perf, Particulate..............                59               118               125
    6292................  Lung Perf, Particulate (E)..........                41                82                87
    6294................  Lung Perf, Gaseous..................                45                90                95
    6297................  Lung Perf: Gas W/VNT, EQ, W/O.......                67               133               141
    6298................  Lung Perf: Gas W/VNT, EQ, W/O (E)...                45                90                96
    6300................  Lung Perf: Part, VNT, 1br...........                62               123               131
    6301................  Lung Perf: Part, VNT, 1br (E).......                39                78                82
    6303................  V/Q Part, Full Study................                93               186               198
    6304................  V/Q Part, Full Study (E)............                68               136               144
    6306................  Pulm Aerosol, 1view.................                40                80                86
    6309................  Pulm Aerosol, Mult View.............                45                90                96
    6310................  Pulm Aerosol, Mult View (E).........                34                68                72
    6312................  Pulm Vent, 1br, 1view...............                44                88                93
    6313................  Pulm Vent, 1br, 1view (E)...........                35                69                73
    6315................  Pulm Vent, W/1br, EQ, W/O, 1view....                53               106               113
    6316................  Pulm Vent, W/1br, EQ, W/O, 1v (E)...                42                84                88
    6318................  Pul Ven, W/1br, EQ, W/O, Mult V.....                71               142               150
    6319................  Pul Ven, W/1br, Eq, W/O, Mult V (E).                60               120               127
    6321................  Brain, Ltd, Static Only.............                45                90                95
    6322................  Brain, Ltd, Static Only (E).........                35                70                74
    6324................  Brain, Flow & Scan, Ltd.............                53               106               113
    6325................  Brain Flow & Scan, Ltd (E)..........                41                82                87
    6327................  Brain Complete, Static Only.........                54               108               114
    6328................  Brain Complete, Static Only (E).....                41                82                87
    6330................  Brain Flow & Scan, Complete.........                62               123               131
    6331................  Brain Flow & Scan, Complete (E).....                47                93                99
    6333................  Brain Spect Complete................               108               216               229
    6334................  Brain Spect Complete (E)............                79               158               168
    6339................  Cerebral Blood Flow.................                56               112               119
    6340................  Cerebral Blood Flow (E).............                47                93                99
    6342................  CSF Flow, W/O Intro, Cisterno.......                77               153               163
    6343................  CST Flow, W/O Intro, Cisterno (E)...                61               122               129
    6345................  CSF Flow Ventriculography...........                45                90                95
    6348................  CSF Flow Shunt Eval.................                55               110               117
    6349................  CSF Flow Shunt Eval (E).............                41                82                87
    6351................  CSF leak Detection & Localize.......                70               140               149
    6352................  CSF Leak Detection & Localize (E)...                56               112               118
    6354................  CSF Flow Spect......................                92               184               195
    6355................  CSF Flow Spect (E)..................                71               142               151
    6357................  Radionucl ID of Eye Tumor...........                73               146               155
    6358................  Radionucl ID of Eye Tumor (E).......                60               120               127
    6360................  Dacrocystography....................                38                76                81
    6363................  Renal Static Only...................                47                94               100
    6364................  Renal Static Only (E)...............                37                74                78
    6366................  Renal W/Flow........................                55               109               116
    6367................  Renal W/Flow (E)....................                43                86                91
    6369................  Renal W/Funct (EG IM Reno)..........                65               130               138
    6370................  Renal W/Funct (EG IM Reno) (E)......                48                96               102
    6372................  Renal W/Flow & Funct................                76               152               161
    6373................  Renal W/Flow & Funct (E)............                54               108               115
    6375................  Renal Spect.........................                87               173               184
    6376................  Renal Spect (E).....................                71               142               151
    6384................  Renal Funct W/Pharm Interv..........                56               112               119
    6385................  Renal Funct W/Pharm Interv (E)......                36                72                76
    6387................  Renal Transplant Eval...............                71               142               151
    6388................  Renal Transplant Eval (E)...........                48                96               102
    6396................  Testicular Imaging..................                48                95               101
    6397................  Testicular Imaging (E)..............                32                64                68
    6400................  Testicular Imaging W/Flow (E).......                39                78                82
    6402................  Tumor Localization, Ltd.............                56               112               119
    6403................  Tumor Localization, Ltd (E).........                41                82                87
    6405................  Tumor Locatization Mult Area........                69               138               147
    6406................  Tumor Locatization Mult Area (E)....                51               102               108
    6408................  Tumor Local Whole Body..............                87               174               185
    6409................  Tumor Local Whole Body (E)..........                68               136               145
    6411................  Tumor Localization Spect............                84               167               178
    6412................  Tumor Localization Spect (E)........                83               165               175
    6414................  Gallium Study, Ltd..................                57               114               121
    6415................  Gallium Study, Ltd (Exam)...........                41                82                87
    6417................  Gallium Study Whole Body............                87               173               184
    6418................  Gallium Study Whole Body (E)........                67               133               141
    6423................  Auto Data Interdisc>30Min...........                34                68                72
    6424................  Auto Data Interdisc>30Min (E).......                32                64                67
    6226................  TX Hyperthy, Init W/Eval............                73               146               155
    6427................  TX Hyperthy, Init W/Eval (E)........                32                64                67
    6428................  TX Hyperthy, Init W/Eval (R)........                42                84                88
    6429................  TX Hyperthy, Subseq, Ea Visit.......                40                80                85
    6432................  Thy Suppress, Euthy (Card D)........                74               147               156
    6433................  Thy Suppress, Euthy (Card D) (E)....                32                64                67
    6434................  Thy Suppress, Euthy (Card D) (R)....                42                84                89
    6435................  Thyroid CA Ablation.................                80               160               170
    6436................  Thyroid CA Ablation (Exam)..........                32                64                67
    6437................  Thyroid CA Ablation (Read)..........                48                96               102
    6438................  RN Metastases of Thy CA.............                90               180               191
    6439................  RN Metastases of Thy CA (E).........                32                64                67
    6440................  RN Metastases of Thy CA (R).........                59               118               125
    6441................  TX For Polycy Vera, Q/TX............                63               125               132
    6442................  TX For Polycy Vera, Q/TX (E)........                32                64                67
    6444................  TX Intracavitary Colloid............                78               156               165
    6445................  TX Intracavitary Colloid (E)........                32                64                67
    6446................  TX Intracavitary Colloid (R)........                46                92                98
    6447................  Non Thy, Non Hemat (Bone Met).......                78               155               164
    6448................  Non Thy, Non Hemat (Bone Met) (E)...                32                64                67
    6449................  Non Thy, Non Hemat (Bone Met) (R)...                46                92                97
    7000................  Th Rad TX Planning; Simple..........                33                65                69
    7003................  Th Rad TX Planning; Intermed........                49                98               104
    7006................  Th Rad TX Planning; Complex.........                73               146               155
    7020................  Th Rad Simul-Aid Fld Set Smpl.......                53               106               112
    7021................  Th Rad Simul-Aid Fld Set Smple......                37                74                78
    7023................  Th Rad Simul-Aid Fld Set Med........                83               166               177
    7024................  Th Rad Simul-Aid Fld Set Med (E)....                59               118               125
    7026................  Th Rad Simul-Aid Fld Set Complx.....               105               210               223
    7027................  Th Rad Simul-Aid Fld Set Cplxe......                69               138               146
    7028................  Th Rad Simul-Aid Fld Set Cplxr......                36                72                76
    7043................  Teletx, Isodose Plan; Simple........                36                72                76
    7046................  Teletx, Isodose Plan; Intermed......                49                98               103
    7060................  Teletx, Isodose Plan; Complx........                65               129               137
    7062................  Teletx, Isodose Plan; Complx (Rea)..                37                74                78
    7063................  Spec Teletx Port PL, Hemi/Tot.......                65               129               137
    7064................  Spec Teletx Port PL, Hemi/Tot (E)...                43                85                90
    7080................  Brachyth Isodose Calcul, Smple......                47                93                99
    7083................  Brachyth Isodose Calcul, Interm.....                69               138               147
    7084................  Brachyth Isodose Calcul, Intere.....                37                74                78
    7085................  Brachyth Isodose Calcul, Interr.....                33                65                69
    7086................  Brachyth Isodose Calcul, Comple.....               101               202               215
    7087................  Brachyth Isodose Calcul, Cmplxe.....                53               105               111
    7088................  Brachyth Isodose Calcul, Complxr....                49                98               103
    7103................  TX Devices, Design & Constr, Inter..                40                79                84
    7106................  TX Devices, Design & Constr, Coml...                63               126               134
    7107................  TX Devices, Design & Constr, Cmpex..                34                68                72
    7120................  Cont Rad Phys Cons Sup W/OA.........                32                64                67
    7123................  Special Med Rad Physic Consul.......                37                74                79
    7130................  Weekly Megavolt TX Manage Simp......               131               261               277
    7131................  Wkly Megavolt TX Manage Smpl (E)....                93               186               198
    7132................  Wkly Megavolt TX Manage Smpl (R)....                38                75                79
    7133................  Weekly Megavolt TX Manage Inte......               168               335               355
    7134................  Wkly Megavolt TX Manage Inte (E)....               111               221               234
    7135................  Wkly Megavolt TX Manage Inte (R)....                57               114               121
    7136................  Wkeely Megavolt TX Manage Comp......               207               413               438
    7137................  Wkly Megavolt TX Manage Cplx (E)....               123               245               260
    7138................  Wkly Megavolt TX Manage Cplx (R)....                84               168               178
    7146................  Spec TC Proc (Tot/Hemibod/P-OS).....               166               332               352
    7147................  Spec TC Proc (Tot/Hemibod/P-OS) (E).                49                98               103
    7148................  Spec TC Proc (Tot/Hemibod/P-OS) (R).               249               235               118
    7160................  Hyperthermia, Ext Gen, Superf.......               155               146                73
    7161................  Hyperthermia, Ext Gen, Superf (E)...                78                74                37
    7162................  Hyperthermia, Ext Gen, Superf (R)...                77                74                37
    7163................  Hyperthermia, Ext Gen, Deep.........               207               195                98
    7164................  Hyperthermia, Ext Gen, Deep (Ex)....               105                98                49
    7165................  Hyperthermia, Ext Gen, Deep (Re)....               103                98                49
    7166................  Hyperthermia, Interstit Probe.......               156               146                73
    7167................  Hyperthermia, Interstit Probe (Ex)..                79                74                37
    7168................  Hyperthermia, Interstit Probe (Re)..                79                74                37
    7170................  Hyperthermia, Interstit Pro>5.......               207               195                98
    7171................  Hyperthermia, Interstit Pro>5E......               207               195                98
    7172................  Hyperthermia, Interstit Pro>5R......               104                98                49
    7173................  Hypertherm Gen By Intracav Pro......               156               146                73
    7174................  Hypertherm Gen By Intracav Pre......                78                74                37
    7175................  Hypertherm Gen By Intracav Prr......                77                74                37
    7176................  Infusion/Instill Radioelem Sol......               261               245               123
    7178................  Infusion/Instill Radioele Solr......               226               214               107
    7200................  Intracav Radioele Appl Simple.......               232               219               110
    7202................  Intracav Radioele Appl Simp (R).....               175               166                83
    7203................  Intracav Radioelem Appl Interm......               163               326               346
    7204................  Intracav Radioele Appl Inte (Ex)....                38                76                81
    7205................  Intracav Radioele Appl Inte (Re)....               125               250               265
    7206................  Intracav Radioelem Applic Comp......               235               469               497
    7207................  Intracav Radioele Appl Cmpl (Ex)....                48                95               101
    7208................  Intracav Radioele Appl Cmpl (Re)....               187               373               397
    7220................  Interstit Radioelem Appl Simpl......               135               270               286
    7222................  Interstit Radioel Appl Smple (R)....               109               217               231
    7223................  Interstit Radioelem Applic Int......               214               427               454
    7224................  Interstit Radioele Appl; Inte (E)...                51               102               109
    7225................  Interstit Radioele Appl; Inte (R)...               163               325               345
    7226................  Interstit Radioelem Appl Compl......               306               611               649
    7227................  Interstit Radioele Appl Cmp (Ex)....                62               123               131
    7228................  Interstit Radioele Appl Cmp (Re)....               244               487               518
    8000................  MrI, Brain (W/O Contrast)...........               125               250               265
    8001................  MRI, Brain (W/O Contrast) (Exam)....                95               190               201
    8003................  MRI, Brain (W/Contrast).............               221               441               469
    8004................  MRI, Brain (W/Contrast) (Exam)......               181               361               382
    8005................  MRI, Brain (W/Contrast) (Read)......                41                82                87
    8006................  MRI, Brain (W W/O Contrast).........               356               710               753
    8007................  MRI, Brain (W W/O Contrast) (Ex)....               301               600               637
    8008................  MRI, Brain (W W/O Contrast) (Re)....                55               110               117
    8010................  MRI, Angiogram......................               356               710               753
    8011................  MRI, Angiogram (Exam)...............               301               600               637
    8012................  MRI, Angiogram (Read)...............                55               110               117
    8020................  MRI, Orbit Wo/Contrast..............                93               186               198
    8021................  MRI, Orbit Wo/Contrast (Exam).......                63               126               134
    8023................  MRI, Orbit W/Contrast...............                93               186               198
    8024................  MRI, Orbit W/Contrast (Exam)........                63               126               134
    8026................  MRI, Orbit Wo/W Contrast............               129               257               273
    8027................  MRI, Orbit Wo/W Contrast (Exam).....                95               190               201
    8028................  MRI, Orbit Wo/W Contrast (Read).....                34                68                72
    8040................  MRI, Sinus Wo/Contrast..............                90               179               190
    8041................  MRI, Sinus Wo/Contrast (Exam).......                63               126               134
    8043................  MRI, Sinus W/Contrast...............               106               212               225
    8044................  MRI, Sinus W/Contrast (Exam)........                76               152               161
    8046................  MRI, Sinus W/Wo Contrast............               128               256               272
    8047................  MRI, Sinus W/Wo Contr (Exam)........                95               190               201
    8048................  MRI, Sinus W/Wo Contr (Read)........                33                66                71
    8060................  MRI, Neck (W/O Contrast)............                83               166               177
    8061................  MRI, Neck (W/O Contrast) (Exam).....                63               126               134
    8063................  MRI, Neck (W/Contrast)..............               102               204               216
    8064................  MRI, Neck (W/Contrast) (Exam).......                76               152               161
    8066................  MRI, Neck (W W/O Contrast)..........               166               332               352
    8067................  MRI, Neck (W W/O Contrst) (Exam)....                95               190               201
    8080................  MRI, Chest Wo/Contrast..............                93               186               198
    8081................  MRI, Chest Wo/Contrast (Exam).......                63               126               134
    8083................  MRI, Chest W/Contrast...............                93               186               198
    8084................  MRI, Chest W/Contrast (Exam)........                63               126               134
    8086................  MRI, Chest Wo/W Contrast............               129               257               273
    8087................  MRI, Chest Wo/W Contrast (Exam).....                95               190               201
    8088................  MRI, Chest Wo/W Contrast (Read).....                34                68                72
    8100................  MRI, C-Spine Wo/Contrast............               106               212               225
    8101................  MRI, C-Spine Wo/Contrast (Exam).....                79               158               168
    8103................  MRI, C-Spine W/Contrast.............               225               449               477
    8104................  MRI, C-Spine W/Contrast (Exam)......               180               359               382
    8105................  MRI, C-Spine W/Contrast (Read)......                45                90                95
    8106................  MRI, C-Spine Wo/W Contrast..........               361               720               764
    8107................  MRI, C-Spine Wo/W Contrast (Exam)...               301               600               637
    8108................  MRI, C-Spine Wo/W Contrast (Read)...                60               120               127
    8120................  MRI, T-Spine Wo/Contrast............               106               212               225
    8121................  MRI, T-Spine Wo/Contrast (Exam).....                79               158               168
    8123................  MRI, T-Spine W/Contrast.............               225               449               477
    8124................  MRI, T-Spine W/Contrast (Exam)......               180               359               382
    8125................  MRI, T-Spine W/Contrast (Read)......                45                90                95
    8126................  MRI, T-Spine Wo/W Contrast..........               361               720               764
    8127................  MRI, T-Spine Wo/W Contrast (Exam)...               301               600               637
    8128................  MRI, T-Spine Wo/W Contrast (Read)...                60               120               127
    8140................  MRI, L-Spine Wo/Contrast............               106               212               225
    8141................  MRI, L-Spine Wo/Contrast (Exam).....                79               158               168
    8143................  MRI, L-Spine W/Contrast.............               222               443               470
    8144................  MRI, L-Spine W/Contrast (Exam)......               181               361               382
    8145................  MRI, L-Spine W/Contrast (Read)......                41                82                87
    8146................  MRI, L-Spine Wo/Contrast............               148               296               314
    8147................  MRI, L-Spine Wo/Contrast (Exam).....               356               710               753
    8148................  MRI, L-Spine Wo/W Contrast (Read)...               301               600               637
    8160................  MRI, Pelvis Wo/Contrast.............               103               206               219
    8161................  MRI, Pelvis Wo/Contrast (Exam)......                76               152               161
    8163................  MRI, Pelvis W/Contrast..............               121               242               257
    8164................  MRI, Pelvis W/Contrast (Exam).......                92               183               194
    8166................  MRI, Pelvis Wo/Contrast.............               147               293               311
    8167................  MRI, Pelvis Wo/Contrast (Exam)......               114               227               241
    8168................  MRI, Pelvis Wo/Contrast (Read)......                33                66                70
    8180................  MRI, Upper Ext Wo/Contrast..........               173               345               366
    8181................  MRI, Upper Ext Wo/Contrast (Exam)...               150               299               318
    8183................  MRI, Upper Ext W/Contrast...........               106               212               225
    8184................  MRI, Upper Ext W/Contrast (Exam)....                79               158               168
    8186................  MRI, Upper Ext Wo/W Contrast........               128               255               271
    8187................  MRI, Upper Ext Wo/W Contrast (E)....               100               199               211
    8200................  MRI, Lower Ext Wo/Contrast..........               173               345               366
    8201................  MRI, Lower Ext Wo/Contrast (Exam)...               150               299               318
    8203................  MRI, Lower Ext W/Contrast...........               106               212               225
    8204................  MRI, Lower Ext W/Contrast (Exam)....                79               158               168
    8206................  MRI, Lower Ext Wo/W Contrast........               128               255               271
    8207................  MRI, Lower Ext Wo/W Contrast (E)....               100               199               211
    8220................  MRI, Abdomen Wo/Contrast............               106               212               225
    8221................  MRI, Abdomen Wo/Contrast (Exam).....                79               158               168
    8223................  MRI, Abdomen W/Contrast.............               123               246               261
    8224................  MRI, Abdomen W/Contrast (Exam)......                95               190               201
    8226................  MRI, Abdomen Wo/W Contrast..........               148               296               314
    8227................  MRI, Abdomen Wo/W Contrast (Exam)...               119               237               252
    8240................  MRI, Heart Wo/Contrast..............               106               212               225
    8241................  MRI, Heart Wo/Contrast (Exam).......                79               158               168
    8243................  MRI, Heart W/Contrast...............               123               246               261
    8244................  MRI, Heart W/Contrast (Exam)........                95               190               201
    8246................  MRI, Heart Wo/W Contrast............               148               296               314
    8247................  MRI, Heart Wo/W Contrast (Exam).....               119               237               252
    8260................  MRI, TMJ Wo/Contrast................               172               343               365
    8261................  MRI, TMJ Wo/Contrast (Exam).........               150               299               318
    8263................  MRI, TMJ W/Contrast.................               106               212               225
    8264................  MRI, TMJ W/Contrast (Exam)..........                79               158               168
    8996................  MRI, Other..........................               125               250               265
    8997................  MRI, Other (Exam)...................                95               190               201
    8266................  MRI, TMJ Wo/W Contrast..............               128               255               271
    8267................  MRI, TMJ Wo/W Contrast (Exam).......               100               199               211
    ----------------------------------------------------------------------------------------------------------------
    Explanations at end of docket.                                                                                  
    
    F. Elective Cosmetic Surgery Procedures and Rates
    
    ----------------------------------------------------------------------------------------------------------------
                                          International     Common                                                  
                                         classification   procedure                                        Amount of
        Cosmetic surgery procedure       diseases (ICD-  terminology           FY 95 charge\7\              charge  
                                               9)         (CPT)\6\                                                  
    ----------------------------------------------------------------------------------------------------------------
    Mammaplasty........................           85.50       19325   Surgical care services or same day  (a)       
                                                  85.32       19324    surgery.                           (b)       
                                                  85.31       19318                                                 
    Mastopexy..........................           85.60       19316   Surgical care services or same day  (a)       
                                                                       surgery.                           (b)       
    Facial Rhytidectomy................           86.82       15824   Surgical care services or same day  (a)       
                                                  86.22                surgery.                           (b)       
    Blepharoplasty.....................           08.70       15820   Surgical care services or same day  (a)       
                                                  08.44       15821    surgery.                           (b)       
                                                              15822                                                 
                                                              15823                                                 
    Mentoplasty (Augmentation                     76.68       21208   Surgical care services or same day  (a)       
     Reduction).                                  76.67       21209    surgery.                           (b)       
    Abdominoplasty.....................           86.83       15831   Surgical care services or same day  (a)       
                                                                       surgery.                           (b)       
    Lipectomy, suction per region\8\...           86.83       15876   Surgical care services or same day  (a)       
                                                              15877    surgery.                           (b)       
                                                              15878                                                 
                                                              15879                                                 
    Rhinoplasty........................           21.87       30400   Surgical care services or same day  (a)       
                                                  21.86       30410    surgery.                           (b)       
    Scar revisions beyond CHAMPUS......           86.84      1578__   Surgical care services or same day  (a)       
                                                                       surgery.                           (b)       
    Mandibular or maxillary                       76.41       21194   Surgical care services or same day  (a)       
     repositioning.                                                    surgery.                           (b)       
    Minor skin lesions\9\..............           86.30      1578__   Surgical care services or same day  (a)       
                                                                       surgery.                           (b)       
    Dermabrasion.......................           86.25       15780   Surgical care services or same day  (a)       
                                                                       surgery.                           (b)       
    Hair Restoration...................           86.64       15775   Surgical care services or same day  (a)       
                                                                       surgery.                           (b)       
    Removing Tatoos....................           86.25       15780   Surgical care services or same day  (a)       
                                                                       surgery.                           (b)       
    Chemical Peel......................           86.24       15790   Surgical care services or same day  (a)       
                                                                       surgery.                           (b)       
    Arm/Thigh Dermolipectomy...........           86.83      1583__   Surgical care services or same day  (a)       
                                                                       surgery.                           (b)       
    Brow Lift..........................            86.3       15839   Surgical care services or same day  (a)       
                                                                       surgery.                           (b)       
    ----------------------------------------------------------------------------------------------------------------
    
    Notes on Cosmetic Surgery Charges
    
        aCharges for surgical care are contained in Section I.B. (See 
    notes 7 through 9 on reimbursable rates for further details.)
        bCharges for same day surgery are contained in Section II.L. 
    (See notes 7 through 9 on reimbursable rates for further details.)
    
    Notes on Reimbursable Rates
    
        \1\Percentages are applied to both inpatient and outpatient 
    services provided when billing third party payers (e.g., insurance 
    companies). Pursuant to the provisions of 10 U.S.C. 1095, the inpatient 
    Diagnosis Related Groups are 95 percent hospital and 5 percent 
    professional fee. The outpatient per visit percentages are 57 percent 
    hospital, 33 percent ancillary and 10 percent professional.
        \2\DoD civilian employees located in overseas areas shall be 
    rendered a bill when services are performed. Payment is due 60 days 
    from the date of the bill.
        \3\The cost of DRG (Diagnosis Related Groups) is based on the 
    inpatient full reimbursement rate per hospital discharge, weighted to 
    reflect the intensity of the principal diagnosis involved. The adjusted 
    standardized amounts (ASA) per Relative Weighted Product (RWP) for use 
    in the Direct Care System will be comparable to procedures utilized by 
    Health Care Financing Administration (HFCA) and the Civilian Health and 
    Medical Program for the Uniformed Services (CHAMPUS). These expenses 
    include all direct care expenses associated with direct patient care. 
    The average cost per relative weight product for large urban, other 
    urban, rural and overseas will be published annually as an inpatient 
    standardized amount and will include the cost of inpatient professional 
    services. The DRG rates will apply to reimbursement from all sources, 
    not just third party payers.
        \4\A third party payer may be billed if the total prescription 
    costs exceed $60. The prescription cost is calculated by multiplying 
    the number of units (tablets, capsules, etc.) times the unit cost and 
    adding a $3.95 dispensing fee per prescription.
        \5\Charges for high cost medications/services requested by external 
    providers (Physicians, Dentists, etc.) are only relevant to the Third 
    Party Collection Program. Third party payers (such as insurance 
    companies) shall be billed for high cost services in those instances in 
    which dependents who have medical insurance, seen by providers external 
    to a Military Medical Treatment Facility (MTF), obtain the prescribed 
    service or medication from an MTF. Eligible beneficiaries (family 
    members or retirees with medical insurance) are not personally liable 
    for this cost and shall not be billed by the MTF. The standard cost of 
    high cost medications includes the cost of the drugs plus a dispensing 
    fee, per prescription.
        \6\The attending physician is to complete the common procedure 
    terminology code to indicate the appropriate procedure followed during 
    cosmetic surgery. The appropriate rate will be applied depending on the 
    admission type of the patient, e.g., outpatient surgical, same day/
    ambulatory surgery, or surgical care services.
        \7\Family members of active duty personnel, retirees and their 
    family members, and survivors will be charged cosmetic surgery rates. 
    The patient shall be charged the rate as specified in the FY 1995 
    reimbursable rates for an episode of care. The charges for elective 
    cosmetic surgery are at the full reimbursement rate (designated as the 
    Other rate) in Section I.B., general surgery (designated as the Other 
    rate) in Section II.B., or same day surgery as contained in Section 
    II.L. of this attachment. The patient will be responsible for both the 
    cost of the implant(s) in addition to the prescribed cosmetic surgery 
    rates.
    
        Note: The implants and procedures used for the augmentation 
    mammaplasty are in compliance with Federal Drug Administration 
    guidelines.
    
        \8\Each regional lipectomy will carry a separate charge. Regions 
    include head and neck, abdomen, flanks, and hips.
        \9\These procedures are inclusive in the minor skin lesions. 
    However, CHAMPUS separates them as noted here. All charges are for the 
    entire treatment regardless of the number of visits required.
    
        Dated: October 17, 1994.
    L.M. Bynum,
    Alternate OSD Federal Register Liaison Officer, Department of Defense.
    [FR Doc. 94-26081 Filed 10-21-94; 8:45 am]
    BILLING CODE 5000-04-M
    
    
    

Document Information

Published:
10/24/1994
Department:
Defense Department
Entry Type:
Uncategorized Document
Document Number:
94-26081
Pages:
0-0 (1 pages)
Docket Numbers:
Federal Register: October 24, 1994