Part 2Service and fees

Part 2 Service and fees

<table cellspacing="0" cellpadding="0" style="border-collapse:collapse"><thead><tr><td style="width:38.85pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span>Item</span></p></td><td colspan="2" style="width:251.45pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span>Diagnostic imaging service</span></p></td><td colspan="2" style="width:52.95pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span>Fee ($)</span></p></td></tr></thead><tbody><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span>Group I1</span><span> </span><span>— Ultrasound</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 1</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— General</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55028</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-bottom:3pt"><span>Head, ultrasound scan of, performed by, or on behalf of, a medical practitioner where:</span></p><p class="TableP1a" style="margin-bottom:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a service to which item 55055 or an item in Subgroup 2 or 3 of this Group applies; and</span></p><p class="TableP1a"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the referring medical practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$100.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55029</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Head, ultrasound scan of, where the patient is not referred by a medical practitioner, not being a service associated with a service to which item 55055 or an item in Subgroup 2 or 3 of this Group applies (NR)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$34.85</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55030</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-bottom:3pt"><span>Orbital contents, ultrasound scan of, performed by, or on behalf of, a medical practitioner where:</span></p><p class="TableP1a" style="margin-bottom:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a service to which item 55055 or an item in Subgroup 2</span><span> </span><span>or 3 of this Group applies; and</span></p><p class="TableP1a"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the referring medical practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$100.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55031</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Orbital contents, ultrasound scan of, where the patient is not referred by a medical practitioner, not being a service associated with a service to which item 55055 or an item in Subgroup 2 or 3 of this Group applies (NR)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$34.85</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55032</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-bottom:3pt"><span>Neck, 1 or more structures of, ultrasound scan of, performed by, or on behalf of, a medical practitioner where:</span></p><p class="TableP1a" style="margin-bottom:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a service to which item 55055 or an item in Subgroup 2</span><span> </span><span>or 3 of this Group applies; and</span></p><p class="TableP1a"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the referring medical practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$100.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55033</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Neck, 1 or more structures of, ultrasound scan of, where the patient is not referred by a medical practitioner, not being a service associated with a service to which item 55055 or an item in Subgroup 2 or 3 of this Group applies (NR)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$34.85</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55034</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-bottom:3pt"><span>Breast, 1 or both, ultrasound scan of, performed by, or on behalf of, a medical practitioner where:</span></p><p class="TableP1a" style="margin-bottom:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a service to which item 55055 or an item in Subgroup 2</span><span> </span><span>or 3 of this Group applies; and</span></p><p class="TableP1a"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the referring medical practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$100.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55035</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Breast, 1 or both, ultrasound scan of, where the patient is not referred by a medical practitioner, not being a service associated with a service to which item 55055 or an item in Subgroup 2 or 3 of this Group applies (NR)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$34.85</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55036</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-bottom:3pt"><span>Abdomen, ultrasound scan of, including scan of urinary tract when undertaken, performed by, or on behalf of, a medical practitioner where:</span></p><p class="TableP1a" style="margin-bottom:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a service to which item 55055 or an item in Subgroup 2</span><span> </span><span>or 3 of this Group applies; and</span></p><p class="TableP1a"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the referring medical practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$100.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55037</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Abdomen, ultrasound scan of, including scan of urinary tract when undertaken, where the patient is not referred by a medical practitioner, not being a service associated with a service to which item 55055 or an item in Subgroup 2 or 3 of this Group applies (NR)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$34.85</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55038</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-bottom:3pt"><span>Urinary tract, ultrasound scan of, performed by, or on behalf of, a medical practitioner where:</span></p><p class="TableP1a" style="margin-bottom:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a service to which item 55055 or an item in Subgroup 2</span><span> </span><span>or 3 of this Group applies; and</span></p><p class="TableP1a"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the referring medical practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$100.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55039</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Urinary tract, ultrasound scan of, where the patient is not referred by a medical practitioner, not being a service associated with a service to which item 55055 or an item in Subgroup 2 or 3 of this Group applies (NR)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$34.85</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55040</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-bottom:3pt"><span>Pelvis or abdomen, pregnancy related or pregnancy complication, ultrasound scan of, by any or all approaches, performed by, or on behalf of, a medical practitioner where:</span></p><p class="TableP1a" style="margin-bottom:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a service to which item 55055 or an item in Subgroup 2 or 3 of this Group applies; and</span></p><p class="TableP1a"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the referring medical practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$100.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55041</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Pelvis or abdomen, pregnancy related or pregnancy complication, ultrasound scan of, by any or all approaches, where the patient is not referred by a medical practitioner for ultrasonic examination</span><span> </span><span>— each ultrasonic examination, not exceeding 2 examinations in any 1</span><span> </span><span>pregnancy, not being a service associated with a service to which item 55055 or an item in Subgroup 2 or 3 of this Group applies (NR)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$34.85</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55042</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-bottom:3pt"><span>Pelvis, female, ultrasound scan of, by any or all approaches, performed by, or on behalf of, a medical practitioner where:</span></p><p class="TableP1a" style="margin-bottom:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a service to which item 55055 or an item in Subgroup 2</span><span> </span><span>or 3 of this Group applies; and</span></p><p class="TableP1a"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the referring medical practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$100.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55043</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Pelvis, female, ultrasound scan of, by any or all approaches, where the patient is not referred by a medical practitioner, not being a service associated with a service to which item 55055 or an item in Subgroup 2 or 3 of this Group applies</span><span> </span><span>(NR)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$34.85</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55044</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-bottom:3pt"><span>Pelvis, male, ultrasound scan of, by any or all approaches, performed by, or on behalf of, a medical practitioner where:</span></p><p class="TableP1a" style="margin-bottom:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a service to which item 55055 or an item in Subgroup 2</span><span> </span><span>or 3 of this Group applies; and</span></p><p class="TableP1a"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the referring medical practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$100.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55045</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Pelvis, male, ultrasound scan of, by any or all approaches, where the patient is not referred by a medical practitioner, not being a service associated with a service to which item 55055 or an item in Subgroup 2 or 3 of this Group applies</span><span> </span><span>(NR)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$34.85</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55048</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-bottom:3pt"><span>Scrotum, ultrasound scan of, performed by, or on behalf of, a medical practitioner where:</span></p><p class="TableP1a" style="margin-bottom:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a service to which item 55055 or an item in Subgroup 2</span><span> </span><span>or 3 of this Group applies; and</span></p><p class="TableP1a"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the referring medical practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$100.85</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55049</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Scrotum, ultrasound scan of, where the patient is not referred by a medical practitioner, not being a service associated with a service to which item 55055 or an item in Subgroup 2 or 3 of this Group applies (NR)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$34.85</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55050</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-bottom:3pt"><span>Musculo</span><span> </span><span>— skeletal, 1 or more regions, ultrasound scan of, performed by, or on behalf of, a medical practitioner where:</span></p><p class="TableP1a" style="margin-bottom:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a service to which item 55055 or an item in Subgroup 2</span><span> </span><span>or 3 of this Group applies; and</span></p><p class="TableP1a"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the referring medical practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$100.85</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55051</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Musculo</span><span> </span><span>— skeletal, 1 or more regions, ultrasound scan of, where the patient is not referred by a medical practitioner, not being a service associated with a service to which item 55055 or an item in Subgroup 2 or 3 of this Group applies</span><span> </span><span>(NR)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$34.85</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55052</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-bottom:3pt"><span>Joint, 1 or more, ultrasound scan of, performed by, or on behalf of, a medical practitioner where:</span></p><p class="TableP1a" style="margin-bottom:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a service to which item 55055 or an item in Subgroup 2</span><span> </span><span>or 3 of this Group applies; and</span></p><p class="TableP1a"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the referring medical practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$100.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55053</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Joint, 1 or more, ultrasound scan of, where the patient is not referred by a medical practitioner, not being a service associated with a service to which item 55055 or an item in Subgroup 2 or 3 of this Group applies (NR)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$34.85</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55054</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Ultrasonic cross-sectional echography, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which any other item in this Group applies</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$100.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55055</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Orbital contents, ultrasonic echography of, unidimensional, not being a service associated with a service to which another item in this Group applies (NR)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$60.80</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55058</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Measurement of umbilical blood flow using pulsed wave or continuous wave Doppler techniques after the 26th week of gestation where the patient is referred by a medical practitioner for this procedure and where there is reason to suspect intrauterine growth retardation or a significant risk of foetal death, not being a service associated with a service to which an item in this Group applies</span><span> </span><span>— examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$27.40</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 2</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Cardiac</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55102</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>M-Mode and 2 dimensional real time echocardiographic examination of the heart from at least 2 thoracic windows, performed using a mechanical sector scanner or phased array transducer, with measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques, with recordings on video tape, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this Group applies (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$164.80</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55105</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>M-Mode and 2 dimensional real time echocardiographic examination of the heart from at least 2 thoracic windows, performed using a mechanical sector scanner or phased array transducer, with measurement of cardiac dimensions, with recordings on video tape, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this Group applies</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$93.25</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55112</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>M-Mode and 2 dimensional real time echocardiographic examination of the heart from at least 2 thoracic windows, performed using a mechanical sector scanner or phased array transducer, with measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques, and real time colour flow mapping from at least 2 thoracic windows, with recordings on video tape, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this Group applies</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$259.00</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55118</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-bottom:3pt"><span>Heart, 2 dimensional real time transoesophageal examination of, from at least 2 oesophageal windows:</span></p><p class="TableP1a" style="margin-bottom:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>performed using a mechanical sector scanner or phased array transducer with:</span></p><p class="TableP2i" style="margin-bottom:3pt"><span style="width:25.87pt; text-indent:0pt; display:inline-block"></span><span>(i)</span><span style="width:7.15pt; text-indent:0pt; display:inline-block"> </span><span>measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous Doppler techniques; and</span></p><p class="TableP2i" style="margin-bottom:3pt"><span style="width:22.81pt; text-indent:0pt; display:inline-block"></span><span>(ii)</span><span style="width:7.15pt; text-indent:0pt; display:inline-block"> </span><span>real time colour flow mapping from at least 2 oesophageal windows; and</span></p><p class="TableP2i" style="margin-bottom:3pt"><span style="width:19.76pt; text-indent:0pt; display:inline-block"></span><span>(iii)</span><span style="width:7.15pt; text-indent:0pt; display:inline-block"> </span><span>recordings on video tape; and</span></p><p class="TableP1a"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this Group applies (R) (Anaes. 17708 = 6B + 2T)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$258.40</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55130</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Intra-operative 2 dimensional real time transoesophageal echocardiography incorporating Doppler techniques with colour flow mapping and recording onto video tape, performed during cardiac surgery incorporating sequential assessment of cardiac function before and after the surgical procedure (R) (Anaes. 17710 = 6B + 4T)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$374.20</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 3</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Vascular</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55238</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Duplex scanning, unilateral, involving B</span><span> </span><span>mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the lower limb or of arteries and bypass grafts in the lower limb, below the inguinal ligament, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this Group applies</span><span> </span><span>— 1</span><span> </span><span>examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$170.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55240</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Duplex scanning, unilateral, involving B</span><span> </span><span>mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the lower limb or of arteries and bypass grafts in the lower limb, below the inguinal ligament, including a service referred to in item 11603, 11606 or 11609, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this group applies</span><span> </span><span>— 1 examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$198.05</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55242</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Duplex scanning, unilateral, involving B</span><span> </span><span>mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the lower limb or of arteries and bypass grafts in the lower limb,</span><span> </span><span>below the inguinal ligament, including a service referred to in item 11612, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this Group applies</span><span> </span><span>— 1</span><span> </span><span>examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$219.65</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55244</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Duplex scanning, unilateral, involving B</span><span> </span><span>mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the lower limb, below the inguinal ligament, for acute venous thrombosis, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this Group applies</span><span> </span><span>— 1</span><span> </span><span>examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$170.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55246</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Duplex scanning, unilateral, involving B</span><span> </span><span>mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the lower limb, below the inguinal ligament, for chronic venous disease, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this Group applies</span><span> </span><span>— 1</span><span> </span><span>examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$170.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55248</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Duplex scanning, unilateral, involving B</span><span> </span><span>mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the upper limb or of arteries and bypass grafts in the upper limb, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this Group applies</span><span> </span><span>— 1</span><span> </span><span>examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$170.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55250</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Duplex scanning, unilateral, involving B</span><span> </span><span>mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the upper limb or of arteries and bypass grafts in the upper limb, including a service referred to in item 11603, 11606 or 11609, not being a service associated with a service to which an item in Subgroup</span><span> </span><span>1 (with the exception of item</span><span> </span><span>55054) or 4 of this Group applies</span><span> </span><span>— 1</span><span> </span><span>examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$198.05</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55252</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Duplex scanning, unilateral, involving B</span><span> </span><span>mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the upper limb, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this Group applies</span><span> </span><span>— 1 examination and report</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$170.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55254</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Duplex scanning, unilateral, involving B</span><span> </span><span>mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the upper limb, including a service referred to in item 11603, 11606 or 11609, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this Group applies</span><span> </span><span>— 1</span><span> </span><span>examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$198.05</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55256</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Duplex scanning, bilateral, involving B</span><span> </span><span>mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the lower limbs or of arteries and bypass grafts in the lower limbs, below the inguinal ligament, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this group applies</span><span> </span><span>— 1</span><span> </span><span>examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$170.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55258</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Duplex scanning, bilateral, involving B</span><span> </span><span>mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the lower limbs or of arteries and bypass grafts in the lower limbs, below the inguinal ligament, including a service referred to in item 11603, 11606 or 11609, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this Group applies</span><span> </span><span>— 1 examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$198.05</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55260</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Duplex scanning, bilateral, involving B</span><span> </span><span>mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the lower limbs or of arteries and bypass grafts in the lower limbs, below the inguinal ligament, including a service referred to in item 11612, not being a service associated with a service to which an item in Subgroup 1 (with exception of item 55054) or 4 of this Group applies</span><span> </span><span>— 1</span><span> </span><span>examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$219.65</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55262</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Duplex scanning, bilateral, involving B</span><span> </span><span>mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the lower limbs, below the inguinal ligament, for acute venous thrombosis, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this Group applies</span><span> </span><span>— 1</span><span> </span><span>examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$170.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55264</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Duplex scanning, bilateral, involving B</span><span> </span><span>mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the lower limbs, below the inguinal ligament, for chronic venous disease, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this Group applies</span><span> </span><span>— 1</span><span> </span><span>examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$170.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55266</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Duplex scanning, bilateral, involving B</span><span> </span><span>mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the upper limbs or of arteries and bypass grafts in the upper limbs, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this Group applies</span><span> </span><span>— 1</span><span> </span><span>examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$170.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55268</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Duplex scanning, bilateral, involving B</span><span> </span><span>mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the upper limbs, or of arteries and bypass grafts in the upper limbs, including a service referred to in item 11603, 11606 or 11609, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this Group applies</span><span> </span><span>— 1 examination and report</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$198.05</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55270</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Duplex scanning, bilateral, involving B</span><span> </span><span>mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the upper limbs, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this Group applies</span><span> </span><span>— 1 examination and report</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$170.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55272</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Duplex scanning, bilateral, involving B</span><span> </span><span>mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the upper limbs, including a service referred to in item 11603, 11606 or 11609, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this Group applies</span><span> </span><span>— 1</span><span> </span><span>examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$198.05</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55274</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Duplex scanning, bilateral, involving B</span><span> </span><span>mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of extra-cranial bilateral carotid and vertebral vessels, with or without subclavian and innominate vessels, with or without oculoplethysmography or peri</span><span>‑</span><span>orbital Doppler examination, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this Group applies</span><span> </span><span>— 1 examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$170.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55276</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of intra-abdominal, aorta and iliac arteries or inferior vena cava and iliac veins or of intra-abdominal, aorta and iliac arteries and inferior vena cava and iliac veins, excluding pregnancy related studies, for an examination of not less than 45 minutes duration, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this Group applies</span><span> </span><span>— 1 examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$170.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55278</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of renal or visceral vessels or of renal and visceral vessels, including aorta, inferior vena cava and iliac vessels as required, excluding pregnancy related studies, for an examination of not less than 45 minutes duration, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this Group applies</span><span> </span><span>— 1 examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$170.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55280</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of intra-cranial vessels, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this Group applies</span><span> </span><span>— 1</span><span> </span><span>examination and report</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$170.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55282</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of cavernosal artery of the penis following intracavernosal administration of a vasoactive agent, performed during the period of pharmacological activity of the injected agent, to confirm a diagnosis of vasular aetiology for impotence, where a specialist in diagnostic radiology, nuclear medicine, urology, general surgery (sub-specialising in vascular surgery) or a consultant physician in nuclear medicine attends the patient in person at the practice location where the service is rendered, immediately prior to or for a period during the rendering of the service, and that specialist or consultant physician interprets the results and prepares a report, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this Group applies</span><span> </span><span>— examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$170.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55284</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-bottom:3pt"><span>Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of cavernosal tissue of the penis to confirm a diagnosis and, where indicated, assess the progress and management of:</span></p><p class="TableP1a" style="margin-bottom:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>priapism; or</span></p><p class="TableP1a" style="margin-bottom:3pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>fibrosis of any type; or</span></p><p class="TableP1a" style="margin-bottom:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(c)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>fracture of the tunica; or</span></p><p class="TableP1a" style="margin-bottom:6pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(d)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>arteriovenous malformations;</span></p><p class="TableText"><span>where a specialist in diagnostic radiology, nuclear medicine, urology, general surgery (sub-specialising in vascular surgery) or a consultant physician in nuclear medicine attends the patient in person at the practice location where the service is rendered, immediately prior to or for a period during the rendering of the service, and that specialist or consultant physician interprets the results and prepares a report, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this Groups applies</span><span> </span><span>— 1</span><span> </span><span>examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>170.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55286</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Duplex scanning, unilateral or bilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of vessels not otherwise specified (excluding the cavernosal artery and the dorsal artery of the penis), not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054), 3 or 4 of this Group applies</span><span> </span><span>— 1 examination and report</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$170.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55288</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-bottom:6pt"><span>Two examinations of a kind referred to in items 55238 to 55286 inclusive (excluding items 55282 and 55284) except for an examination of the kind referred to in the items shown in the blocks below, where only one examination can be provided from the items in any one block:</span></p><p class="TableText" style="margin-bottom:6pt"><span>block</span><span> </span><span>(a)</span><span> </span><span>— items 55238, 55240, 55242, 55256, 55258 and 55260;</span></p><p class="TableText" style="margin-bottom:6pt"><span>block</span><span> </span><span>(b)</span><span> </span><span>— items 55244, 55246, 55262 and 55264;</span></p><p class="TableText" style="margin-bottom:6pt"><span>block</span><span> </span><span>(c)</span><span> </span><span>— items 55248, 55250, 55266 and 55268;</span></p><p class="TableText" style="margin-bottom:6pt"><span>block</span><span> </span><span>(d)</span><span> </span><span>— items 55252, 55254, 55270 and 55272;</span></p><p class="TableText" style="margin-bottom:6pt"><span>block</span><span> </span><span>(e)</span><span> </span><span>— item 55276 and 55278;</span></p><p class="TableText"><span>not being a service associated with a service to which an item in Subgroup 1</span><span> </span><span>(with the exception of item 55054), 3 (where the examination is of a kind referred to in item 55286) or 4 of this Group applies</span><span> </span><span>— examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>300.25</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55290</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-bottom:6pt"><span>Three examinations of a kind referred to in items 55238 to 55286 inclusive (excluding items 55282 and 55284) except for an examination of the kind referred to in the items shown in the blocks below, where only one examination can be provided from the items in any one block:</span></p><p class="TableText" style="margin-bottom:6pt"><span>block</span><span> </span><span>(a)</span><span> </span><span>— items 55238, 55240, 55242, 55256, 55258 and 55260;</span></p><p class="TableText" style="margin-bottom:6pt"><span>block</span><span> </span><span>(b)</span><span> </span><span>— items 55244, 55246, 55262 and 55264;</span></p><p class="TableText" style="margin-bottom:6pt"><span>block</span><span> </span><span>(c)</span><span> </span><span>— items 55248, 55250, 55266 and 55268;</span></p><p class="TableText" style="margin-bottom:6pt"><span>block</span><span> </span><span>(d)</span><span> </span><span>— items 55252, 55254, 55270 and 55272;</span></p><p class="TableText" style="margin-bottom:6pt"><span>block</span><span> </span><span>(e)</span><span> </span><span>— items 55276 and 55278;</span></p><p class="TableText"><span>not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054), 3 (where the examination is of a kind referred to in item</span><span> </span><span>55286) or 4 of this Group applies</span><span> </span><span>— examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$300.25</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 4</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Urological</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55300</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-bottom:3pt"><span>Prostate, bladder base and urethra, transrectal ultrasound scan of, where performed:</span></p><p class="TableP1a" style="margin-bottom:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>personally by a medical practitioner</span><span> </span><span>(not being the medical practitioner who assessed the patient as specified in paragraph (c)) using a transducer probe or probes that:</span></p><p class="TableP2i" style="margin-bottom:3pt"><span style="width:25.87pt; text-indent:0pt; display:inline-block"></span><span>(i)</span><span style="width:7.15pt; text-indent:0pt; display:inline-block"> </span><span>have a nominal frequency of 7</span><span> </span><span>to 7.5 megahertz or a nominal frequency range which includes frequencies of 7 to 7.5</span><span> </span><span>megahertz; and</span></p><p class="TableP2i" style="margin-bottom:3pt"><span style="width:22.81pt; text-indent:0pt; display:inline-block"></span><span>(ii)</span><span style="width:7.15pt; text-indent:0pt; display:inline-block"> </span><span>can obtain both axial and sagittal scans in 2 planes at right angles; and</span></p><p class="TableP1a"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>following a digital rectal examination of the prostate by that medical practitioner; and</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$100.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span></span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableP1a" style="margin-bottom:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(c)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>on a patient who has been assessed by a specialist in urology, radiation oncology or medical oncology or a consultant physician in medical oncology who has:</span></p><p class="TableP2i" style="margin-bottom:3pt"><span style="width:25.87pt; text-indent:0pt; display:inline-block"></span><span>(i)</span><span style="width:7.15pt; text-indent:0pt; display:inline-block"> </span><span>examined the patient in the 60</span><span> </span><span>days prior to the scan; and</span></p><p class="TableP2i"><span style="width:22.81pt; text-indent:0pt; display:inline-block"></span><span>(ii)</span><span style="width:7.15pt; text-indent:0pt; display:inline-block"> </span><span>recommended the scan for the management of the patient’s current prostatic disease (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span></span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55303</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-bottom:3pt"><span>Prostate, bladder base and urethra, transrectal ultrasound scan of, where performed:</span></p><p class="TableP1a" style="margin-bottom:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>personally by a medical practitioner who undertook the assessment referred to in paragraph (c) using a transducer probe or probes that:</span></p><p class="TableP2i" style="margin-bottom:3pt"><span style="width:25.87pt; text-indent:0pt; display:inline-block"></span><span>(i)</span><span style="width:7.15pt; text-indent:0pt; display:inline-block"> </span><span>have a nominal frequency of 7 to 7.5 megahertz or a nominal frequency range which includes frequencies of 7 to 7.5 megahertz; and</span></p><p class="TableP2i" style="margin-bottom:3pt"><span style="width:22.81pt; text-indent:0pt; display:inline-block"></span><span>(ii)</span><span style="width:7.15pt; text-indent:0pt; display:inline-block"> </span><span>can obtain both axial and sagittal scans in 2 planes at right angles; and</span></p><p class="TableP1a" style="margin-bottom:3pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>following a digital rectal examination of the prostate by that medical practitioner; and</span></p><p class="TableP1a" style="margin-bottom:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(c)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>on a patient who has been assessed by a specialist in urology, radiation oncology or medical oncology or a consultant physician in medical oncology who has:</span></p><p class="TableP2i" style="margin-bottom:3pt"><span style="width:25.87pt; text-indent:0pt; display:inline-block"></span><span>(i)</span><span style="width:7.15pt; text-indent:0pt; display:inline-block"> </span><span>examined the patient in the 60</span><span> </span><span>days prior to the scan; and</span></p><p class="TableP2i"><span style="width:22.81pt; text-indent:0pt; display:inline-block"></span><span>(ii)</span><span style="width:7.15pt; text-indent:0pt; display:inline-block"> </span><span>recommended the scan for the management of the patient’s current prostatic disease (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$100.45</span></p></td></tr><tr><td colspan="4" style="width:363.65pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span>Group I2</span><span> </span><span>— Computerised tomography</span><span> </span><span>— examination and report</span></p></td><td style="vertical-align:top"></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>56001</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of brain without intravenous contrast medium, not being a service to which item 57001 applies (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$198.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>56007</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of brain with intravenous contrast medium and with any scans of the brain prior to intravenous contrast injection when undertaken, not being a service to which item 57007 applies (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$253.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>56010</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of pituitary fossa with or without intravenous contrast medium and with or without brain scan when undertaken (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$287.15</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>56013</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of orbits with or without intravenous contrast medium and with or without brain scan when undertaken (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$287.15</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>56016</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of middle ear and temporal bone, unilateral or bilateral, with or without intravenous contrast medium and with or without brain scan when undertaken (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$341.95</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>56019</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of temporal bones with air study (including reconstructions), with intrathecal injection but not including an associated brain scan</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$420.10</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>56022</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of facial bones, para nasal sinuses or both without intravenous contrast medium (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$227.50</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>56028</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of facial bones, para nasal sinuses or both with intravenous contrast medium and with any scans of the facial bones, para nasal sinuses or both prior to intravenous contrast injection, when undertaken (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$338.60</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>56101</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of soft tissues of neck, including larynx, pharynx, upper oesophagus and salivary glands (not associated with cervical spine) without intravenous contrast medium, not being a service to which item 56801 applies (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$233.95</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>56107</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of soft tissues of neck, including larynx, pharynx, upper oesophagus and salivary glands (not associated with cervical spine) with intravenous contrast medium and with any scans of soft tissues of neck, including larynx, pharynx, upper oesophagus and salivary glands (not associated with cervical spine) prior to intravenous contrast injection, when undertaken, not being a service associated with a service</span><span> </span><span>to which item 56807 applies (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$345.00</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>56210</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of spine, 1 or more regions, without intravenous contrast medium, payable once only whether 1 or more attendances are required to complete the service (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$246.25</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>56216</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of spine, 1 or more regions, with intravenous contrast medium and with any scans of the spine, prior to intravenous contrast injection, when undertaken, only 1 benefit is payable whether 1 or more attendances are required to complete the service (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$356.85</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>56219</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of spine, 1 or more regions with intrathecal contrast medium, including the preparation for intrathecal injection of contrast medium and any associated plain X-rays, not being a service to which item 59724 applies (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$331.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>56301</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of chest, including lungs, mediastinum, chest wall and pleura, with or without scans of the upper abdomen, without intravenous contrast medium, not being a service to which item 56801 or 57001 applies (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$300.55</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>56307</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of chest, including lungs, mediastinum, chest wall and pleura, with or without scans of the upper abdomen, with intravenous contrast medium and with any scans of chest, including lungs, mediastinum, chest wall and pleura and upper abdomen prior to intravenous contrast injection, when undertaken, not being a service to which item 56807 or 57007 applies (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$406.60</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>56401</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of upper abdomen only (diaphragm to iliac crest) without intravenous contrast medium, not being a service to which item 56301, 56501, 56801 or 57001 applies (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$255.00</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>56407</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of upper abdomen only (diaphragm to iliac crest), with intravenous contrast medium and with any scans of upper abdomen (diaphragm to iliac crest) prior to intravenous contrast injection, when undertaken, not being a service to which item 56307, 56507, 56807 or 57007 applies (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$364.85</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>56409</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of pelvis only (iliac crest to pubic symphysis) without intravenous contrast medium not being a service associated with a service to which item 56401 applies</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$255.00</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>56412</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of pelvis only (iliac crest to pubic symphysis), with intravenous contrast medium and with any scans of pelvis (iliac crest to pubic symphysis) prior to intravenous contrast injection, when undertaken, not being a service to which item 56407 applies (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$364.85</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>56501</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of upper abdomen and pelvis without intravenous contrast medium, not being a service to which item 56801 or 57001 applies (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$388.30</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>56507</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of upper abdomen and pelvis with intravenous contrast medium and with any scans of upper abdomen and pelvis prior to intravenous contrast injection, when undertaken, not being a service to which item 56807 or 57007 applies (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$490.00</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>56619</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of extremities, 1 or more regions without intravenous contrast medium, payable once only, whether 1 or more attendances are required to complete the service (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$225.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>56625</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of extremities, 1 or more regions with intravenous contrast medium and with any scans of extremities, prior to intravenous contrast injection, when undertaken, only 1</span><span> </span><span>benefit is payable whether 1 or more attendances are required to complete the service (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$336.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>56801</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of chest, abdomen and pelvis with or without scans of soft tissues of neck without intravenous contrast medium (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$469.00</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>56807</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of chest, abdomen and pelvis with or without scans of soft tissues of neck with intravenous contrast medium and with any scans of chest, abdomen and pelvis with or without scans of soft tissue of neck prior to intravenous contrast injection, when undertaken (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$570.70</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57001</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of brain and chest with or without scans of upper abdomen without intravenous contrast medium (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$469.10</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57007</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— scan of brain and chest with or without scans of upper abdomen with intravenous contrast medium and with any scans of brain and chest and upper abdomen prior to intravenous contrast injection, when undertaken (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$570.80</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57201</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— pelvimetry (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$156.05</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57341</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which another item in this table applies (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$486.60</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57350</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Computerised tomography</span><span> </span><span>— spiral angiography with intravenous contrast medium and with any scans prior to intravenous contrast injection when undertaken</span><span> </span><span>— 1 or more spiral data acquisitions, including image editing, and maximum intensity projections or 3</span><span> </span><span>dimensional surface shaded display, including multiple projections, not being a service to which another item in this group applies (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$531.10</span></p></td></tr><tr><td colspan="5" style="width:364.9pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableColHead"><span>Group I3</span><span> </span><span>— Diagnostic radiology</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 1</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Radiographic examination of extremities and report</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57506</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Hand, wrist, forearm, elbow or humerus</span><span> </span><span>(NR)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$31.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57509</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Hand, wrist, forearm, elbow or humerus</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$41.85</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57512</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Hand, wrist and forearm, or forearm and elbow, or elbow and humerus (NR)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$42.60</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57515</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Hand, wrist and forearm, or forearm and elbow, or elbow and humerus (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$56.85</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57518</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Foot, ankle, leg, knee or femur (NR)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$34.25</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57521</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Foot, ankle, leg, knee or femur (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$45.70</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57524</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Foot and ankle, or ankle and leg, or leg and knee, or knee and femur (NR)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$51.95</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57527</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Foot and ankle, or ankle and leg, or leg and knee, or knee and femur (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$69.25</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead" style="page-break-before:always"><span style="font-weight:normal; font-style:italic">Subgroup 2</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Radiographic examination of shoulder or pelvis and report</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57700</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Shoulder or scapula (NR)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$42.60</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57703</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Shoulder or scapula (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$56.85</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57706</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Clavicle (NR)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$34.25</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57709</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Clavicle (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$45.70</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57712</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Hip joint (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$49.65</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57715</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Pelvic girdle (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$64.20</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57721</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Femur, internal fixation of neck or intertrochanteric (pertrochanteric) fracture</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$104.50</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 3</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Radiographic examination of head and report</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57900</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Skull or cephalometry (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$67.95</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57903</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Sinuses (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$49.65</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57906</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Mastoids (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$67.95</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57909</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Petrous temporal bones (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$67.95</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57912</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Facial bones</span><span> </span><span>— orbit, maxilla or malar, any or all (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$49.65</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57915</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Mandible, not by orthopantomography technique (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$49.65</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57918</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Salivary calculus (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$49.65</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57921</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Nose (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$49.65</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57924</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Eye (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$49.65</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57927</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Temporo-mandibular joints (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$52.25</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57930</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Teeth</span><span> </span><span>— single area (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$34.65</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57933</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Teeth</span><span> </span><span>— full mouth (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$82.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57936</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Teeth</span><span> </span><span>— orthopantomography (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$49.85</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57939</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Palato-pharyngeal studies with fluoroscopic screening (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$67.95</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57942</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Palato-pharyngeal studies without fluoroscopic screening (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$52.25</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>57945</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Larynx, lateral airways and soft tissues of the neck, not being a service associated with a service to which item 57939 or 57942 applies (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$45.70</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 4</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Radiographic examination of spine and report</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58100</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Spine</span><span> </span><span>— cervical (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$70.75</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58103</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Spine</span><span> </span><span>— thoracic (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$58.10</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58106</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Spine</span><span> </span><span>— lumbo-sacral (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$81.05</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58109</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Spine</span><span> </span><span>— sacro-coccygeal (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$49.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58112</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Spine</span><span> </span><span>— 2 regions (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$102.40</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58115</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Spine</span><span> </span><span>— 3 or more regions (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$140.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 5</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Bone age study and skeletal surveys and report</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58300</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Bone age study (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$42.20</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58306</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Skeletal survey (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$94.10</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 6</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Radiographic examination of thoracic region and report</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58500</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Chest (lung fields) by direct radiography</span><span> </span><span>(NR)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$37.20</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58503</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Chest (lung fields) by direct radiography</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$49.65</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58506</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Chest (lung fields) by direct radiography with fluoroscopic screening (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$64.00</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58509</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Thoracic inlet or trachea (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$41.85</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58521</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Left ribs, right ribs or sternum (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$45.70</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58524</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Left and right ribs, left ribs and sternum, or right ribs and sternum (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$59.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58527</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Left ribs, right ribs and sternum (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$73.15</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 7</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Radiographic examination of urinary tract and report</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58700</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Plain renal only (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$48.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58706</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Intravenous pyelography, with or without preliminary plain films and with or without tomography</span><span> </span><span>— examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$166.30</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58715</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Antegrade or retrograde pyelography, with or without preliminary plain films and with preparation and contrast injection</span><span> </span><span>— 1</span><span> </span><span>side</span><span> </span><span>— examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$159.55</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58718</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Retrograde cystography or retrograde urethrography with or without preliminary plain films and with preparation and contrast injection</span><span> </span><span>— examination and report (R) (Anaes. 17705 = 3B + 2T)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$132.80</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58721</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Retrograde micturating cysto-urethrography, with preparation and contrast injection</span><span> </span><span>— examination and report (R) (Anaes. 17705 = 3B + 2T)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$145.55</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 8</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Radiographic examination of alimentary tract and biliary system and report</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58900</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Plain abdominal only, not being a service associated with a service to which item 58909, 58912, 58915 or 58924 applies</span><span> </span><span>(NR)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$37.60</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58903</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Plain abdominal only, not being a service associated with a service to which item 58909, 58912, 58915 or 58924 applies (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$50.10</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58909</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Barium or other opaque meal of 1 or more of pharynx, oesophagus, stomach or duodenum, with or without preliminary plain films of pharynx, chest or duodenum, not being a service associated with a service to which item 57939, 57942 or 57945 applies</span><span> </span><span>— examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$94.75</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58912</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Barium or other opaque meal of oesophagus, stomach, duodenum and follow through to colon, with or without screening of chest and with or without preliminary plain film (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$116.10</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58915</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Barium or other opaque meal, small bowel series only, with or without preliminary plain film (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$83.10</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58916</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Small bowel enema, barium or other opaque study of the small bowel, including duodenal intubation, with or without preliminary plain films, not being a service associated with a service to which item 30488 applies</span><span> </span><span>— examination and report (R) (Anaes. 17707 = 5B + 2T)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$145.80</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58921</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Opaque enema, with or without air contrast study and with or without preliminary plain films</span><span> </span><span>— examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$142.10</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58924</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Graham’s test (cholecystography), with preliminary plain films and with or without tomography</span><span> </span><span>— examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$88.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58927</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Cholegraphy direct, with or without preliminary plain films and with preparation and contrast injection, not being a service associated with a service to which item 30439 applies</span><span> </span><span>— examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$80.50</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58933</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Cholegraphy, percutaneous transhepatic, with or without preliminary plain films and with preparation and contrast injection</span><span> </span><span>— examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$216.50</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58936</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Cholegraphy, drip infusion, with or without preliminary plain films, with preparation and contrast injection and with or without tomography</span><span> </span><span>— examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$206.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>58939</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Defaecogram (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$146.70</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 9</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Radiographic examination for localisation of foreign bodies and report</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59103</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Foreign body, localisation of and report, not being a service to which another item in this Group applies (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Amount under rule</span><span> </span><span>10</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 10</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Radiographic examination of breasts and report</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59300</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Radiographic examination of both breasts, (with or without thermography) and report if:</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$82.40</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span></span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableP1a" style="margin-bottom:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the patient is referred with a specific request for this procedure; and</span></p><p class="TableP1a"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>there is reason to suspect the presence of malignancy in the breasts because of:</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span></span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span></span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableP2i"><span style="width:25.87pt; text-indent:0pt; display:inline-block"></span><span>(i)</span><span style="width:7.15pt; text-indent:0pt; display:inline-block"> </span><span>the past occurrence of breast malignancy in the patient or members of the patient’s family; or</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span></span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span></span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableP2i"><span style="width:22.81pt; text-indent:0pt; display:inline-block"></span><span>(ii)</span><span style="width:7.15pt; text-indent:0pt; display:inline-block"> </span><span>symptoms or indications of malignancy found on an examination of the patient by a medical practitioner (R) (S)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span></span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="page-break-inside:avoid; page-break-after:avoid"><span>59303</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="page-break-inside:avoid; page-break-after:avoid"><span>Radiographic examination of 1 breast, (with or without thermography) and report if:</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="page-break-inside:avoid; page-break-after:avoid"><span>$49.70</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span></span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableP1a" style="margin-bottom:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the patient is referred with a specific request for this procedure; and</span></p><p class="TableP1a"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>there is reason to suspect the presence of malignancy in the breast because of:</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span></span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span></span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableP2i"><span style="width:25.87pt; text-indent:0pt; display:inline-block"></span><span>(i)</span><span style="width:7.15pt; text-indent:0pt; display:inline-block"> </span><span>the past occurrence of breast malignancy in the patient or members of the patient’s family; or</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span></span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span></span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableP2i"><span style="width:22.81pt; text-indent:0pt; display:inline-block"></span><span>(ii)</span><span style="width:7.15pt; text-indent:0pt; display:inline-block"> </span><span>symptoms or indications of malignancy found on an examination of the patient by a medical practitioner (R) (S)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span></span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59306</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Mammary ductogram (galactography)</span><span> </span><span>— 1</span><span> </span><span>breast (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$95.05</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59309</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Mammary ductogram, (galactography)</span><span> </span><span>— 2</span><span> </span><span>breasts (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$190.10</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59312</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Radiographic examination of both breasts, in conjunction with a surgical procedure on each breast, using interventional techniques</span><span> </span><span>— examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$82.40</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59314</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Radiographic examination of 1 breast, in conjunction with a surgical procedure using interventional techniques</span><span> </span><span>— examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$49.70</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59318</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Radiographic examination of excised breast tissue to confirm satisfactory excision of 1</span><span> </span><span>or more lesions in 1 or both breasts following pre-operative localisation in conjunction with a service under item 30361</span><span> </span><span>— examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$44.60</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 11</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Radiographic examination in connection with pregnancy and report</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59503</span></p></td><td style="width:236.65pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Pelvimetry, not being a service associated with a service to which item 57201 applies (R)</span></p></td><td colspan="3" style="width:67.75pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$94.10</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 12</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Radiographic examination with opaque or contrast media and report</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59700</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Discography, each disc, with or without preliminary plain films and with preparation and contrast injection</span><span> </span><span>— examination and report (R) (Anaes. 17707 = 5B + 2T)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$101.65</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59703</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Dacryocystography, 1 side, with or without preliminary plain film and with preparation and contrast injection</span><span> </span><span>— examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$79.90</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59712</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Hysterosalpingography, with without preliminary plain films and with preparation and contrast injection</span><span> </span><span>— examination and report (R) (Anaes. 17705 = 3B + 2T)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$119.75</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59715</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Bronchography, 1 side, with or without preliminary plain films and with preparation and contrast injection</span><span> </span><span>— examination and report (R) (Anaes. 17709 = 6B + 3T)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$151.15</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59718</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Phlebography, 1 side, with or without preliminary plain films and with preparation and contrast injection</span><span> </span><span>— examination and report (R) (Anaes. 17708 = 5B + 3T)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$141.80</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59724</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Myelography, 1 or more regions, with or without preliminary plain films and with preparation and contrast injection, not being a service associated with a service to which item 56219 applies</span><span> </span><span>— examination and report (R) (Anaes. 17712 = 7B + 5T)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$238.40</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59733</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Sialography, 1 side, with preparation and contrast injection, not being a service associated with a service to which item 57918 applies</span><span> </span><span>— examination and report</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$113.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59736</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Vasoepididymography, 1 side, for other than an investigation for reversal of previous sterilisation</span><span> </span><span>— examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$65.30</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59739</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Sinogram or fistulogram, 1 or more regions, with or without preliminary plain films and with preparation and contrast injection</span><span> </span><span>— examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$77.65</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59751</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Arthrography, each joint, excluding the facet (zygapophyseal) joints of the spine, single or double contrast study, with or without preliminary plain films and with preparation and contrast injection</span><span> </span><span>— examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$146.50</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59754</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Lymphangiography, one or both sides, with preliminary plain films and follow-up radiography and with preparation and contrast injection</span><span> </span><span>— examination and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$231.00</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59760</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Peritoneogram (herniography) with or without contrast medium including preparation</span><span> </span><span>— performed on a person over 14 years of age (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$121.25</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59763</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Air insufflation during video-fluoroscopic imaging, including associated consultation (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$140.95</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 13</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Angiography and report</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59900</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Serial angiocardiography (rapid cassette changing)</span><span> </span><span>— each series (R) (Anaes. 17711 = 7B + 4T)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$88.05</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59903</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Serial angiocardiography (single plane)</span><span> </span><span>— each series (R) (Anaes. 17711 = 7B + 4T)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$121.25</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59906</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Serial angiocardiography (bi-plane)</span><span> </span><span>— each series (R) (Anaes. 17711 = 7B + 4T)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$121.25</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59912</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Selective coronary arteriography (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$322.95</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59915</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Cerebral angiography</span><span> </span><span>— 1 side (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$82.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59918</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Arteriography, peripheral</span><span> </span><span>— 1 side (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$104.50</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59921</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Aortography (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$104.50</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59924</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Selective arteriography</span><span> </span><span>— per injection and film or data acquisition run (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$104.50</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>59970</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Angiography with fluoroscopy and image acquisition using a mobile image intensifier, one or more regions including any preliminary plain films, preparation and contrast injection (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$159.50</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60000</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Digital subtraction angiography, examination of head and neck with or without arch aortography</span><span> </span><span>— 1 to 3 data acquisition runs (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$534.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60003</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Digital subtraction angiography, examination of head and neck with or without arch aortography</span><span> </span><span>— 4 to 6 data acquisition runs (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$783.75</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60006</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Digital subtraction angiography, examination of head and neck with or without arch aortography</span><span> </span><span>— 7 to 9 data acquisition runs (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$1114.50</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60009</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Digital subtraction angiography, examination of head and neck with or without arch aortography</span><span> </span><span>— 10 or more data acquisition runs (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$1304.25</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60012</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Digital subtraction angiography, examination of thorax</span><span> </span><span>— 1 to 3 data acquisition runs (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$534.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60015</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Digital subtraction angiography, examination of thorax</span><span> </span><span>— 4 to 6 data acquisition runs (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$783.75</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60018</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Digital subtraction angiography, examination of thorax</span><span> </span><span>— 7 to 9 data acquisition runs (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$1114.50</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60021</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Digital subtraction angiography, examination of thorax</span><span> </span><span>— 10 or more data acquisition runs (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$1304.25</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60024</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Digital subtraction angiography, examination of abdomen</span><span> </span><span>— 1 to 3 data acquisition runs (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$534.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60027</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Digital subtraction angiography, examination of abdomen</span><span> </span><span>— 4 to 6 data acquisition runs (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$783.75</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60030</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Digital subtraction angiography, examination of abdomen</span><span> </span><span>— 7 to 9 data acquisition runs (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$1114.50</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60033</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Digital subtraction angiography, examination of abdomen</span><span> </span><span>— 10 or more data acquisition runs (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$1304.25</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60036</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Digital subtraction angiography, examination of upper limb or limbs</span><span> </span><span>— 1 to 3 data acquisition runs (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$534.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60039</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Digital subtraction angiography, examination of upper limb or limbs</span><span> </span><span>— 4 to 6 data acquisition runs (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$783.75</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60042</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Digital subtraction angiography, examination of upper limb or limbs</span><span> </span><span>— 7 to 9 data acquisition runs (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$1114.50</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60045</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Digital subtraction angiography, examination of upper limb or limbs</span><span> </span><span>— 10 or more data acquisition runs (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$1304.25</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60048</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Digital subtraction angiography, examination of lower limb or limbs</span><span> </span><span>— 1 to 3 data acquisition runs (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$534.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60051</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Digital subtraction angiography, examination of lower limb or limbs</span><span> </span><span>— 4 to 6 data acquisition runs (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$783.75</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60054</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Digital subtraction angiography, examination of lower limb or limbs</span><span> </span><span>— 7 to</span><br><span>9 data acquisition runs (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$1114.50</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60057</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Digital subtraction angiography, examination of lower limb or limbs</span><span> </span><span>— 10 or more data acquisition runs (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$1304.25</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60060</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Digital subtraction angiography, examination of aorta and lower limb or limbs</span><span> </span><span>— 1 to 3 data acquisition runs (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$534.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60063</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Digital subtraction angiography, examination of aorta and lower limb or limbs</span><span> </span><span>— 4 to 6 data acquisition runs (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$783.75</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60066</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Digital subtraction angiography, examination of aorta and lower limb or limbs</span><span> </span><span>— 7 to 9 data acquisition runs (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$1114.50</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60069</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Digital subtraction angiography, examination of aorta and lower limb or limbs</span><span> </span><span>— 10 or more data acquisition runs</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$1304.25</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60072</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Selective arteriography or selective venography by digital subtraction angiography technique</span><span> </span><span>— 1 vessel (NR)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$45.55</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60075</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Selective arteriography or selective venography by digital subtraction angiography technique</span><span> </span><span>— 2 vessels (NR)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$91.10</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60078</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Selective arteriography or selective venography by digital subtraction angiography technique</span><span> </span><span>— 3 or more vessels</span><span> </span><span>(NR)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$136.65</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 14</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Tomography and report</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60100</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Tomography of any region and report (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$64.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 15</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Fluoroscopic examination and report</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60500</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Fluoroscopy, with general anaesthesia, not being a service associated with a radiographic examination (R) (Anaes. 17707 = 5B + 2T)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$45.70</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60503</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Fluoroscopy, without general anaesthesia, not being a service associated with a radiographic examination (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$31.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60506</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Fluoroscopy using a mobile image intensifier, in conjunction with a surgical procedure lasting less than 1 hour, not being a service associated with a service to which another item in this table applies</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$67.15</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60509</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Fluoroscopy using a mobile image intensifier, in conjunction with a surgical procedure lasting 1 hour or more, not being a service associated with a service to which another item in this table applies</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$104.10</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 16</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Preparation for radiological procedure</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60903</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Cerebral angiography, 1 side</span><span> </span><span>— percutaneous, catheter or open exposure, when used in association with a service to which item 59900, 59903, 59906, 59912, 59915, 59918, 59921, 59924 or 59970 applies, not being a service associated with a service to which items 60000 to 60078 inclusive apply (NR) (Anaes. 17710 = 5B + 5T)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$135.00</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60915</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Aortography, when used in association with a service to which item 59900, 59903, 59906, 59912, 59915, 59918, 59921, 59924 or 59970 applies, not being a service associated with a service to</span><span> </span><span>which items 60000 to 60078 inclusive apply (NR) (Anaes. 17709 = 5B + 4T)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$74.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60918</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Arteriography (peripheral) or phlebography</span><span> </span><span>— 1 vessel, when used in association with a service to which item 59900, 59903, 59906, 59912, 59915, 59918, 59921, 59924 or 59970 applies, not being a service associated with a service to which items 60000 to 60078 inclusive apply (NR) (Anaes. 17708 = 5B + 3T)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$55.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>60927</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Selective arteriogram or phlebogram, when used in association with a service to which item 59900, 59903, 59906, 59912, 59915, 59918, 59921, 59924 or 59970 applies, not being a service associated with a service to which items 60000 to 60078 inclusive apply (NR)</span><span> </span><span>(Anaes. 17708 = 5B + 3T)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$45.75</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 17</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Interventional Techniques</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61109</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Fluoroscopy in an angiography suite with image intensification, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which another item in this table applies (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$272.60</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span>Group I4</span><span> </span><span>— Nuclear medicine imaging</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61302</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Single stress or rest myocardial perfusion study</span><span> </span><span>— planar imaging (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$385.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61303</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Single stress or rest myocardial perfusion study</span><span> </span><span>— with single photon emission tomography and with planar imaging when undertaken (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$497.30</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61306</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Combined stress and rest, stress and re-injection or rest and redistribution myocardial perfusion study, including delayed imaging or re-injection protocol on a subsequent occasion</span><span> </span><span>— planar imaging (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$609.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61307</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Combined stress and rest, stress and re</span><span>‑</span><span>injection or rest and redistribution myocardial perfusion study, including delayed imaging or re-injection protocol on a subsequent occasion</span><span> </span><span>— with single photon emission tomography and with planar imaging when undertaken (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$741.65</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61310</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Myocardial infarct-avid study, with planar imaging and single photon emission tomography, or planar imaging, or single photon emission tomography (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$315.40</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61313</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Gated cardiac blood pool study, (equilibrium), with planar imaging and single photon emission tomography, or planar imaging, or single photon emission tomography (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$265.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61314</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Gated cardiac blood pool study, and first pass blood flow or cardiac shunt study, with planar imaging and single photon emission tomography, or planar imaging, or single photon emission tomography (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$365.60</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61316</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Gated cardiac blood pool study, with intervention, with planar imaging and single photon emission tomography, or planar imaging, or single photon emission tomography (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$332.20</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61317</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Gated cardiac blood pool study, with intervention and first pass blood flow study or cardiac shunt study, with planar imaging and single photon emission tomography, or planar imaging, or single photon emission tomography (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$427.75</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61320</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Cardiac first pass blood flow study or cardiac shunt study, not being a service to which another item in this Group applies</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$196.60</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61328</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Lung perfusion study, with planar imaging and single photon emission tomography, or planar imaging, or single photon emission tomography (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$186.60</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61340</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Lung ventilation study using aerosol, technegas or xenon gas, with planar imaging and single photon emission tomography, or planar imaging, or single photon emission tomography (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$217.30</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61348</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Lung perfusion study and lung ventilation study using aerosol, technegas or xenon gas, with planar imaging and single photon emission tomography, or planar imaging, or single photon emission tomography (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$383.20</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61352</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Liver and spleen study (colloid)</span><span> </span><span>— planar imaging (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$222.70</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61353</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Liver and spleen study (colloid), with single photon emission tomography and with planar imaging when undertaken (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$331.95</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61356</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Red blood cell spleen or liver study, including single photon emission tomography when undertaken (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$337.30</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61360</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Hepatobiliary study, including morphine administration or pre-treatment with cholecystokinin (CCK) when undertaken</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$350.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61361</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Hepatobiliary study with formal quantification following baseline imaging, using an infusion of cholecystokinin (CCK) (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$401.20</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61364</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Bowel haemorrhage study (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$426.75</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61368</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Meckel’s diverticulum study (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$191.60</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61372</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Salivary study (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$191.60</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61373</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Gastro-oesophageal reflux study, including delayed imaging on a separate occasion when undertaken (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$420.55</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61376</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Oesophageal clearance study (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$123.15</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61381</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Gastric emptying study, using single tracer (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$517.90</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61383</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Combined solid and liquid gastric emptying study using dual isotope technique or the same isotope on separate days (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$561.40</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61384</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Radionuclide colonic transit study (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$620.15</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61386</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Renal study, including perfusion and renogram images and computer analysis or cortical study with planar imaging (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$285.50</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61387</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Renal cortical study, with single photon emission tomography and planar quantification (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$391.60</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61389</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Single renal study with pre-procedural administration of a diuretic or angiotensin converting enzyme (ACE) inhibitor (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$318.25</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61390</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Renal study with diuretic administration following a baseline study (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$352.10</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61393</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Combined examination involving a renal study following angiotensin converting enzyme (ACE) inhibitor provocation and a baseline study, in either order and related to a single referral episode (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$529.85</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61397</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Cystoureterogram (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$212.00</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61401</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Testicular study (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$139.35</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61402</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Brain study using TC-exametazine, with single photon emission tomography and with planar imaging when undertaken (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$519.60</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61405</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Brain study with blood brain barrier agent, with planar imaging and single photon emission tomography, or planar imaging, or single photon emission tomography (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$297.15</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61409</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Cerebro-spinal fluid transport study, with imaging on 2 or more separate occasions</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$750.15</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61413</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Cerebro-spinal fluid shunt patency study</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$194.05</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61417</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Dynamic blood flow study or regional blood volume quantitative study, not being a service associated with a service to which another item in this Group applies (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$102.00</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61421</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Bone study</span><span> </span><span>— whole body, with, when undertaken, blood flow, blood pool and delayed imaging on a separate occasion</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$416.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61425</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Bone study</span><span> </span><span>— whole body and single photon emission tomography, with, when undertaken, blood flow, blood pool and delayed imaging on a separate occasion</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$522.25</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61426</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Whole body study using iodine (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$476.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61429</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Whole body study using gallium (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$466.30</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61430</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Whole body study using gallium, with single photon emission tomography (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$578.15</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61433</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Whole body study using cells labelled with Technetium (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$426.75</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61434</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Whole body study using cells labelled with Technetium, with single photon emission tomography (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$528.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61437</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Whole body study using thallium (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$466.10</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61438</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Whole body study using thallium, with single photon emission tomography (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$577.95</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61441</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Bone marrow study</span><span> </span><span>— whole body (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$420.55</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61442</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Whole body study, using gallium</span><span> </span><span>— with single photon emission tomography of 2</span><span> </span><span>or more body regions acquired separately (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$669.70</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61446</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Localised bone or joint study, including when undertaken, blood flow, blood pool and repeat imaging on a separate occasion</span><span> </span><span>(R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$289.90</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61449</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Localised bone or joint study and single photon emission tomography, including when undertaken, blood flow, blood pool and imaging on a separate occasion (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$397.75</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61450</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Localised study using gallium (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$341.40</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61453</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Localised study using gallium, with single photon emission tomography (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$453.80</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61454</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Localised study using cells labelled with Technetium (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$298.90</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61458</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Localised study using thallium (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$340.85</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61461</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Localised study using thallium, with single photon emission tomography (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$453.30</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61462</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Repeat planar and single photon emission tomography imaging, or repeat planar or single photon emission tomography imaging on a subsequent occasion where no fee has been paid for the first investigation and there is no additional administration of radiopharmaceutical agent, not being a service associated with item 61373, 61409, 61421, 61425, 61446, 61449, 61484 or 61485 (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Amount under rule 14</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61465</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Venography (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$228.05</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61469</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Lymphoscintigraphy (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$298.90</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61473</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Thyroid study including uptake measurement when undertaken (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$152.55</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61480</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Parathyroid study, planar imaging and single photon emission tomography when undertaken (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$332.20</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61484</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Adrenal study, with imaging on 2 or more separate occasions (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$756.45</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61485</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Adrenal study, with imaging on 2 or more occasions and renal localisation and single photon emission tomography when undertaken (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$858.15</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61495</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Tear duct study (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$191.60</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>61499</span></p></td><td colspan="2" style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Particle perfusion study (intra-arterial) or Le Veen shunt study (R)</span></p></td><td colspan="2" style="width:52.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>$217.30</span></p></td></tr><tr><td colspan="5" style="width:364.9pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableColHead"><span>GROUP I5</span><span> </span><span>— MAGNETIC RESONANCE IMAGING</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 1</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of head for the exclusion of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63000</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for the exclusion of tumour of the brain or meninges (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63003</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for the exclusion of skull base or orbital tumour (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63006</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for the exclusion of acoustic neuroma (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63009</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for the exclusion of pituitary tumour (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63012</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for the exclusion of inflammation of brain or meninges (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63015</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for the exclusion of toxic or metabolic or ischaemic encephalopathy (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63018</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for the exclusion of demyelinating disease of the brain (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63021</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for the exclusion of congenital malformation of brain or meninges (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63024</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for the exclusion of venous sinus thrombosis (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 2</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of head and cervical spine for the exclusion of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63050</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for the exclusion of tumour of the central nervous system or meninges (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63053</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for the exclusion of inflammation of the central nervous system or meninges (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63056</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for the exclusion of demyelinating disease of the central nervous system (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63059</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for the exclusion of congenital malformation of the central nervous system or meninges (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63062</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for the exclusion of syrinx</span><span> </span><span>— congenital or acquired (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 3</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of head for further investigation of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63100</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for further investigation of tumour of the brain or meninges (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63103</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for further investigation of skull base or orbital tumour (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63106</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for further investigation of acoustic neuroma (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63109</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for further investigation of pituitary tumour (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63112</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for further investigation of inflammation of the brain or meninges (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63115</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for further investigation of toxic or metabolic or ischaemic encephalopathy (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="page-break-inside:avoid; page-break-after:avoid"><span>63118</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for further investigation of demyelinating disease of the brain (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63121</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for further investigation of congenital malformation of the brain or meninges (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63124</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for further investigation of head trauma (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63127</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for further investigation of epilepsy (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63130</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for further investigation of stroke (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63133</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for further investigation of venous sinus thrombosis (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 4</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of head and cervical spine for further investigation of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63150</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for further investigation of tumour of the central nervous system or meninges (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63153</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for further investigation of inflammation of the central nervous system or meninges (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63156</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for further investigation of demyelinating disease of the central nervous system (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63159</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for further investigation of congenital malformation of the central nervous system or meninges (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63162</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for further investigation of syrinx</span><span> </span><span>— congenital or acquired (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 5</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of head for monitoring of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63200</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for monitoring of acoustic neuroma (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63203</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for monitoring of pituitary tumour (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63206</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for monitoring of demyelinating disease of the brain (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63209</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for monitoring of congenital malformation of brain or meninges (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63212</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for monitoring of head trauma (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63215</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for monitoring of epilepsy (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63218</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for monitoring of stroke (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63221</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for monitoring of toxic or metabolic or ischaemic encephalopathy (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 6</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of head and cervical spine for monitoring of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63250</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for monitoring of demyelinating disease of the central nervous system (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63253</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for monitoring of congenital malformation of the central nervous system or meninges (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63256</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for monitoring of syrinx</span><span> </span><span>— congenital or acquired (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 7</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of head and cervical spine for monitoring of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63270</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for monitoring of tumour of the brain or meninges (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63273</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for monitoring of skull base or orbital tumour (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63276</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for monitoring of inflammation of brain or meninges (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63279</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head (with or without intravenous contrast and including MRA, if performed) for monitoring of venous sinus thrombosis (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 8</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of head and cervical spine for monitoring of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63290</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for monitoring of tumour of the central nervous system or meninges (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63293</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for monitoring of inflammation of the central nervous system or meninges (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 9</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of 1 region of spine or 2 contiguous regions for the exclusion of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63300</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for the exclusion of infection (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63303</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of one region or 2 contiguous regions of the spine (with or without intravenous contrast) for the exclusion of tumour (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63306</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of one region or 2 contiguous regions of the spine (with or without intravenous contrast) for the exclusion of demyelinating disease (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63309</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of one region or 2 contiguous regions of the spine (with or without intravenous contrast) for the exclusion of congenital malformation of the spinal cord or the cauda equina or the meninges (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63312</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of one region or 2 contiguous regions of the spine (with or without intravenous contrast) for the exclusion of myelopathy (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63315</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of one region or 2 contiguous regions of the spine (with or without intravenous contrast) for the exclusion of syrinx</span><span> </span><span>— congenital or acquired (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 10</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of 3 contiguous or 2</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">non</span><span style="font-weight:normal; font-style:italic">‑</span><span style="font-weight:normal; font-style:italic">contiguous regions of spine for the exclusion of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63350</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for the exclusion of infection (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63353</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for the exclusion of tumour (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63356</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for the exclusion of demyelinating disease (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63359</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for the exclusion of congenital malformation of the spinal cord or the cauda equina or the meninges (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63362</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for the exclusion of myelopathy (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63365</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for the exclusion of syrinx</span><span> </span><span>— congenital or acquired (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 11</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of 1 region of spine or 2</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">contiguous regions for further investigation of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63400</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for further investigation of infection (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63403</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for further investigation of tumour (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63406</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for further investigation of demyelinating disease (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63409</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for further investigation of congenital malformation of the spinal cord or the cauda equina or the meninges (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63412</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for further investigation of myelopathy (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63415</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for further investigation of syrinx</span><span> </span><span>— congenital or acquired (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63418</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for further investigation of cervical radiculopathy (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63421</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for further investigation of sciatica (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63424</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for further investigation of spinal canal stenosis (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63427</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for further investigation of previous spinal surgery (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63430</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for further investigation of trauma (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 12</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of 3 contiguous of spine or 2</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">non</span><span style="font-weight:normal; font-style:italic">‑</span><span style="font-weight:normal; font-style:italic">contiguous regions for further investigation of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63450</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for the further investigation of infection (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63453</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for the further investigation of tumour (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63456</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for the further investigation of demyelinating disease (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63459</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for the exclusion of congenital malformation of the spinal cord or the cauda equina or the meninges (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63462</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for the further investigation of myelopathy (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63465</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for the further investigation of syrinx</span><span> </span><span>— congenital or acquired (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63468</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for the further investigation of cervical radiculopathy (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63471</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for the further investigation of sciatica (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="page-break-inside:avoid; page-break-after:avoid"><span>63474</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for the further investigation of spinal canal stenosis (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63477</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for the further investigation of previous spinal surgery (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63480</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for the further investigation of trauma (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 13</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of 1 region of spine or 2</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">contiguous regions for monitoring of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63500</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for monitoring of demyelinating disease (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63503</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for monitoring of congenital malformation of the spinal cord or the cauda equina or the meninges (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63506</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for monitoring of myelopathy (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63509</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for monitoring of syrinx</span><span> </span><span>— congenital or acquired (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63512</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for monitoring of cervical radiculopathy (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63515</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for monitoring of sciatica (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63518</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for monitoring of spinal canal stenosis (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="page-break-inside:avoid; page-break-after:avoid"><span>63521</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for monitoring of previous spinal surgery (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63524</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for monitoring of trauma (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 14</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of 3 contiguous or 2</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">non</span><span style="font-weight:normal; font-style:italic">‑</span><span style="font-weight:normal; font-style:italic">contiguous regions of the spine for monitoring of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63550</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for the monitoring of demyelinating disease (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63553</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for the monitoring of congenital malformation of the spinal cord or the cauda equina or the meninges (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63556</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for the monitoring of myelopathy (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63559</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for the monitoring of syrinx</span><span> </span><span>— congenital or acquired (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63562</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of up to 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for monitoring of cervical radiculopathy (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63565</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of up to 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for monitoring of sciatica (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63568</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of up to 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for monitoring of spinal canal stenosis (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="page-break-inside:avoid; page-break-after:avoid"><span>63571</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of up to 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for monitoring of previous spinal surgery (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63574</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of up to 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for monitoring of trauma (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 15</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of 1 region of spine or 2</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">contiguous region for monitoring of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63580</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for monitoring of infection (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63583</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for monitoring of tumour (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 16</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of 3 contiguous or 2</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">non</span><span style="font-weight:normal; font-style:italic">‑</span><span style="font-weight:normal; font-style:italic">contiguous regions of spine for monitoring of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63590</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for monitoring of infection (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63593</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of 3 contiguous regions or 2</span><span> </span><span>non</span><span>‑</span><span>contiguous regions of the spine (with or without intravenous contrast) for monitoring of tumour (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">17</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of musculoskeletal system for the exclusion of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63600</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for the exclusion of tumour arising in bone or other connective tissue (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63603</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for the exclusion of infection arising in bone or other connective tissue (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63606</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for the exclusion of osteonecrosis (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63609</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for the exclusion of derangement of hip or its supporting structures (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63612</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for the exclusion of derangement of shoulder or its supporting structures (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63615</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for the exclusion of derangement of knee or its supporting structures (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63618</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for the exclusion of derangement of ankle or its supporting structures (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63621</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for the exclusion of derangement of temporomandibular joint or its supporting structures (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63624</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for the exclusion of derangement of wrist or its supporting structures (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63627</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for the exclusion of derangement of elbow or its supporting structures (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 18</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of musculoskeletal system for further investigation of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63650</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for further investigation of tumour arising in bone or other connective tissue (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63653</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for further investigation of infection arising in bone or other connective tissue (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63656</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for further investigation of osteonecrosis (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63659</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for further investigation of derangement of hip or its supporting structures (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63662</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for further investigation of derangement of shoulder or its supporting structures (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="page-break-inside:avoid; page-break-after:avoid"><span>63665</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for further investigation of derangement of knee or its supporting structures (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63668</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for further investigation of derangement of ankle or its supporting structures (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63671</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for further investigation of derangement of temporomandibular joint or its supporting structures (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63674</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for further investigation of derangement of wrist or its supporting structures (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63677</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for further investigation of derangement of elbow or its supporting structures (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63680</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for further investigation of post inflammatory or post traumatic physeal fusion in a person under 16 years of age (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 19</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of musculoskeletal system for monitoring of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63700</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for monitoring of derangement of hip or its supporting structures (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63703</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for monitoring of derangement of shoulder or its supporting structures (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63706</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for monitoring of derangement of knee or its supporting structures (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63709</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for monitoring of derangement of ankle or its supporting structures (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63712</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for monitoring of derangement of temporomandibular joint or its supporting structures (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63715</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for monitoring of derangement of wrist or its supporting structures (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63718</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for monitoring of derangement of elbow or its supporting structures (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63721</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for monitoring of post inflammatory or post traumatic physeal fusion in a person under 16</span><span> </span><span>years of age (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 20</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of musculoskeletal system for monitoring of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63736</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for monitoring of osteonecrosis (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63739</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for monitoring of tumour arising in bone or other connective tissue (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63742</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for monitoring of infection arising in bone or other connective tissue (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 21</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of musculoskeletal system for further investigation or monitoring of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63745</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the musculoskeletal system (with or without intravenous contrast) for further investigation, or monitoring, of Gaucher disease (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 22</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of cardiovascular system for further investigation of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63750</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the cardiovascular system (with or without contrast and including MRA, if performed) for further investigation of congenital disease of the heart or a great vessel (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63753</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the cardiovascular system (with or without contrast and including MRA, if performed) for further investigation of tumour of the heart or a great vessel (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63756</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the cardiovascular system (with or without contrast and including MRA, if performed) for further investigation of abnormality of thoracic aorta (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 23</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of cardiovascular system for monitoring of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63800</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the cardiovascular system (with or without contrast and including MRA, if performed) for monitoring of congenital disease of the heart or a great vessel (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="page-break-inside:avoid; page-break-after:avoid"><span>63803</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the cardiovascular system (with or without contrast and including MRA, if performed) for monitoring of tumour of the heart or a great vessel (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63806</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the cardiovascular system (with or without contrast and including MRA, if performed) for monitoring of abnormality of the thoracic aorta (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 24</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Magnetic resonance angiography</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of cardiovascular system for the exclusion of or further investigation of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63850</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRA</span><span> </span><span>— scan of cardiovascular system (with or without contrast) for exclusion, or further investigation, of stroke (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63853</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRA</span><span> </span><span>— scan of cardiovascular system (with or without contrast) for exclusion, or further investigation, of carotid or vertebral artery dissection (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63856</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRA</span><span> </span><span>— scan of cardiovascular system (with or without contrast) for exclusion, or further investigation of intracranial aneurysm (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63859</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRA</span><span> </span><span>— scan of cardiovascular system (with or without contrast) for exclusion, or further investigation of intracranial arteriovenous malformation (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63862</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRA</span><span> </span><span>— scan of cardiovascular system (with or without contrast) for exclusion, or further investigation of venous sinus thrombosis (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63865</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRA</span><span> </span><span>— scan of cardiovascular system (with or without contrast) for exclusion, or further investigation of vascular abnormality in a patient with a previous anaphylactic reaction to an iodinated contrast medium (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="page-break-inside:avoid; page-break-after:avoid"><span>63868</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRA</span><span> </span><span>— scan of cardiovascular system (with or without contrast) for exclusion, or further investigation of obstruction of the superior vena cava, inferior vena cava or a major pelvic vein (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 25</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Magnetic resonance angiography</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of cardiovascular system for further investigation of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63870</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRA</span><span> </span><span>— scan of cardiovascular system in a person under the age of 16 (with or without contrast) for further investigation of the vasculature of limbs prior to limb or digit transfer surgery in congenital limb deficiency syndrome (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 26</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Magnetic resonance angiography</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of cardiovascular system for further investigation of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63880</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRA</span><span> </span><span>— scan of cardiovascular system (with or without contrast) for monitoring of carotid or vertebral artery dissection (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63883</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRA</span><span> </span><span>— scan of cardiovascular system (with or without contrast) for monitoring of venous sinus thrombosis (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">27</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of body for further investigation of a specified condition</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Person under the age of 16 years</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63900</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the body in a person under the age of 16 years (with or without intravenous contrast) for further investigation of pelvic or abdominal mass (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63903</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the body in a person under the age of 16 years (with or without intravenous contrast) for further investigation of mediastinal mass (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63906</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the body in a person under the age of 16 years (with or without intravenous contrast) for further investigation of congenital uterine or anorectal abnormality (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63909</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the body in a person under the age of 16 years (with or without intravenous contrast) for further investigation of Gaucher disease (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">28</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of body for further investigation of a specified condition</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="page-break-inside:avoid; page-break-after:avoid"><span>63920</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the body (with or without intravenous contrast) for further investigation of adrenal mass in a patient with a malignancy which is otherwise resectable (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">29</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of body for monitoring of a specified condition</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Person under the age of 16 years</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63930</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the body (with or without intravenous contrast) for monitoring of congenital uterine or anorectal abnormality in a person under the age of 16 years (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td colspan="5" style="width:364.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">30</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Scan of body for monitoring of a specified condition</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Person under the age of 16 years</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63940</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the body in a person under the age of 16 years (with or without intravenous contrast) for monitoring of mediastinal mass (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63943</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the body in a person under the age of 16 years (with or without intravenous contrast) for monitoring of pelvic or abdominal mass (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>63946</span></p></td><td colspan="2" style="width:251.55pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>MRI</span><span> </span><span>— scan of the body in a person under the age of 16 years (with or without intravenous contrast) for monitoring of Gaucher disease (R)</span></p></td><td colspan="2" style="width:53.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>$475.00</span></p></td></tr><tr style="height:0pt"><td style="width:49.65pt"></td><td style="width:247.45pt"></td><td style="width:14.8pt"></td><td style="width:62.55pt"></td><td style="width:1.2pt"></td></tr></tbody></table>