- Short DescriptionOral mr contrast, 100 ml
- HCPCS Coverage CodeD = Special coverage instructions apply
- HCPCS Action CodeN = No maintenance for this code
- HCPCS Action Effective DateApr 01, 2005
- HCPCS Code Added DateApr 01, 2005
- HCPCS Pricing Indicator Code57 = Other carrier priced
- HCPCS Multiple Pricing Indicator CodeA = Not applicable as HCPCS priced under one methodology
- HCPCS Cross Reference Code
- HCPCS Type Of Service Code4
- HCPCS Anesthesia Base Unit Quantity