NOTE: (1) Interest Will Be Charged on Overdue Invoices

Nuclear Medicine: 1 April 2016 ANNEXURE E1

Full Paying Patients (Externally Funded, Foreigners, RGP and Patients with Private Doctor incl )

Substrate Radiopharmaceuticals Code Cost* R X4774 HMPAO 451 X4775 ECD 3 856 X4235 MDP 224 X4776 Mebrofenin 641 X4222 DISIDA 224 X4234 MAG-3 342 X4223 DMSA 373 X4224 DTPA 224 X4237 MIBI 308 X4238 Nanocolloid 862 X4777 Tc-99m Octreotide 11 190 X4778 Tin colloid 224 X4779 MAA 392 X4244 RBC 224 X5049 Technegas 548 X5050 HSA (Vasculocis) 564 Isotope Code X4220 Cr-51 chromate 5 293 X4221 Cr-51 EDTA 746 X4376 F-18 FDG 5 935 X4793 F-18 fluoride 3 556 X5058 F-18 DOPA 8 480 X4225 Fe-59 citrate 5 456 X4780 Ga-67 citrate 4 297 X4781 Ga-67 resin 1 423 X5059 Ga-68 DATANOC 5 935 X5060 Ga-68 PSMA 5 935 X4377 I-123 DaTSCAN 23 581 X4782 I-123 iodide (diagnostic - thyroid) 1 985 X4783 I-123 iodide (diagnostic – whole body) 4 512 X4784 I-123 MIBG (diagnostic) 2 371 X4794 I-131 MIBG (diagnostic) 4 722 X4785 I-131 MIBG (therapy) 11 914 X4227 I-125 albumin 8 627 X4245 Tc-99m 236 X4787 I-131 (therapy for hyperthyroidism) 1 567 X4788 I-131 (therapy for thyroid Ca) 7 375 X4230 In-111 chloride 12 760 X4231 In-111 Octreotide 14 650 X4232 In-111 oxine 10 836 X5057 Lu-177 DATANOC (therapy) 66 120 X5061 Lu-177 PSMA (therapy) 66 120 X4246 Tl-201 chloride 2 856 1010/1012 Outpatient Consultation 317 NB: Refer to the Nuclear Medicine code book in respect of procedures NOTE: (1) Interest will be charged on overdue invoices (2) Legal costs incurred and (3) Any ancillary costs which may be levied by third parties may also be added