Date of Request: $09/11/2024$

Name of Department: Radilogy Department$$

Department Code:$$

Submitted by: Tina Boyd$$

Reason for Request: deletion

Justification for Request

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Department Code$$Service Code$$Service Description$$ Revenue Code$$ CPT Code$$Charge Amount$$ Relative Value Unit

$8550001$n$/$a$$

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Chargemaster Change Request #$2$

Date of Request:

Name of Department:

Department Code:

Submitted by:

Reason for Request:

Justification for Request

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Department Code$$Service Code$$Service Description$$Revenue Code$$ CPT Code$$Charge Amount$$ Relative Value Unit