Gastric Emptying Study
| DETAIL FOR SERVICES: | Study | Radiopharmaceuticals | Radiologist reading (interpretation) |
| 2020 CPT/HCPCS Primary Code | 78264 | A9541 | Not provided by Hospital (may be billed separately) |
| Negotiated Private Fee | $83.00 | $89.00 | Not provided by Hospital (may be billed separately) |
| Prossam | $120.00 | As Cost By Supplier | Not provided by Hospital (may be billed separately) |
| Champva | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | |
| First Medical | $82.50 | As Cost By Supplier | Not provided by Hospital (may be billed separately) |
| First Medical Vital | $214.39 | $26.46 | Not provided by Hospital (may be billed separately) |
| Plan de Salud Menonita | $74.50 | As Cost By Supplier + 3% | Not provided by Hospital (may be billed separately) |
| Menonita Vital | $215.32 | $62.00 | Not provided by Hospital (may be billed separately) |
| Humana Gold Plus / Gold Choice | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | |
| Humana | $77.50 | $54.50 | Not provided by Hospital (may be billed separately) |
| Mapfre | Not contracted | Not provided by Hospital (may be billed separately) | |
| Mcsclassicare | $85.00 | $70 | Not provided by Hospital (may be billed separately) |
| MCS Life | $85.00 | $70 | Not provided by Hospital (may be billed separately) |
| Medicare | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | |
| MMM | $171.64 | Not provided by Hospital (may be billed separately) | |
| MMM Vital | $222.03 | $20.00 | Not provided by Hospital (may be billed separately) |
| Panamerican Life | Not contracted | Not provided by Hospital (may be billed separately) | |
| PMC | $171.64 | Not provided by Hospital (may be billed separately) | |
| Tricare | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | |
| Triple S Salud | $82.50 | $75.22 | Not provided by Hospital (may be billed separately) |
| Triple S Vital | $127.17 | $26.46 | Not provided by Hospital (may be billed separately) |
| Triple S Advantage | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | |
| Negotiated Minimum Charge | $74.50 | $50.00 | Not provided by Hospital (may be billed separately) |
| Negotiated Maximum Charge | $222.03 | $75.22 | Not provided by Hospital (may be billed separately) |
| Discounted Cash Price | $8.00 | $71.20 | Not provided by Hospital (may be billed separately) |
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