Tumor Imaging whole body single imaging
| DETAIL FOR SERVICES: | Study | Radiopharmaceuticals | Radiologist reading (interpretation) |
| 2020 CPT/HCPCS Primary Code | 78802 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Negotiated Private Fee | $113.00 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Prossam | $112.50 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Champva | Ambulatory Payment classification (APC) | Provided when is required study | Not provided by Hospital (may be billed separately) |
| First Medical | $112.50 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| First Medical Vital | $199.65 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Plan de Salud Menonita | $100.00 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Menonita Vital | $262.88 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Humana Gold Plus / Gold Choice | Ambulatory Payment classification (APC) | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Humana | $107.00 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Mapfre | Not contracted | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Mcsclassicare | $112.50 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| MCS Life | $112.50 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Medicare | Ambulatory Payment classification (APC) | Provided when is required study | Not provided by Hospital (may be billed separately) |
| MMM | $198.57 | Not provided by Hospital (may be billed separately) | |
| MMM Vital | $210.86 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Panamerican Life | Not contracted | Provided when is required study | Not provided by Hospital (may be billed separately) |
| PMC | $198.57 | Not provided by Hospital (may be billed separately) | |
| Tricare | Ambulatory Payment classification (APC) | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Triple S Salud | $112.50 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Triple S Vital | $119.28 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Triple S Advantage | Ambulatory Payment classification (APC) | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Negotiated Minimum Charge | $100.00 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Negotiated Maximum Charge | $262.88 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Discounted Cash Price | $90.40 | Provided when is required study | Not provided by Hospital (may be billed separately) |
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