DETAIL FOR SERVICES: | Study | Radiopharmaceuticals | Radiologist reading (interpretation) |
2020 CPT/HCPCS Primary Code | 78315 | Provided when is required study | Not provided by Hospital (may be billed separately) |
Negotiated Private Fee | $100.00 | Provided when is required study | Not provided by Hospital (may be billed separately) |
Prossam | $100.00 | 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 | $100.00 | Provided when is required study | Not provided by Hospital (may be billed separately) |
First Medical Vital | $215.92 | Provided when is required study | Not provided by Hospital (may be billed separately) |
Plan de Salud Menonita | $85.00 | Provided when is required study | Not provided by Hospital (may be billed separately) |
Menonita Vital | $217.01 | 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 | $80.00 | 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 | $125.00 | Provided when is required study | Not provided by Hospital (may be billed separately) |
MCS Life | $125.00 | 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 | $173.77 | Not provided by Hospital (may be billed separately) | |
MMM Vital | $221.52 | 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 | $173.77 | 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 | $100.00 | Provided when is required study | Not provided by Hospital (may be billed separately) |
Triple S Vital | $132.35 | 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 | $80.00 | Provided when is required study | Not provided by Hospital (may be billed separately) |
Negotiated Maximum Charge | $221.52 | Provided when is required study | Not provided by Hospital (may be billed separately) |
Discounted Cash Price | $80.00 | Provided when is required study | Not provided by Hospital (may be billed separately) |
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