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Gastroesophageal Reflux

DETAIL FOR SERVICES: Study Radiopharmaceuticals  Radiologist reading (interpretation)
2020 CPT/HCPCS Primary Code 78262 A9541 Not provided by Hospital (may be billed separately)
Negotiated Private Fee $95.00 $89.00 Not provided by Hospital (may be billed separately)
Prossam $95.00 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 $95.00 As Cost By Supplier Not provided by Hospital (may be billed separately)
First Medical Vital $151.89 $26.46 Not provided by Hospital (may be billed separately)
Plan de Salud Menonita $85.50 As Cost By Supplier + 3% Not provided by Hospital (may be billed separately)
Menonita Vital $164.86 $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 $90.00 $54.50 Not provided by Hospital (may be billed separately)
Mapfre Not contracted Not provided by Hospital (may be billed separately)
Mcsclassicare $95.00 $70 Not provided by Hospital (may be billed separately)
MCS Life $95.00 $70 Not provided by Hospital (may be billed separately)
Medicare Ambulatory Payment classification (APC) Not provided by Hospital (may be billed separately)
MMM $152.90 Not provided by Hospital (may be billed separately)
MMM Vital $155.54 $20.00 Not provided by Hospital (may be billed separately)
Panamerican Life Not contracted Not provided by Hospital (may be billed separately)
PMC $152.90 Not provided by Hospital (may be billed separately)
Tricare Ambulatory Payment classification (APC) Not provided by Hospital (may be billed separately)
Triple S Salud $95.00 $75.22 Not provided by Hospital (may be billed separately)
Triple S Vital $91.62 $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 $85.50 $20.00 Not provided by Hospital (may be billed separately)
Negotiated Maximum Charge $164.86 $75.22 Not provided by Hospital (may be billed separately)
Discounted Cash Price $76.00 $71.20 Not provided by Hospital (may be billed separately)

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