Hepatobiliary Systam Image W/Drug
| DETAIL FOR SERVICES: | Study | Radiopharmaceuticals | Radiologist reading (interpretation) |
| 2020 CPT/HCPCS Primary Code | 78227 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Negotiated Private Fee | $205.55 | 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 | $95.00 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| First Medical Vital | $290.27 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Plan de Salud Menonita | $173.83 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Menonita Vital | $291.45 | 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 | $156.78 | 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 | $111.95 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| MCS Life | $111.95 | 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 | $210.56 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| MMM Vital | $301.70 | 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 | $210.56 | Provided when is required study | 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 | $204.50 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Triple S Vital | $205.70 | 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 | $95.00 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Negotiated Maximum Charge | $301.7 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Discounted Cash Price | $164.00 | Provided when is required study | Not provided by Hospital (may be billed separately) |
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