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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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