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MRI Breast Without and With contrast unilateral

DETAIL FOR SERVICES: Study Radiologist reading (interpretation)
2020 CPT/HCPCS Primary Code 77048 Not provided by Hospital (may be billed separately)
Negotiated Private Fee $730.00 Not provided by Hospital (may be billed separately)
Prossam $225.00 Not provided by Hospital (may be billed separately)
Champva $370.90 Not provided by Hospital (may be billed separately)
First Medical $312.50 Not provided by Hospital (may be billed separately)
First Medical Vital $207.54 Not provided by Hospital (may be billed separately)
Plan de Salud Menonita $276.25 Not provided by Hospital (may be billed separately)
Menonita Vital $276.25 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 $362.50 Not provided by Hospital (may be billed separately)
Mapfre $325.00 Not provided by Hospital (may be billed separately)
Mcsclassicare $202.00 Not provided by Hospital (may be billed separately)
MCS Life $202.00 Not provided by Hospital (may be billed separately)
Medicare Ambulatory Payment classification (APC) Not provided by Hospital (may be billed separately)
MMM $370.90 Not provided by Hospital (may be billed separately)
MMM Vital $207.54 Not provided by Hospital (may be billed separately)
Panamerican Life $387.50 Not provided by Hospital (may be billed separately)
PMC $387.50 Not provided by Hospital (may be billed separately)
Tricare $369.79 Not provided by Hospital (may be billed separately)
Triple S Salud $342.00 Not provided by Hospital (may be billed separately)
Triple S Vital $191.10 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 $191.10 Not provided by Hospital (may be billed separately)
Negotiated Maximum Charge $387.50 Not provided by Hospital (may be billed separately)
Discounted Cash Price $584.00 Not provided by Hospital (may be billed separately)

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