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MRI Breast Without contrast unilateral

DETAIL FOR SERVICES: Study Radiologist reading (interpretation)
2020 CPT/HCPCS Primary Code 77046 Not provided by Hospital (may be billed separately)
Negotiated Private Fee $650.00 Not provided by Hospital (may be billed separately)
Prossam $125.00 Not provided by Hospital (may be billed separately)
Champva $233.49 Not provided by Hospital (may be billed separately)
First Medical $312.50 Not provided by Hospital (may be billed separately)
First Medical Vital $126.00 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 $325.00 Not provided by Hospital (may be billed separately)
Mapfre $325.00 Not provided by Hospital (may be billed separately)
Mcsclassicare $127.17 Not provided by Hospital (may be billed separately)
MCS Life $127.17 Not provided by Hospital (may be billed separately)
Medicare $239.78 Not provided by Hospital (may be billed separately)
MMM $233.49 Not provided by Hospital (may be billed separately)
MMM Vital $126.00 Not provided by Hospital (may be billed separately)
Panamerican Life $387.50 Not provided by Hospital (may be billed separately)
PMC $233.49 Not provided by Hospital (may be billed separately)
Tricare $233.59 Not provided by Hospital (may be billed separately)
Triple S Salud $325.00 Not provided by Hospital (may be billed separately)
Triple S Vital $332.71 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 $125.00 Not provided by Hospital (may be billed separately)
Negotiated Maximum Charge $387.50 Not provided by Hospital (may be billed separately)
Discounted Cash Price $520.00 Not provided by Hospital (may be billed separately)

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