DETAIL FOR SERVICES: | Study | Radiopharmaceuticals | Radiologist reading (interpretation) |
2020 CPT/HCPCS Primary Code | 78070 | A9500 | Not provided by Hospital (may be billed separately) |
Negotiated Private Fee | $72.00 | $70.00 | Not provided by Hospital (may be billed separately) |
Prossam | $50.00 | 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 | $71.50 | As Cost By Supplier | Not provided by Hospital (may be billed separately) |
First Medical Vital | $187.91 | $70.00 | Not provided by Hospital (may be billed separately) |
Plan de Salud Menonita | $52.50 | As Cost By Supplier + 3% | Not provided by Hospital (may be billed separately) |
Menonita Vital | $188.66 | $80.00 | 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 | $57.50 | $100.00 | Not provided by Hospital (may be billed separately) |
Mapfre | Not contracted | Not provided by Hospital (may be billed separately) | |
Mcsclassicare | $70.00 | $121.70 | Not provided by Hospital (may be billed separately) |
MCS Life | $70.00 | $121.70 | Not provided by Hospital (may be billed separately) |
Medicare | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | |
MMM | $158.18 | Not provided by Hospital (may be billed separately) | |
MMM Vital | $195.13 | $80.00 | Not provided by Hospital (may be billed separately) |
Panamerican Life | Not contracted | Not provided by Hospital (may be billed separately) | |
PMC | $158.18 | Not provided by Hospital (may be billed separately) | |
Tricare | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | |
Triple S Salud | $71.50 | $70.00 | Not provided by Hospital (may be billed separately) |
Triple S Vital | $113.26 | $70.00 | 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 | $52.50 | $70.00 | Not provided by Hospital (may be billed separately) |
Negotiated Maximum Charge | $195.13 | $121.50 | Not provided by Hospital (may be billed separately) |
Discounted Cash Price | $57.60 | $56.00 | Not provided by Hospital (may be billed separately) |
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