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Thyroid imaging W/blood FL

DETAIL FOR SERVICES: Study Radiopharmaceuticals  Radiologist reading (interpretation)
2020 CPT/HCPCS Primary Code 78013 A9512 Not provided by Hospital (may be billed separately)
Negotiated Private Fee $68.00 $37.00 Not provided by Hospital (may be billed separately)
Prossam $57.50 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 $102.00 As Cost By Supplier Not provided by Hospital (may be billed separately)
First Medical Vital $128.99 Not Covered Not provided by Hospital (may be billed separately)
Plan de Salud Menonita $57.8 As Cost By Supplier + 3% Not provided by Hospital (may be billed separately)
Menonita Vital $126.87 $12.50 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 $72.90 $12.00 Not provided by Hospital (may be billed separately)
Mapfre Not contracted Not provided by Hospital (may be billed separately)
Mcsclassicare $58.67 As Cost By Supplier Not provided by Hospital (may be billed separately)
MCS Life $58.67 As Cost By Supplier Not provided by Hospital (may be billed separately)
Medicare Ambulatory Payment classification (APC) Not provided by Hospital (may be billed separately)
MMM $101.40 Not provided by Hospital (may be billed separately)
MMM Vital $129.66 $12.00 Not provided by Hospital (may be billed separately)
Panamerican Life Not contracted Not provided by Hospital (may be billed separately)
PMC $101.40 Not provided by Hospital (may be billed separately)
Tricare Ambulatory Payment classification (APC) Not provided by Hospital (may be billed separately)
Triple S Salud $68.00 Not Covered Not provided by Hospital (may be billed separately)
Triple S Vital $124.95 Not Covered 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 $57.50 $12.00 Not provided by Hospital (may be billed separately)
Negotiated Maximum Charge $129.66 $12.50 Not provided by Hospital (may be billed separately)
Discounted Cash Price $54.40 $29.60 Not provided by Hospital (may be billed separately)

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